Questions about Vaginal Size

Why vaginal laxity is a problem that most men simply cannot discuss with their wives

Q: For the past few years my husband refuses to sleep with me. Every night it is the same old story: he falls asleep watching television and spends the night on the couch. This began shortly after I gave birth. We resumed intercourse after my vagina healed sufficiently, but that lasted only for a month or so. I don't know what the problem is. Otherwise, I have a great relationship with my husband. He doesn't use drugs or alcohol, and I know he's not cheating on me because he works out of our house so I always know where he is. He still has a sex drive because I sometimes see him masturbating when I walk into the bathroom when he's in the shower. I don't have any big stretch marks, I lost all of the weight I gained during pregnancy, and I work out regularly to keep myself in shape so that can't explain why he's evidently repulsed by me. One of my friends thought he may have the Madonna/Whore Syndrome, but I really don't think so. We saw a counselor several times at my insistence, but my husband never revealed just what is going on in his head to explain why our sex life is a big zero. I've read all the usual explanations for why men lose interest in sex after childbirth (such as wives ignoring their husbands), but none of them seem to apply to our situation. He still says he loves me, but it obviously seems more like the love of a brother for a sister. Do you have any insight as to why he's acting the way he is? Pamela

A: Let me summarize this to put it into perspective: you have a husband with an apparently intact libido who isn't having an affair, doesn't otherwise manifest disaffection from you, and he "tried out" sex for a month before giving it up? This is not one of the Great Mysteries of the Universe. The most likely explanation is that he found sex after childbirth much less pleasurable than it once was. This commonly results from vaginal stretching and tearing during delivery. This affects some women far more than others. A few lucky women seem to emerge unscathed by vaginal delivery, but most experience some permanent dilation of the vagina that reduces sexual pleasure for both partners, but men seem to be more finicky and sensitive to this change than women. It isn't that uncommon for a woman's vagina to be so stretched by childbirth that men find it very difficult to obtain a gratifying level of pleasure from intercourse. I've heard some men complain to me that they sometimes have difficulty telling whether or not they're still inside the vagina because it is so loose. May I let you in on a little secret, ladies? Judging by how often I've heard men discussing this problem, men seem to have no difficulty discussing it with other men. However, this is something than most men find almost impossible to discuss with their wives. Even if you can appreciate how uncomfortable a typical man is if he even thinks about bringing up his dissatisfaction with his wife's weight, you probably have no idea how utterly impossible it is for most men to discuss such a sensitive and potentially hurtful issue as dissatisfaction over vaginal tightness. Many people are uncomfortable discussing any sexual problems with their partners, and men may be hesitant to discuss vaginal tightness because it may make them seem shallow. However, I don't think that it is shallow for anyone to not want to be shortchanged on life's greatest pleasure. Therefore, it is unreasonable to blame men who are dissatisfied by this problem. Sweeping this problem under the rug won't solve it, so what will? Men often aren't great communicators, and it is sometimes easier for a man to keep silent, stew over his disappointment, and chase after another woman instead of having the courage to discuss this problem with his current partner. Ironically, men who truly love their partners may not want to discuss topics that they feel might emotionally wound their loved one. Hence, the problem is swept under the rug, not solved, and the marriage slowly dissolves or remains perpetually dissatisfying.

His choice to sleep on the couch likely results from the fact that he doesn't want to take the risk that you might initiate intercourse. For him to break off your advances would require some direct refusal that he might find uncomfortable, whereas if he sleeps on the couch that is a very passive and easy way to say no.

My advice for you is to see your gynecologist and ask him for his opinion on whether or not your vagina is too loose. Don't assume that your doctor would have already mentioned this even if he'd noticed it, because doctors are usually trained to not point out a problem unless it may be serious. For example, if a doctor noticed that a man had skin cancer and did not mention it to the patient, that would be a serious mistake. In contrast, if a doctor noticed that a man had an unusually small penis, the doctor certainly would not comment upon this unless the patient first broached the subject. Similarly, a doctor would be remiss for telling a woman that she had a loose vagina unless she specifically inquired about that. I've performed pelvic exams on many women who had loose vaginas (some of whom had never given birth), but I never told them how tight they were unless they first asked me. A woman with a loose vagina may have a husband with a large penis, so her vagina may be just the right size for him.

