Understanding Vaginismus: Symptoms, Causes, and Treatment Options
Vaginismus is classified as a genito-pelvic pain/penetration disorder, in which there is an involuntary contraction of the pelvic floor muscles that surround the vagina whenever vaginal penetration is attempted. This contraction can make sexual intercourse, gynecological examinations, and even inserting a tampon difficult or impossible, leading to pain, distress, and a significant impact on quality of life. The muscle tightening can be so strong in some cases that it is described as a “vaginal spasm”.
Vaginismus has been classified as a primary sexual dysfunction accourding to a study done at the International Urogynecology Journal in 2001. This research suggests that vaginismus is a significant condition that can independently impair sexual function, rather than being a secondary symptom or side effect of another medical issue.
Unfortunately, very little information is available on the consultation and treatment histories of women with lifelong, or primary, and acquired, or secondary, vaginismus.
While several treatment options are available, it is important to understand the root causes of vaginismus in order to provide effective care and support.
This article provides an overview of vaginismus, including its symptoms, potential causes, prevention strategies, coping strategies for living with it, and medical professionals’ role in providing comprehensive care.
Vaginismus, a genito-pelvic pain/penetration disorder, is the involuntary, instantaneous contraction of the pelvic floor muscles by the vaginal opening in anticipation of penetration, making vaginal penetrations – finger, sexual intercourse, tampon, vaginal applicator, gynecologic examination – difficult or impossible.
Vaginismus used to be viewed as a sexual dysfunction condition that is associated with history of sexual abuse, and characterized by painful intercourse. This has been refuted: vaginismus is about any vaginal penetration, not only sex, and is always an anxiety-based condition, whether the woman is aware of her underlying anxiety, or not.
The primary symptom of vaginismus is pain or discomfort during vaginal penetration. This can include a range of activities such as sexual intercourse, insertion of tampons, or during gynecological examinations. The intensity of the pain or discomfort can vary among individuals – for some vaginismus can be a slight discomfort, while for others it can be intense pain.
This pain or discomfort is due to involuntary contractions or spasms of the muscles of the pelvic floor that surround the vagina. These contractions are typically triggered by the attempt to insert something into the vagina, but they can also occur in anticipation of penetration, even before actual physical contact occurs. This reaction can make penetration difficult or impossible.
The experience of pain is often described as a feeling of tightness or burning. Some women describe the sensation as if they’re hitting a wall at the vaginal opening. It’s important to note that the pain associated with vaginismus can occur even if a woman is sexually aroused and wants to have sex.
Besides physical pain, vaginismus can lead to psychological symptoms. Women suffering from vaginismus often experience high levels of anxiety or fear around sexual activity, which can lead to avoidance of sex, decreased sexual desire, and relationship stress. Some women may also experience feelings of inadequacy, frustration, or guilt, and it can also affect their self-esteem and body image.
There is evidence that women have higher likelihood of vaginismus if they present fears of pain, injuries, bleeding, fear of losing control, and having a panic attack if they engage in sex with penetration according to one study done by The Journal of Sex & Marital Therapy.
It is essential to note that symptoms may vary in severity, and can occur in different situations, depending on the individual.
There are several potential causes of vaginismus and its onset isn’t always completely understood according to the National Health Service of UK. Some women might grapple with this condition throughout their adult lives, preventing them from having sexual intercourse. For others, it may be linked to distressing experiences, such as a challenging childbirth or traumatic sexual encounter.
Vaginismus may arise in women who have had a history of satisfying and pain-free sex. Certain situations like a vaginal infection, post-childbirth complications, exhaustion, or depression may be triggers. Physical issues such as injury or inflammation in the vagina, pelvic region, or bladder can also lead to the development of vaginismus. Other causes can be chronic vaginal dryness or irritation from spermicides or latex present in condoms. Interestingly, even when the initial physical cause resolves, vaginismus might persist. It can also be a side effect of alcohol, certain medications, or drugs.
