Navigating pain for women can be a twisted maze of questions, referrals and specialists, but amid the ever-growing list of diagnoses lies a silent condition that is experienced by many.
It's called vaginismus.
Six months ago, Sophie*, 22, started to endure painful sex with her long-term partner.
"It's just like a heavy pressure," she said.
"I thought it was because I left it too long, like a month between intercourse, but then that shouldn't really change anything.
"I was looking for answers with the gynaecologist being like 'it must be PCOS' (polycystic ovarian syndrome), but PCOS doesn't actually cause pain.
" I think I was just looking for a reason because I didn't want it to be vaginismus."
What is vaginismus?
Vaginismus is when vaginal muscles involuntarily contract in anticipation of penetration.
It causes immense pain or discomfort during intercourse, physical examinations or inserting a tampon and is psychologically triggered.
Those triggers vary greatly, from a general fear of penetration, to medical conditions like endometriosis, to a past trauma such as sexual assault or a distressing childbirth.
Equal to the physical pain can be the emotional toll it takes on women, the isolation they feel and the pressure it places on their relationships.
"The anxiety that came with it, because one time would be painful and then if you'd leave it for too long, it would just build up in my head more than anything," Sophie said.
A cycle of pain
She thinks of vaginismus as a cycle, where one painful experience builds fear for the next time, which feeds the muscle tension and leads to more pain.
"My boyfriend doesn't feel like I want to be intimate with him, which I do, and then I had to explain to him I get anxious because of the pain, not because of the situation," she said.
"Him trying to comfort me, but not knowing the language to use, kind of makes me feel worse.
"It's so tiring having the conversation, it's exhausting."
The prevalence of the condition is blurry but health professionals, like sexologist Melissa Hadley Barrett, believe the numbers are much higher because of under-reporting.
"In a clinic like mine it's between five and 17 per cent … but in the general population, they say between one and six per cent," she said.
"It's just not something people talk about, so people don't know that it even exists until they come across it."
Ms Hadley Barrett helps women and their partners work through the condition, which she said takes time but is achievable with a comprehensive approach and open communication.
"The partner often blames themselves and I think it's about getting them to understand that it's nothing they've done, it's just the person has anxiety around having pain in general," she said.
"You're not going to touch a hot oven if it burns you."
Ms Hadley Barrett said a lot of women try to work around the symptoms of vaginismus instead of seeking professional help.
Like many women's health issues, knowing where to go can be overwhelming — and there's often a cloud of shame surrounding sexual complications.
Finding the trigger
Pelvic floor physiotherapist Alison Wroth said along with a psychological approach, health professionals can work to retrain and relax the pelvic floor muscles.
"It's thought that the pelvic floor muscles have a protective response … it makes sense to think if a woman is feeling unsafe, that these muscles would tense," she said.
Ms Wroth helps her clients understand what the initial trigger may be and how to address that fear emotionally and then physically.
"I think it's really confronting to go and see someone about this part of the body," she said.
"Sometimes even in taking a really thorough history, we don't really get to what the initial onset was, but we can still work with the body and how it's responding now."
Seeking help can be hard
Sophie is yet to seek professional help, because of the barriers a lot of women face when dealing with pain and complex health complications.
"It always puts me off because of the amount of money it costs and it's intimidating, I don't know I'll just cry, but I think it's worth it," she said.
"It's been months of trying to fix it myself, which is not happening.
"As much as I think that I'm in control of it, the brain is just a lot more powerful."
However difficult treating vaginismus may seem, there is hope in overcoming the condition, Ms Wroth said.
"I'm constantly amazed at humans and the complexity of systems that are all working together just to keep us functioning in the body, and how quickly they can change if that person is ready, with the right practitioners to help them," she said.