If you want an immediate improvement in subjective tightness during intercourse, you can use a vaginal wedge, as I discuss in my book.

Some people think that Kegel's exercises can completely correct childbirth-induced vaginal loosening. In some cases, that is true. However, in most cases — Kegel's or no Kegel's — there is a noticeable laxity of the vagina after delivery. Surgery may be the only way to undo the damage. I understand that some women feel an emotional compulsion to give birth vaginally, but vaginal childbirth can cause problems other than vaginal loosening. The following excerpt from Fascinating Health Secrets discusses some of these problems:

Want to maximize the intelligence of your child? Deliver by C-section rather than vaginally. For a variety of reasons, some children born through vaginal delivery have compromised oxygen delivery for variable periods of time. This can be enough to cause some degree of mental deterioration. Only rarely is this pronounced enough to warrant a label or diagnosis such as "cerebral palsy" or "mental retardation." If the child was otherwise destined to have a superior I.Q. and sustained some degree of hypoxia (low oxygen) during delivery, this might only reduce his I.Q. from 140 to 100. Since 100 is by definition normal or average, it is difficult to retrospectively appreciate the tragedy which occurred during the birth of this child.

Since many C-sections are done only after some problem has already developed, a simple statistical analysis of the intelligence of children born via C-section versus vaginal delivery does not serve to adequately illuminate the cerebral risk of vaginal birth.

Unquestionably, if I were a woman, I would choose to deliver all of my children via C-section. Vaginal childbirth can be excruciating, and C-sections can be done almost painlessly. Furthermore, vaginal childbirth often permanently stretches the vagina and surrounding structures. This can reduce pleasure during intercourse for both the woman and the man. The stretching can also predispose a woman to prolapse of her uterus and other problems, such as stress incontinence. Stress incontinence, in case you are curious, has nothing to do with psychological stress. Rather, it refers to a momentary loss of urinary continence that results when the pressure within the abdomen increases as a result of coughing, sneezing, laughing, heavy lifting, or even something as seemingly innocuous as standing up. It may also cause a woman to discharge spurts of urine during sexual orgasm, which is often erroneously interpreted as representing a female ejaculation.

The preceding topic prompted a woman to write to me. The gist of her e-mail was this: "Well, I've already had kids by vaginal delivery. My vagina is loose, I have stretch marks, I've gained weight, my husband seems distant, and the sky is falling. So, your advice may help women if they haven't yet had kids, so they can choose to have a C-section, but what about us other women?"

My response? Generally, I eschew writing about topics unless I can offer a solution. After all, what is the point of broaching a topic unless I can suggest a remedy? I don't think it does much good to commiserate, so you'll rarely find me wailing about an insolvable problem. Hence, when I write about a problem, it's because I have the answer. And in this case, I do. In my book, I discuss several ways to either tighten or effectively tighten the vagina, such as by using a vaginal wedge. In regard to her other laments, I presented solutions to them elsewhere in my books and web site.

A too-tight vagina?

Q: I've been with my husband for two years and we have had a sporadic sexual history. The frequency of intercourse declined from every day to once every two to three months. I asked him why the change occurred and he gave me several reasons, such as a poor adjustment to us living together, change in his work schedule, and decrease in energy due to allergies. This year we got married and began trying to have a baby. Our sex life improved slightly and we began having sex once every month around my ovulation time. Recently I told my husband that I would like for us to have sex more than once a month and he finally told me that the REAL reason we don't have sex more often is because my vagina is too tight and it causes him pain. It is worth noting that my husband is the first uncircumcised man that I have ever been with and it usually takes a second for my body to adjust to the width of his penis. But after that period of adjustment is over, I truly enjoy having sex with him. Moreover, I always have an orgasm. Can you suggest something that I can do to loosen up? Oh, we already tried K-Y jelly and he says that it's still too tight. (Name withheld by request)

