I experience acute pain upon any type of vaginal entry - even just a finger. My doctor has failed repeatedly to do a cervical smear test. I can just about tolerate the speculum going in but when she tries to open it the pain is unbearable. I am dating someone who I might marry and want to deal with this so I can enjoy a normal sexual relationship within marriage. My doctor has recommended psychosexual counselling but my concern is that the counsellor won’t be sympathetic to my Christian stance on things and will either blame my condition on an inbred fear of having sex due to indoctrination (which I’m pretty sure it isn’t) or will make therapeutic suggestions which conflict with what God would be wanting me to do. What should I do?

Your first priority is to get an accurate diagnosis as to what is causing the pain. There are a number of possibilities from what you have told me, though I do not have enough information to be sure. I suggest you go back to your GP and ask for a referral either to a gynaecologist, a GU clinic or a vulval pain clinic. It needs to be established where and what exactly the pain is, so that they know how to treat it. It may be that you are suffering from vaginismus which is an involuntary spasm of the musculature surrounding the vagina, causing pain at any form of penetration. This can be treated with the help of a psychosexual therapist, using vaginal dilators and PC muscle exercises, combined with helping you through the psychological aspects causing you to close up to any form of penetration.

Vaginismus is severely painful as you describe. However, you do say that although it is difficult, you can tolerate the speculum going in and so it may be that the cause of your pain is not vaginismus. You describe pain at vaginal entry: there are a variety of other conditions that could be causing this. If it is a burning pain it may be vulvodynia, particularly if the pain is at the point of the bartholin glands at 2, 4, 8 and 10 o’clock points around the vaginal entrance. This can be treated with lidocaine gel/ointment to desensitise the nerves and break the pain cycle, amitriptyline or an antihystamine if it is more of an atopic skin disorder. However, vulvodynia hurts on penetration but is less likely to hurt once inside. Other conditions can also cause pain such as thrush (more of an itching pain), skin splits, and various other infections that could be tested for in a GU clinic.

My message is: you need a diagnosis so that the correct treatment can be given for the pain. Pain as you are describing can take a while to accurately diagnose as it can be unclear initially which specialist department you should be going to. Sometimes we have to be persistent with the medical system to ask for the referrals we need and I would encourage you to be nicely pushy!

I definitely think it would be a good idea for you to see a psychosexual therapist. By all means ask if there is a Christian you can see, or contact basrt.org.uk and enquire if they have a Christian therapist near you. That said, any good therapist should respect your values if you explain them and listen to your attitudes, rather than presume that you fit into any stereotype they may have of Christians. You can explain that you do not have an inbred fear of having sex and let them know what you feel at ease with. If they make therapeutic suggestions that you feel are incompatible with Christian sexual ethics, then talk this through and feel confident that you do not need to do anything that you don’t agree with.

Let the therapist understand you, so they can tailor the interventions to your faith and values. However, I think you will find that most of what they suggest will be very helpful and it is better to see an expert who doesn’t share your faith, than a Christian who doesn’t know how to help.