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Effective Vaginismus Treatment Options: Mental and Physical Therapy

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Learn about our proprietary sexual pain & vaginismus treatment, the DiRoss Methodology sm.

I Thought My Vagina Was Just Abnormally Small or Tight

What is Vaginismus?

Vaginismus is a genito-pelvic pain/penetration disorder, or a vagina in panic… The instantaneous, involuntary (psychosomatic) contraction and tightening of the pelvic floor muscles and pelvic pain in anticipation of vaginal penetration. This reaction will occur if penetration is perceived as upsetting, painful (even before attempting it!), frightening, or dangerous, making the body scream out loud, “NO ENTRY!” Occasionally, the condition will be caused by a physical problem such as a birth defect or surgery.

Vaginismus and its cure continue to be an elusive and embarrassing problem despite widespread online visibility in recent years. Professionals are still unsure how to diagnose vaginismus, vaginismus treatment is not standardized, misconceptions abound, and the women who suffer from vaginismus often find themselves left alone searching for solutions.

Vaginismus is a form of painful intercourse, or dyspareunia.

Vaginismus Treatment

When seeking treatment for vaginismus, women are divided into:

  • Those who cannot self-treat or are not successful with self-treatment, as well as those who opt for professional help upon diagnosis.
  •  Those who self-treat with education, encouragement, and/or self-help dilator kits obtained from their doctors, counselors, the Internet, sex shops, etc. Read Christiane’s story.

What are the Vaginismus treatment Options?

We offer the following vaginismus treatment options to account for travel and time logistics. Either program leads to the same end result, Overcoming vaginismus.

  • The weekly program: come to us once, or twice per week if you so choose and our schedule allows. The entire treatment process takes 7-10 sessions, with each session lasting about 45-55 minutes. You pay per session;
  • The hybrid program – 2 plans:
    • Stay in the area for 4-5 weeks (with family, or if you work virtually) and be treated 2-3 times weekly over the course of the stay.  The entire treatment process takes 7-10 sessions, with each session lasting about 45-55 minutes. You pay per session;
    • Come in for 2-day chunks at a time so save on travel.  The entire treatment process takes 7-10 sessions, with each session lasting about 45-55 minutes. You pay per session;
  • The concentrated 2-week program: for those who live too far to attend the weekly program, or have minimal vacation time. For more information, read the page dedicated to this option.
  • Virtual Vaginismus Coaching: Designed for women who cannot possible arrive for in-person treatment at our New York location. See More

Why choose us? Read about our approach, style, and other details that will help you better understand our intervention and what to expect.

Vaginismus therapy and treatment process – In this YouTube video, we talk about our process to curing vaginismus.

Will Vaginismus Treatment Hurt? – See our video reply to this commonly asked question.

Can vaginismus be treated online or virtually? 

Yes, we offer online vaginismus coaching to help you overcome vaginismus from the comfort of your home if coming to us for in-person treatment is not possible, or if you wish to start online before converting to in-person treatment.

Will vaginismus come back after treatment?

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

DiRoss Methodology

With years of experience and thousands of treatment hours, we have developed a practical and quantitative approach that addresses the whole woman, not just her genitals.

Read More

What Causes Vaginismus?

The causes of vaginismus are not entirely understood, and are likely multifactorial, including both psychological and physiological factors. 

The most common causes of vaginismus, in order of prevalence. Note that, contrary to common belief, abuse is not at all on this list!

  • Fear of pain, mostly because they heard from friends how painful it was for them.
  • Fear of the unknown: how will it feel inside, how will I react, what if I don’t like it, etc.
  • Religious inhibitions and taboos
  • Fear of the vagina: being an invisible body part is a substantial contributing factor to worries and fallacies
  • You perceive the vagina as fragile, thus worrying about scratching, hurting, breaking something inside it (invisible, remember?), etc.
  • Past experience with discomfort, i.e., infection, a rough partner, a dry & uncomfortable vagina, etc.
  • Misconception about sex and sexuality
  • The inability to say NO to unwanted sex
  • Parental indulgence and over-protectiveness, limiting the ability to deal with life’s challenges (including vaginal use)

While the woman may not know why she has vaginismus, she certainly knows that she is not friendly with her vagina and cannot use it naturally or in “the normal way.” Anxiety is common in women with vaginismus and can be linked to other conditions such as vulvodynia.

