Why Do I Have Vaginismus If Nothing Bad Ever Happened to Me?

• “I was never sexually abused.”
• “I didn’t have a traumatic childhood.”
• “Nothing bad happened to me.”
• “So why do I have vaginismus?”

There has always been a widespread perception that vaginismus is caused by a traumatic event, especially sexual abuse.  Back in the 90s, when we launched our specialty vaginismus practice, all patients referred to us were labeled with ‘must have been abused.’Thankfully, our clinical findings and experience do not support that notion. In fact, sexual abuse is not a prerequisite for developing vaginismus. In our patient population, fewer than 5% report a history of any abuse (clinical data not yet published).Fact: having vaginismus does not mean that something terrible must have happened to you.

Vaginismus Is Not Simply a Muscle Problem

Vaginismus is not simply a muscle disorder. It is the physical expression of an underlying anticipatory anxiety response that triggers involuntary pelvic floor muscle clenching in anticipation of penetration.

The physical response is involuntary

Women with vaginismus want to own their vagina and have normal penetrations and, therefore, they do not consciously decide to clench their vaginal opening.  Unfortunately, wanting penetration does not necessarily prevent the clenching response, a dilemma that causes her much frustration and anger.Often women will say, “but I love my partner and I want to be with him” as if that will counter the clenching and open wide the vagina.  Sadly, that is not how this clenching response works and having a loving and trusting a partner does not prevent it.The physical reaction is real even when the woman cannot explain why it is happening. It is not ‘just’ in her mind.  She is not faking it.

You Do Not Need a History of Sexual Abuse to Develop Vaginismus

Sexual abuse can be relevant in an individual woman’s history, but it is only one possible – albeit uncommon – cause of vaginismus.As mentioned above, most of our patients have not experienced sexual abuse, which makes them question whether their vaginismus is real.  Some even feel compelled to search for an abusive experience to explain it, which may lead to emotional spiraling and growing worries.

Vaginismus is not evidence of forgotten sexual trauma

We see great harm when a woman is told or led to believe that she must have experienced trauma or abuse that she cannot remember.Vaginismus itself is not evidence that a forgotten sexual trauma occurred.

What Can Give Birth to Vaginismus?

Understanding the mechanism of vaginismus and relevant contributing experiences is key to providing proper intervention.

Experiences or triggers can provoke an anxiety response

When specific negative experiences related to the genitals or to fear become triggers, they activate an anxiety response that leads to the birth of vaginismus.  Let’s describe possible scenarios that are common to the condition:

• Having been diagnosed with a genital infection or another painful genital experience
• Having experienced a difficult childbirth
• Past painful or frightening penetration experiences
• Witnessing aggressive sexual intimacy between parents
• Being told that sex will hurt
• Being taught that sex is primarily for the man’s benefit, and something a woman is expected to submit to or endure
• Perceiving penetration as an unsafe or dangerous activity
• Having encountered different frightening messages about penetration, virginity, bleeding, pregnancy, or gynecologic examinations
• Connecting with events that the woman experiences as traumatic or threatening
• Not understanding how her genitals work, what to expect, and how to care for them
• Any other experiences that provoke a fight-or-flight/anxiety response

What matters is the woman’s experience of the event

A triggering event does not have to meet someone else’s definition of a “major trauma” to provoke an anxiety response.  It is about how she sees the negative event, without judgement.  What matters most is what occurred, how the woman perceived what happened, her emotional response, as well as her age and understanding at the time.  A seemingly modest experience at one point in a woman’s development may have a different effect than the same experience at another time.

Sometimes There Is No Identifiable Trigger

It is not unusual for women to present with a statement of, “I have been thinking and searching but I still don’t really know why I have vaginismus.”There does not necessarily have to be one dramatic moment when vaginismus began.  It could have developed over time through accumulating negative experiences.Not finding an initiating event does not invalidate the diagnosis, and treatment should not depend on uncovering a hidden explanation.

What Gives Birth to Vaginismus Is Not Necessarily What Keeps It Going

Once vaginismus gets established, the perpetuating mechanism can become more clinically important than the original trigger: with each adverse event, the anxiety response becomes more validated, and the snowball effect intensifies.