A: I'm not going to beat around the bush: I don't believe your husband. First, he offered some lame excuses, then he fessed up to the "REAL" reason, your tight vagina. I don't doubt that your vagina is tight, but tight enough to cause pain for him? Unless he has some penile abnormality or has taken Accutane*, it is safe to say that he still isn't telling you the truth. Why can I say this with confidence? Because sex is pleasurable for you. Even though it usually takes a second for your body "to adjust to the width of his penis" (which is common), you experience pleasure, not pain. In my experience as a doctor, I've seen women with vaginas so small that they'd tightly grip a pencil, and men who are hung like horses and make male porno stars look like boys with pre-pubescent penises. Even when the fit is tight enough so the woman is literally ripped open and wincing with enough pain to cause her to go to an emergency room, I've yet to hear a man complain about a painfully tight vagina. Instead, they're dreamily marveling at how great a tight vagina feels.

* Some men who've used Accutane reported to me that it made intercourse unpleasant and even painful, even after discontinuing that drug. One man was so distraught over this that he was suicidal. Incidentally, I've heard from several women who reported that Accutane made intercourse painful, too. For more information on the adverse sexual effects of Accutane, visit this web page.

When I was in medical school, my girlfriend had a vagina so tight that it took me months of trying before I penetrated her — and that success was only due to hours of patiently using a series of progressively larger dilators. By the way, when I finally got in, it was pure pleasure, not pain. It sounds as if your vagina isn't quite that tight in relation to the penile size, so it doesn't make any sense that tightness is what is dissuading your husband. Furthermore, even if tightness were the problem, your husband could gratify you and himself by stroking his penis on your labia minora, clitoris, and vestibule (the area around the vaginal opening). Or you could perform oral sex on one another, or do other satisfying things.

I think it is apropos to briefly mention two scientific facts before I proceed. First, there is a tidbit from physics, Newton's third law, which states that for every action, there is an equal and opposite reaction. This law is applicable everywhere, including the vagina. Translating this principle of physics into everyday sexual language boils down to one simple fact: the pressure or "tightness" is the same for the penis and the vagina.

Next tidbit, this one from anatomy and physiology. When a woman experiences pain from an overly thick (relative to her vaginal diameter) penis, that pain is due to stimulation of stretch receptors. During intercourse, a man's penis is compressed, not stretched. The threshold for pain in stretching the vagina is far less than the threshold of pain for compressing the penis. If the penis were stretched, it'd be just as sensitive as the vagina, or even more so. Any man who doubts this can prove it to himself by placing his penis in a vacuum/pressure chamber. Noting the sensation when the absolute value (such as 5 psi, or pounds per square inch) of the vacuum is the same as the absolute value of an applied pressure, it is obvious than men will flinch with pain at vacuum levels that are not unpleasant if that same number of psi is applied as a pressure. However, because the penis is compressed, not stretched, during intercourse, the penis is impervious to coital stretch pain. Practically speaking, the threshold for penile pain in compression is so great that it virtually never occurs during vaginal intercourse, except if the penis is very forcefully bent during rapid thrusting when there is a mismatch between the axes of the penis and vagina; that can stimulate stretch receptors. In general, any body part — vagina, penis, arm, etc. — is more sensitive to pain from stretching than compression.

Let's consider the foregoing two principles together. Because of Newton's third law, I know that the pressure stretching your vagina during intercourse is the same as the pressure compressing his penis. Because people are more sensitive to pain from stretching tissue than compressing it, you would experience pain from stretch long before he'd experience pain from compression. The fact that you don't have pain indicates that tightness isn't the problem.

So what is the problem? I have my own suspicions, but I am not a psychologist or psychiatrist, so I consulted several people who have expertise in understanding problems in relationships. Incidentally, the initial reaction of every person was the same; they thought it was preposterous that your vagina was the source of the problem. They suggested a few possibilities, such as him having a low libido, or inadequate attraction to you (or perhaps to women in general). I may not be a relationship expert, but in this case the answer seems so obvious to me that I'm willing to go out on a limb and speculate about what I think the problem is. I think your husband either now has the libido of an 88-year-old man, or his attraction to women is questionable. In short, I don't think the problem is you. There are many things that attract men to women. Some of these factors are optical (that is, what a woman looks like), some are behavioral, and some are purely sensual. Women feel good to men because it is pleasurable to hold you, caress you, and make love to you. In regard to the latter point, your tight vagina would make you very desirable, not someone to be sexually shunned.

