Struggling with painful sexual intercourse? Contact us for help.

Vaginismus FAQ

There is no reason to live with vaginismus – it is a treatable condition!

Vaginismus continues to be an elusive and embarrassing condition 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.

Grading Vaginismus – Many of our patients will attempt to grade the severity of their vaginismus from mild to severe, from partial to complete. They will do so for their own self-reassurance and comfort, or because they worry that we won’t know what to do if they are ‘severe,’ or because that is what they were told by others.

Having treated nearly 2000 cases (as of March 2021), we differ from the current published criteria for grading vaginismus (see listing below).

For us, it is NEVER a matter of ‘mild’ or ‘severe’ but is rather about the severity and disruptive quality of the underlying anxiety. And, it is not just about the gynecologic examination, but about any & all vaginal penetrations – it is about the whole woman and her use of the vagina!

Be reminded that vaginismus is a psychosomatic condition, or to say it differently – it is a symptom of anxiety, not the cause of it.

That said, we never grade vaginismus nor find a reason to do such. For us, it is about offering expert body-mind intervention while managing HER anxiety, may it be mild, severe, or anything in-between.

 

*******************************

 

Currently published criteria for grading the severity of vaginismus include,

  • The presence of reactions upon an intended or actual gynecologic examination, such as increased heart rate, palpitations, hyperventilation, trembling, shaking, nausea or vomiting, crying uncontrollably, a feeling of lightheadedness and fainting, a desire to jump off the table, run away or even attack the clinician;

  • Visibly identifiable vaginal muscle spasm upon examination;

  • The ability/inability to follow vaginismus treatment recommendation due to level of fear and anxiety;

  • The ability to self-treat vs the need for professional intervention.

Coping With Vaginismus: How does a woman, whether single or in a relationship, lesbian or heterosexual, cope with the devastation of vaginismus?

Women will employ a wide range of survival tools aimed at painting as normal a picture as possible, in essence pretending that all is fine yet knowing full well that there is a painful truth behind it, including:

  • Rationalization and self-reasoning, such as “I am waiting for the right man;”
  • keeping such an active life as to disallow any opportunity for unwanted thoughts or actions about her vaginismus;
  • planning life to avoid any opportunity to encounter vaginismus, such as refusing to watch romantic movies, not dating, not walking by the tampon aisle, not going to weddings; entering compromised relationships where vaginismus becomes just another item on a long list of issues;
  • somatization, the phenomenon of multiple and recurring physical complaints for which medical intervention is constantly being sought, yet for which a physical explanation cannot be found.
  • More extreme coping tools include terminating a relationship, ending a marriage, substance abuse, depression, suffering in silence, and resorting to assisted reproduction or adoption.

YES, vaginismus can be cured!

Vaginismus treatment & vaginismus cure require diffusing the associated psychosomatic reaction so the woman can befriend her vagina and use it as she wishes. Effective treatment is key — there is no reason to live with vaginismus!

See our testimonials page vaginismus success stories

How Long Does it Take to Cure Vaginismus with Vaginismus Treatments?

(The following are statistical averages and should not be taken as absolute numbers)

  • 7-10 sessions for those who live close enough to be treated once or twice weekly;

  • 20 sessions for those who come for the 2-week program. This process requires more time because of its concentrated, intense nature.

An effective, proven treatment intervention is key to the successful management of vaginismus.

  • Because vaginismus is NOT a disease/pathology/physical anomaly but rather a stress response of the sympathetic nervous system, our guardian, at times of fear, worry, or danger. Vaginismus is a psychosomatic condition, a fusion between medical and mental health that is not yet in the professional mainstream.

  • Because of the woman’s inability to look at the vagina to see if anything is wrong because of its location inside the pelvis, unlike the male’s penis that is external and may be looked at anytime. The only time she can see her vagina is when a speculum is used, which is typically done only during a gynecologic examination.  No wonder this invisibility makes the vagina quite mysterious and misunderstood to the point of believing that pain upon penetration – or complete inability to penetrate – must signal a physical problem with the potential for further harm.