Trauma to the genital area, whether in the distant past or more recent, can trigger a protective bodily response that may manifest as vaginismus. An uncomfortable or painful sexual experience or medical examination might be the root cause. Fears related to sexual intercourse, such as a belief that the vagina is too small, often stem from distressing early sexual experiences. For some, vaginismus may be a consequence of sexual abuse, assault, or rape.
Psychological factors can also play a significant role. A stringent upbringing where sex was taboo, or misleading messages causing guilt or shame around sex can trigger vaginismus. Inadequate sex education or being told that sexual intercourse is painful or that sexual desire is wrong can provoke fear and anxiety around sex. Cultural or religious prohibitions, concerns about pregnancy, or relationship issues can all contribute to the condition as well.
- Fear of the unknown, such as “will it hurt?”
- Negative emotions, such as guilt or shame, associated with vaginal use or sex
- Religious or cultural inhibitions
- Anxiety or fear related to sexual intercourse
- Relationship issues, including trust or communication problems
- Being forced into sexual intimacy
- A failed gynecologic examination, with clinician’s berating the patient for it
- Past negative experiences
- Infections,, such as urinary tract, yeast infection, sexually transmitted
- Gynecological issues, including endometriosis or vulvodynia
- Complicated vaginal childbirth
- Hormonal decline, such as in menopause or cancer treatment
- Pelvic surgeries or injuries
Diagnosing vaginismus can be challenging due to its symptomatic similarities with dyspareunia, according to The BMJ, a weekly peer-reviewed medical trade journal,. To differentiate between the two, a comprehensive history, encompassing medical, psychosocial, relationship, and sexual aspects, is crucial. Any instances of traumatic sexual experiences must also be taken into account.
In the context of a psychological evaluation, understanding the individual’s sexual knowledge and her family’s attitudes towards sexual behavior is significant. It’s essential to gain a thorough understanding of the pain, fear, and avoidance behaviors associated with the condition. The patient’s comfort level with genital exploration, whether self-conducted or by another person, is also an important factor to consider in the assessment process.
Most women with vaginismus keep quiet about the condition and do not disclose it nor reach for medical advice. Instead, they embark on Internet search and join vaginismus support groups through which they validate their vaginismus. In other words, vaginismus is commonly self diagnosed.
For those women who do seek medical advice, a comprehensive medical assessment by a knowledgeable clinician is crucial for accurately diagnosing vaginismus. The assessment process might involve the following:
- A thorough medical history & evaluation of medical, sexual, social, and emotional components
- Conducting a pelvic examination, if the woman can handle it, to evaluate and rule out other medical issues or infections
- Referral to a vaginismus specialist
Vaginismus is divided into two types, Primary Vaginismus and Secondary Vaginismus.
Primary vaginismus means that the woman always has had difficulty with vaginal insertions, or has never been able to have them at all.
Secondary vaginismus – the inability or great difficulty with vaginal penetrations – develops after previously having had successful penetrations in the past. There are many possible causes for secondary vaginismus, including surgical scarring, tightly healed episiotomy, Lichen Sclerosus, menopause, estrogen-reducing medications, vaginal radiation, painful experiences (i.e. vaginal infection, sexually transmitted infection, forced penetration), complicated vaginal delivery, emotional crisis, complicated postpartum, and more.
Various vaginismus treatment options exist for individuals struggling with vaginismus, and the best approach will vary based on each person’s specific circumstances. An in-person treatment is always the best way but since it is not always possible, virtual coaching is a viable option.
Treatments for vaginismus includes any combination of the following methods:
A qualified physical therapist can guide those experiencing vaginismus in relaxing and managing their pelvic floor muscles, which can help reduce involuntary contractions.
Vaginal dilators are graduated cylindrical devices inserted into the vagina to help stretch and relax the vaginal muscles gradually. Patients can work up to larger sizes, starting with a small dilator as they become more comfortable.