The vaginismus cycle

The pattern of the vaginismus cycle is quite established: Anticipation of penetration → anxiety response → involuntary pelvic floor clenching → penetration becomes difficult, painful, or impossible → experience reinforces the anticipation → response repeats.With anxiety being an instantaneous, involuntary reaction, conscious reasoning alone cannot simply switch off an anxiety response, making the woman feeling even more trapped.

“But I Don’t Feel Anxious”

Typically, women associate anxiety with jumpy & restless behavior, sweating, feeling panicked, all easily identified.  But many will present cool, calm, and collected while internalizing their anxious feelings or rationalizing certain reactions.  Furthermore, the anxiety may not always look or feel like a conscious fear or panic.However, as soon as treatment begins, anxiety reactions will present themselves, at times surprising even the woman herself who did not realize the enormous impact of the mind (anxiety) over her.   More so, she will be struggling to realize that her anxious reactions are not ‘what everyone else feels’ but rather her own anticipatory response to penetration, and to other events in life that are not associated with sex or the genitals.

“I Want Penetration, So Why Does My Body Still Clench?”

This is a contradiction that is quite common: she has a partner she wants to be with, she feels emotionally safe, she truly believes that with trying hard her vagina will relent, yet her body nevertheless produces the established vaginismus response…Why? Because the anxiety reaction is firmly established, and the Fight-or-Flight reaction of vaginal clenching appears regardless of conscious wants and control.  This reinforces why telling a woman with vaginismus to simply relax does not work.

Does Knowing What Started My Vaginismus Matter?

No, it does not matter if not easily apparent as the relevant anxiety, fears, associations, beliefs, responses, or other clinically meaningful issues reveal themselves during treatment.Understanding relevant experiences can help put the woman’s history into context and will identify additional areas in need of future interventions, but treatment should not become an endless search for an originating event.

You Can Overcome Vaginismus Without First Finding a Hidden “Why”

The relevant issues behind vaginismus will always present themselves during treatment, so insisting on identifying a hidden ‘why’ as a precursor to initiating intervention may add to the woman’s frustration and agony.  However, the woman who tries to self-treat may encounter a bumpy road as it is not easy to be both the guide and the patient…

How We Look at Vaginismus at Women’s Therapy Center

Our integrated assessment takes a deep, detailed look at the woman as a whole, rather than reducing vaginismus to either tight muscles or to presumed psychological trauma.Areas of exploration include penetration history, medical, emotional, and sexual history, physical/anatomical factors, past interventions, relevant relationship/partner factors, and other specifics that present themselves during the initial assessment or that the woman asks for help for.  Once concluded, a treatment plan is presented that includes projected frequency and duration of the process based on our accumulated clinical outcome data.Although the roadmap to overcoming vaginismus is quite clear, the entire process is dynamic to never miss any detail that needs attention.

FAQ

Can you have vaginismus without ever being sexually abused?

Yes.  Based on our clinical data, less than 5% of patients experienced abuse of any kind, with sexual abuse representing only a fraction of that yet.

Can another frightening or painful experience trigger vaginismus?

Yes, frightening or painful experiences associated with her genitals or sexual perception or intimate relationship can trigger vaginismus.

Can I have vaginismus if I don’t feel anxious?

While you may not feel anxious, the anticipatory anxiety percolates beneath the surface and can erupt upon attempted penetration.

Does vaginismus mean I may have experienced trauma that I don’t remember?

No. Vaginismus itself is not evidence of a forgotten traumatic or sexually abusive event.

Do I need to know what caused my vaginismus before I can overcome it?

No. Relevant history can be useful, but identifying a single initiating event is not a prerequisite for successful treatment.

Conclusion

You do not need to have experienced sexual abuse or remember a traumatic event for your vaginismus to be real. And you do not need to discover a hidden event in your past before you can overcome it. If penetration remains difficult, painful, or impossible, understanding the response your body has developed is part of finding the right path toward recovery.Contact Us if you have any questions or to schedule a consultation.