  • Because the woman with vaginismus will have difficulty believing that nothing is wrong with her vagina, she will often insist that there must be something physically wrong, mainly because the connection between our stress response system and the genitals is still not widely recognized nor accepted.

By the time our vaginismus treatment process gets to demonstrating a gynecologic exam, we make sure to have each patient looks at her vagina through the open speculum, to which she will typically exclaim, ‘Oh, it is so big inside — nothing like what I imagined all this time…” 

Some women will ask us to take a photo of their vagina to keep on their mobile phone as proof that it is merely a simple canal that connects the outside world to the uterus. Yet a canal that is subjective to reactive clenching, which vaginismus is all about…

Vaginismus is a common yet secretive medical condition that eludes clinicians and the women who suffer from it. Its prevalence is speculative because most sufferers are too embarrassed to disclose their ‘problem’ at the risk of being shamed or dismissed, opting instead to live in silence while believing that they are the “only one” with the condition.

You may want to visit our Vaginismus Statistics – How many women have vaginismus? page for more information.

Vaginal dilators have been a vital component of vaginismus treatment. They may be used as a home kit for self-treatment or by a clinician attending to the condition.

When trying to self-treat with vaginal dilators, success is variable: some will be successful, some will continue to struggle, and some won’t be able to use even the smallest in the set as they are just too scared to insert anything into their vagina, or are terrified of the pain they anticipate. And some will be able to use the entire dilator set but not be able to transition to intercourse or any other vaginal penetration.

Does a woman need to see herself inserting a dilator into the vagina?

Is a mirror a mandatory component of the treatment? Not at all. We are wired to know our orifices and to use them intuitively without a visual cue: we feed without a mirror, we wipe after voiding without looking, and we can put a finger in our ear or nose without a problem. Had we not been wired such, blindness would have been a devastating affliction, and being in the dark or without a mirror would have stopped us from using our bodies. We would have been extinct…

Do you need to relax before inserting the dilator?

No. Just a quick reflection of acceptance, a quick exhalation upon initial insertion, and a quick reminder that the vagina was built to function should do it.

Sleeping with the vaginismus dilator in the vagina?

No need. Vaginismus is not about a physical restriction but rather a reaction to penetration. And besides, nothing in life stays in the vagina with the exception of a tampon…

A typical comment when practicing with dilators: “I cannot see how this will ever be enjoyable!”  Be reminded that the treatment itself is not arousing,  that for the woman, enjoyable intercourse is not fathomable when penetration is painful and distressing, or while ‘in training,’ and that sexual arousal will not make penetration possible nor will it take the pain away (a common misconception).

Conclusion: the first step is owning the vagina and being able to have vaginal penetrations in neutrality (no pain, no distress); next – opt to allow enjoyment/arousal to happen.

Never hesitate to weigh your success with self-treatment vs. seeking professional help so as to keep the associated anxiety from growing.

There are no ‘vaginismus’ exercises per se because the vagina is a basic body part that should work on auto-pilot!

However, there are vaginal training activities that are an integral part of vaginismus treatment, such as dilator use, practice with a finger or a tampon, etc.

Read the Vaginismus Misconceptions tab on this page for additional comments about often-prescribed exercises such as stretching, Kegels, yoga, etc, which do not contribute to vaginismus resolution, as well as Vaginismus, Vagina, Exercising post.

Clinicians who treat vaginismus include gynecologists, pelvic floor physical therapists, psychotherapists, sexual counselors, sex therapists, and clinical sexologists.

To each their own sexual medicine knowledge, methodology, experience, and statistical outcome. Make sure to explore it with them in order to find the right resource for you.

Our expert vaginismus practice has been in operation since 1996, with thousands of cases cured. On this page you can find information about our treatment options, why choose us, our DiRoss Methodology, outcome statistics, and testimonials.

Contact us for further information or to speak with us directly.

Typically, NO.