Working with a qualified therapist or counselor can help individuals address any underlying psychological or emotional factors contributing to vaginismus. This may involve cognitive-behavioral therapy, mindfulness techniques, or couples counseling.
Done under sedation, its goal is to relax the vaginal muscles and introduce a dilator, with the woman to continue dilation past the procedure. This approach does not address the underlying anxiety that is the cause of vaginismus.
In some cases, medication may be prescribed to help manage anxiety or depression associated with vaginismus or to address any underlying medical conditions contributing to the condition.
Contrary to common belief, lifestyle has no impact on vaginismus. It is a great fallacy that women with vaginismus need to change what they eat, how they exercise, what activities to eliminate and which to escalate, etc. – watch our video Vaginismus Treatment Misconceptions to understand the scope of baseless limitations that various clinicians suggest.
Self-care may help by understanding vaginismus, managing the underlying anxiety, engaging sexually in all ways but penetrative, maintaining open communication with the partner about sexual needs and concerns, and realizing that ‘you are not the only one’ who is struggling with this condition!
Surgical intervention for vaginismus should generally be avoided. Given the complex nature of the condition and its strong association with psychological factors, non-invasive treatments should be prioritized. Surgery will not effectively address the root causes of vaginismus and could lead to additional complications or exacerbate the issue.
However, a hymenectomy may be in order when the hymenal tissue is intact and resistant to manual stretch. Sadly, clinicians often assume that all virgins have an intact hymen (a fallacy!) and that a hymenectomy will sort out any penetrative inability (another fallacy!), and they commonly recommend this surgical solution. While this simple procedure will be of help to the woman without vaginismus (no underlying anxiety about any vaginal penetration), it will not cure vaginismus.
It is not possible to prevent vaginismus, but recognizing it as early as possible is key to limiting its impact on the woman’s life, health, and sexual intimacy.
- Do Internet research to learn about vaginismus
- Speak with your healthcare provider about inability to have vaginal penetrations
- Maintain open communication with your partner about sexual needs and concerns
- Seek treatment
Living with vaginismus is physically and emotionally challenging. However, with the right treatment and support, women can overcome the condition, own their vagina, and enjoy a pain-free & fulfilling sex life. Some coping strategies that may help include:
- Educating oneself about vaginismus to better understand the condition
- Connecting with support groups or online forums to share experiences and learn from others who have faced similar challenges
- Practicing patience and self-compassion, as overcoming vaginismus may take time and effort
- Avoid penetrations that cause pain to minimize the deepening of the associated anxiety, especially painful penetrative sex – more of such is not necessarily better!
- Seek treatment – do not avoid it!
Healthcare providers are crucial in diagnosing and treating vaginismus and providing emotional support to individuals affected. Medical professionals must be knowledgeable about vaginismus, its symptoms, and treatment options to provide the most comprehensive care possible.
Healthcare providers have a responsibility to:
- Take patient concerns seriously and provide a thorough evaluation for individuals presenting with symptoms of vaginismus
- Maintain patient confidentiality and provide a safe, non-judgmental environment for discussing sensitive topics related to sexual health
- Provide appropriate referrals to specialists, such as pelvic floor physical therapists, sex therapists, or psychologists, when necessary
- Stay up-to-date on the latest research and treatment options for female sexual dysfunction in general, and vaginismus in particular.
Vaginismus is an underreported and often misunderstood condition, making it difficult to obtain accurate prevalence data. However, studies suggest vaginismus may affect many women worldwide.
Despite its prevalence, vaginismus remains a relatively unknown and stigmatized condition in many parts of the world. Increased awareness and understanding of vaginismus are essential for improving access to appropriate care and support for those affected.
These disorders are often interrelated and may require a combination of treatments to address the underlying causes.
Vaginismus is always a symptom of underlying anxiety. Medical professionals must be well-informed about vaginismus, its symptoms, and treatment options to provide the most effective care possible. Vaginismus can be overcome with proper diagnosis, treatment, and support – there is no reason to live with vaginismus!