There are five (5) body areas that are responsive to emotional stress, with symptoms of vaginismus being involuntary as well as present on/off as per stress level:

  1. Head — expresses stress like headaches, migraines, TMJ (jaw tightening, teeth grinding);
  2. Neck — expresses stress as a stiff neck, often to the point of arms going numb;
  3. Low back — expresses stress as low back pain, sciatica, etc.
  4. Digestive system — expresses stress as the acidic stomach, irritable bowel syndrome, diarrhea, constipation, pain, etc.;
  5. Genitals/pelvic floor — expresses stress as difficulties relaxing enough to void, spasm pains, and vaginismus.

Of course, the natural tendency is to suspect a medical problem, and, indeed, there are different potential causes for these problems.

When medical examination and testing will not find any physical reason to justify the above complaints, emotional stress can be established, and proper intervention is a must.

Psychosomatic physical expressions like these, under the influence of stress hormones such as cortisol, tend to expand over time and may eventually cause tissue breakdown because of an associated inflammatory process.

In other words, stress is not a good thing for our body-mind health!

A stressed individual – male or female – may have more than one such body area ‘activated.’ And indeed, when it comes to vaginismus symptoms, it is quite common to see women who suffer from stress activation in several of those body areas, not only in her pelvic floor!

How is Vaginismus Diagnosed?

Diagnosing vaginismus requires identifying an inability, or a great difficulty, with one or more of the following Five Penetrations of Life SM

  • Finger
  • Tampon
  • Applicator
  • Intercourse or penetrative sex (or use of penis-size dildo or vaginal dilators)
  • Gynecologic exam or pelvic exam

A woman may have none of the penetrations or she may be able to have some, but not all of them. However, intercourse is always problematic or impossible.

Note: Although most women with vaginismus self-diagnose, this information is not intended to replace prompt medical care. Painful intercourse should always be consult by a medical professional.

What are the Types of Vaginismus?

There are two main types of vaginismus, primary and secondary vaginismus.

Primary vaginismus:

Primary vaginismus is when the woman was never able to have vaginal penetration/s or has always struggled with them, women feel trapped, with feelings of panic and anxiety, being “stuck with it forever,” of feeling inadequate, and “the only one who suffers from this…”

Partners suffer as well, feeling frustrated, helpless, rejected, and inadequate. Inaccurate sexual information and the lack of understanding of the woman’s body will worsen the crisis, often leading to alienation; it is not unusual for some women in a relationship to suggest a breakup because they feel that they cannot “do what a woman should do” because of their primary vaginismus.

Secondary vaginismus:

Secondary vaginismus is when the woman lost the ability to have vaginal penetration/s. Causes of secondary vaginismus include gynecologic surgery, Menopause, cancer treatment & radiation, emotional or relationship crisis, frequent painful urogenital infections, and Sexually Transmitted infections.

Although these women will remember that penetrations used to be fine, they are now faced with painful/impossible vaginal penetrations, making them feel just as isolated and hopeless as those with primary vaginismus.

Typically speaking, a solution is simple and takes just a few treatment sessions.

What are the Symptoms of Vaginismus?

Symptoms of vaginismus always include pain during intercourse.

Pain: Although vaginismus causes various physical and emotional symptoms that every woman will experience in her own way, pain is the main feature and the one shared by all sufferers regardless of the severity of their condition.

It is important to emphasize that vaginismus’s pain is not “in the woman’s head.” Rather, it is a real physical pain from the panic reaction to penetration, the product of a Fight or Flight response.