The presence of a hymen does not cause vaginismus but may restrict or limit vaginal access. Women with an intact hymen but without vaginismus will present in a whole different way than a woman with vaginismus. Read our blog post on vaginismus and hymen.

It is common to group vaginismus, vulvodynia, and vulvar vestibulitis into one and it takes a proficient clinician to know the difference.

  • Vulvodynia refers to symptoms in the vulva, which is the area of the female genitalia when one separates the outer lips (labia majora);

  • Vulvar vestibulitis refers to symptoms in the vestibule, which is the small area surrounding the vaginal opening;

  • Vaginismus is the inability to have vaginal penetration/s, or the severe duress she experiences when having vaginal penetration/s.

Women with vulvodynia or vulvar vestibulitis often feel they have a swollen vestibule yet they can have vaginal penetration/s.  However, the associated pain/burning/discomfort complicate matters, making them avoid any contact or penetration.  Such reluctance may easily escalate – due to a psychosomatic reaction – into becoming vaginismus.

Unfortunately, vaginismus remains an elusive diagnosis while (vulvar) vestibulitis has become the (quick) answer to vulvogenital problems.

Is the Q-tip Test Efficient for Diagnosing Vaginismus, Vulvodynia, or Vulvar Vestibulitis?

Having sex can mean different things to different people, so let’s crystalize it:

  • Sex can be penetrative, i.e. vaginal intercourse, anal sex;

  • Sex can be non-penetrative, i.e. manual, oral, rubbing, virtual, etc.;

  • Sex can be self-masturbation, with or without vaginal penetration with a finger or a sex toy;

Women with vaginismus can lead a satisfying, healthy sexual life that includes all of the above with the exception of vaginal intercourse, which may be either impossible, or possible but with great duress.

Note: you can get pregnant from non-penetrative sexual activity if the man ejaculates by your genital lips during the week leading to ovulation! See our entry about that, below

We regularly hear from women with vaginismus comments such as “I lost my sex drive because of vaginismus… I am no longer interested… I used to love fooling around but it is all gone since I cannot have intercourse… I feel bad for him but I would rather not engage at all.”

This sexual desire shutdown stems from how the woman feels about herself and her sexuality, and not from the vagina itself:

  • Her feeling inadequate, broken, not a ‘real woman;’

  • Her worry that the partner will ‘try to slip into my tight vagina;’

  • Engaging sexually reminds her of the vaginismus in a sad, victimized way;

  • Who wants to engage if pain is inevitable? Why suffer?

With this shutdown, comes another question: “Will I ever regain my sexual interest?” The answer is a positive YES once you no longer feel ‘defective,’ that happens when you befriend your vagina and can use it as wished, and without pain.

Women with vaginismus often find themselves negotiating relationships:

  • Will he stay with me despite my inability to have sexual intercourse?

  • Should I refrain from dating altogether because I am not ready for a real’ relationship?

  • Should I stay with a partner whom I do not like just because he  ‘accepts me and my vaginismus?’

Compromising is synonymous with vaginismus and may even lead to staying in a distressing or abusive relationship just because the woman feels so worthless and defective.  We had patients who opted not to date, patients who stopped dating altogether, a few who dated unavailable (married) men, and we recall one who chose to date a paraplegic because he could not attain an erection…

Furthermore, once cured, several patients told us that they could not leave the (undesired) partner because they feel indebted to them for enduring the vaginismus all that time.  In other words, these women are now liberated from vaginismus yet trapped in guilt and in an undesired relationship… This is so sad because not only is there a cure for vaginismus, but also because there is no need to allow guilt to take over: vaginismus is a medical condition, and your partner could have left the relationship if he wanted!

Ladies, hold your head up and seek a suitable treatment so that you can start a fresh and positive page in life.

How Can the Male Partner Help with Vaginismus?