You mentioned that you're now "having sex once every month around my ovulation time." Unless that timing is intentional (to optimize your chances of conception), this makes me wonder if the problem is your husband's libido. Why do I think that? Because women emit more copulins (pheromones that increases male libido) at ovulation than at other times. If a man typically has a low libido, the boost in sex drive is more noticeable than if he's always hot to trot.

As a next step, I'd ask your husband if he masturbates. If he does not, and his sole source of sexual release is your monthly tryst, his libido is clearly deficient. When men have a problem with their libido, they're apt to conjure up a specious excuse, such as your husband attributing his lack of desire to a "change in his work schedule." Stress of any sort can reduce libido, but a mere schedule change won't decimate libido to the point that he'd go from daily intercourse to once per month. When I worked in the ER, my schedule would sometimes change five times in a week from the day shift to the afternoon shift to the night shift. Sometimes I'd work two shifts in a day, getting off from the night shift at 7 AM, going home to sleep for a few hours, and then returning to work for the afternoon shift at 1 or 2 PM. It's difficult to imagine a more chaotic schedule than that. In spite of that nightmarish routine, my libido was reasonably intact and even brimming if I had a girlfriend. Frankly, I've seen people hospitalized with serious diseases or injuries who want sex more than once per month. Hence, I don't buy your husband's stress excuse.

Your husband needs to see a doctor to exclude a penile abnormality (unlikely but possible) or treatable causes of low libido, such as some pituitary tumors and a number of other endocrine problems (some of which I discuss in my book, The Science of Sex).

Now for the last plausible possibility: latent homosexuality. This isn't rare, and it is often so well camouflaged that it may never have occurred to you. A few of my friends and relatives were engaged to people they thought were heterosexual, and when I met them, I didn't detect any clues that might suggest otherwise. In all of these cases, they engaged in sex and truly enjoyed it — from what I heard, which was sometimes through a very thin wall. So, when their true sexual preference was revealed, I was stunned. I wondered, how could anyone present such a convincing acting job? Our culture is not very accepting of homosexuality, so this undoubtedly makes some homosexuals reluctant to reveal their gender preference. However, I wouldn't fret over this possibility. Statistically, the most likely problem is a flagging libido. The good news for you is that this is easily treatable.

What may reduce vaginal tightness?

Q: Dear Sir: I am in need of help answering a question about my wife's vaginal size. I'll be brief and to the point.

We have both been married before. My wife has three children. Our sex life has been very good until now, nine years after marriage. Her vagina is no longer tight enough for me to enjoy. She lost weight due to dieting, and she is 51 years old. But the change in her vagina seems to have developed suddenly.

I have always trusted my wife, but doubt has moved in because of this. I am not very well endowed, and as most men I have always been bothered by that. But my wife has made me feel secure, until now.

Please advise me as to the ways a woman's vagina can change, other than childbirth and sexual intercourse. My wife is in good health and looks great, and is on hormone therapy and is not experiencing many problems from the change of life.

Your help is needed. Thanks, (name withheld by request)

A: First, let me assuage your apparent concern about the possibility of your wife being unfaithful. It is very unlikely that her reduced vaginal tightness is attributable to intercourse. Given the scenario you presented, the most likely culprit is weight loss. Dieting induces a loss of both fat and muscle. Muscle loss is more pronounced when the diet is more extreme. When muscles are catabolized (broken down) to provide energy, the muscles atrophy. This affects most muscles in the body, including the muscles around the vagina. When they atrophy, vagina tightness decreases.