  • It is like hitting a brick wall;
  • A ripping struggle to enter me (because I must be too small);
  • Sharp pains in the vagina;
  • Burning at the vaginal opening;
  • Pressure in the vagina;
  • Burning and pain for hours or even days afterward;
  • The sensation of a needle/knife poking me;
  • Pains in the lower abdomen;
  • Increased anxiety;
  • Painful sexual intercourse (if she can have penis penetration at all).

Concerning pelvic/gynecologic examination, women will tend to avoid them or will suffer terribly through them.

Tampon use? Women will settle for sanitary pads and come up with excuses for why they prefer them over tampons.

To explain this further, watch the videos on this page. For more information about signs of vaginismus, see our page on vaginismus.

Vaginismus Misconceptions

Vaginismus continues to be a puzzling condition that is often misdiagnosed and poorly managed due to limited understanding and resources.  Even the medical community is mostly clueless as to understanding it, and how to treat.

Women, and partners, have embraced the Internet as it offers them a venue to research resources for vaginismus treatment without disclosing their suffering in fear of shame or embarrassment.

There is widespread false information about overcoming vaginismus, including the following wrong information often given by clinicians.  They totally miss the point that the vagina is an automatic body part that should work without much ado if not for the anxiety that settled within it…

Common misconceptions about vaginismus treatment include:

  • It will be painful;
  • It will take many months to cure;
  • It is impossible to predict how many treatment sessions are needed;
  • You have to get aroused for it to work;
  • Kegel exercises are a must;.  Reverse Kegel promote relaxation;
  • Before using dilators, use a heating pad or take a hot bath to relax;
  • Need to keep the dilator in the vagina for (so many) minutes or hours;
  • Need to wiggle the dilator when inserted;
  • We need to use a mirror for penetration;
  • I need to look at my vaginal insertion;
  • Need to get partner’s finger involved;
  • Need to do relaxation breathing for penetration to happen;
  • The dilator should go in slowly;
  • It helps to image a pretty place while doing penetration/s, a hammock sagging, a flower blooming;
  • It is about sex;
  • Doing sports/swimming/exercising is not advisable;
  • Must always stroll, never walk fast;
  • Do not ever cross your legs;
  • Taking a hot bath before/after treatment is helpful;
  • Stop (dilation/treatment) if uncomfortable;
  • You must have a hymen;
  • Masturbation is important;
  • Child pose (yoga) is helpful;
  • The muscles need to be pulled back;
  • Do dilation standing up;
  • There is no cure; You have to learn to live with vaginismus.

The list is long and goes on. The confusion is deep. The damage to the woman’s body & mind is injurious and devastating. This is wrong!

Fact: vaginal use is a natural activity of the body; there is no reason to medicalize it. Vaginismus is not a broken vagina but rather a healthy vagina that is in-panic.

Table of Contents

Videos About Vaginismus

Our Vaginismus Doctors

vaginismus specialist Dr. Ditza Katz team member Women's Therapy Center

Dr. Ditza Katz, PT, Ph.D.

Founder, Women’s Therapy Center

Specializing in treatment for vaginismus, sexual medicine, female sexual dysfunctions, breast & female cancer rehabilitation, urogynecology rehabilitation, and somatic disorders. Dr. Katz holds an undergraduate degree in Physical Therapy, a Master’s degree in Pastoral Psychology & Counseling, a doctorate in Clinical Sexology, and clinical training in manual therapy and urogynecology.
Ross vaginismus therapist

Dr. Ross Lynn Tabisel, LCSW, Ph.D.

Co-Director, Women’s Health Center

Ross Lynn Tabisel, LCSW, Ph.D., is Co-Director of the Women’s Therapy Center and a Diplomat with the American Board of Sexology. She holds a Master’s degree in Social Work from Adelphi University, a Post – Graduate Certificate in Psychotherapy and Psychoanalysis from the Institute for the Study of Psychotherapy in New York, a doctorate in Clinical Sexology, and Certificate Training in the area of Sexual Abuse.

Vaginismus Treatment Testimonials

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