In The Science of Sex, I discussed weight loss because it is a subject that most people approach in the wrong way, and because obesity affects sexuality. There is a correlation between obesity and a number of diseases (such as heart disease, diabetes, cancer, and arthritis) that can negatively affect sexual pleasure, performance, and libido. I give numerous tips for achieving weight loss without torturing your body or torturing yourself with hunger pangs. One of the tips reveals how to lose weight without dieting, drugs, herbs, exercise, or surgery. That may seem to be impossible and it may seem too good to be true, but it works and it is not unpleasant. Somehow, this fact escaped notice by the weight loss “experts," who recycle the same old tired advice year after year. Surprisingly, some of these supposed experts are themselves fat, which suggests that they are clueless. When I was an intern, I was so fat that I could not see my feet when I stood up. Now, I am in good enough shape to be an underwear model. Back in the days when I was a blimp, I thought I'd never be able to lose weight. I grew fond of my doctor's smock, which camouflaged the blubber fairly well. Eventually, I was so disgusted by my potbelly that I decided to lose weight, and I did. Painlessly. The key is knowing what to do.

OK, back to the subject of vaginal tightness. While dieting likely triggered your wife's vaginal laxity, stopping the diet won't immediately improve vaginal tone. It takes time for muscle to regenerate. This process can be accelerated by performing Kegel exercises, which are discussed in my book and myriad other sources. However, my book discusses Kegel exercises and vaginal muscles in far more detail than you will find elsewhere. Most of these discussions are trite, simplistic, and sometimes even laughable.

If you want an immediate improvement in vaginal tightness, your wife could use a vaginal wedge or the Vag-TTS, both of which are discussed in my book. You could also use a penile vacuum cylinder (colloquially termed a "peter pump"). Correctly used, this device can produce slight to moderate long-term enlargement and pronounced short-term enlargement (the latter effect is accomplished via induction of penile edema). The edema is relatively ephemeral, but it typically lasts a few hours — certainly long enough for intercourse. The edema does almost nothing for penile length, but it can dramatically increase diameter. Naturally, this increases subjective vaginal tightness. For reasons that I explain in my book, tightness improves more than size. Thus, when the penis is thicker, or the vaginal diameter is decreased, tightness increases more than the change in size. This may seem like Greek to you now, but the book makes it crystal clear. The bottom line is that relatively small increases in penile diameter (or a relatively small reduction in vaginal diameter) can produce a substantial improvement in tightness. However, this works both ways, too. A relatively small reduction in penile diameter (or a relatively small increase in vaginal diameter) can substantially diminish tightness. Thus, it may be that your wife's vagina isn't much larger than before. She may be just a bit larger, but this may seem like a big change because of the disproportionate variation in tightness with changes in size. If she was near the threshold at which a small change in size produces a big change in tightness, you could easily interpret her vaginal looseness as developing "suddenly," as you mentioned.

Some medical problems can affect vaginal tightness, such as Cushing's disease, some neurological diseases, and diseases that induce cachexia (wasting), such as certain cancers and AIDS. Several medications can affect vaginal tightness by causing muscle atrophy or reducing muscle tone. Simple aging is usually associated with loss of musculature, and this atrophy is accentuated if testosterone is deficient (as it so often is). Other hormonal problems (such as thyroid disorders) affect muscle strength, and this can manifest as reduced vaginal tightness. Hormone replacement therapy can itself affect vaginal tightness unless both estrogen and testosterone are given. Typically, women receive estrogen only. While this is better for the vagina than receiving nothing, replacing estrogen but not testosterone increases production of a transport protein (sex hormone binding globulin, or SHBG) that binds to, and inactivates, testosterone. This lowers the bioavailable testosterone level, and can exacerbate a testosterone deficiency. This can accelerate muscle loss (thus decreasing vaginal tightness) in addition to affecting bone density, mood, sleep, confidence, certain aspects of intelligence, libido, and other things. The route by which hormones are administered (oral, transdermal patch, etc.) affects SHBG production. I discuss these subjects, and hundreds more, in further detail in The Science of Sex.

Q: I’m a 19-year-old virgin because I fear the pain that comes along with breaking your virginity. Could you give me some advice in order to decrease the pain I will have when I decide to lose my virginity? Thanks.

A: Not all women experience pain the first time they have sex. The hymen can break beforehand as a result of nonsexual activities.

If your hymenal opening is still relatively small, the least traumatic way to prepare for intercourse is to use a series of progressively larger dilators. You can begin by using a small vibrator or dildo (since vibration is not important), and substitute larger ones over time. Once you can accept a standard-sized vibrator without difficulty, you will likely experience no intromission pain.

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