The male partner can play different roles with vaginismus, including

  • Educate himself about the condition;

  • Provide emotional support;

  • Do a research for solutions;

  • Network for treatment options;

  • Support her efforts to find a solution;

  • Strategize financial support for intervention;

  • Cheer her on as she works hard to overcome this condition;

  • Recognize that vaginismus may affect his sexuality as well, but that it is temporary only until she is cured;

  • Develop a sexual repertoire that is agreeable to both.

DO NOT blame her for having vaginismus – she does not want it any more than you do!

What does religion have to do with vaginismus? Apparently, quite a bit.

  • Religions will often specify the nature and extent of intimate contact that is allowed prior to marriage;

  • Some religions spell out specific punishments for forbidden intimate acts;

  • Some religions define women’s sexual roles and duties and, at times, even mandate them!

  • Pregnancy outside of marriage may be punishable; a termination is rarely an option;

  • “Sex talk” is often limited or non-existent, leaving women to their own educational devices;

  • The presence of a hymen is essential; penetrations (i.e. tampon) are discouraged;

  • Guilt is a huge factor when a woman seeks to balance religious boundaries vs. free-will experimentation;

  • There is a common feeling of ‘my vaginismus will be resolved once I get married and can have a sexual relationship worry-free…’

And then there is the Big Switch: forbidden sexual contact prior to marriage, followed by the expectation/hope that so many hours after the wedding ceremony the woman can engage sexually in the most enjoyable, knowledgeable, self-assured way…

Vaginismus: The Story of a Jewish Orthodox Couple

Vaginismus: Massive Ignorance Within the Christian Church

Vaginismus Awareness Podcast (Marriage From a Christian Perspective)

Many women with vaginismus have questions about pregnancy and childbirth. We have written a post about vaginismus and pregnancyContact us if you have any questions on the subject!

We often receive inquiries from young women (ages 16 through 25 or so) who are seeking treatment for vaginismus but need parental assistance with finances, insurance, and travel logistics.  Sadly, many are reluctant to speak about it with their Mom for reasons such as:

  • I can’t talk about sex with Mom;

  • I don’t want her to think that I am having sex (which I don’t because of the vaginismus!);

  • I don’t want her to know that I am sexually active;

  • There is no talk about sex in our household;

  • She will be mad at me;

  • I don’t want Mom to tell everyone about my problem;

  • I am embarrassed to speak about it;

  • In my culture/religion, the vagina is saved for marriage and the husband;

  • Even if I tell Mom it is about not being able to use tampons or have a gynecologic exam, Mom will be thinking SEX…

  • Mom and I do not discuss intimate matters;

  • I don’t want to make Mom worried about me…

And so, many of these young ladies defer treatment for vaginismus to a later date when they are independent and have their own insurance, or married, or can drive, etc.  That is unfortunate because every day of living with the devastation of vaginismus adds a layer to the sadness and to feeling inadequate, or not worthy.

On occasion, though, we witness happy situations: mothers, and even fathers, who are open for discussion and who urge their daughter to seek the treatment, who help with Internet search about solutions, who are on driving duties to/from treatment sessions, who tell us that no amount of money is too high for curing their daughter, who cheer on and celebrate success. 

We vividly recall one Mom who drove her daughter to our office carrying a mysterious package.  When the session was over, the mother called everyone to the waiting room – her daughter included – and voila!  There was a beautifully decorated cake with a message, Hooray to Tampons!  Yes, her daughter was taught that day how to use tampons.  Tears were flowing, hugs were flying, all were happy.

And then there was the following email titled Thankful, received only few hours after their daughter and son-in-law departed back to their country having successfully completed our 2-week treatment for vaginismus:

Dear doctors,
We do not know how to even begin to thank you all for what you have done for our daughter and son-in-law. For what you have done for our whole family. You are such an answer to our prayers over the last 2 1/2 years.

As a mother, this journey with vaginismus has consumed my heart, breaking it every day that she endured this. I have spent many hours searching for help and information on her health issues. I found sites that shared the same problem but no answers. Just read many stories of women trying to find help. I saw my daughter put on her brave face and kept hope after each failed attempt of advice given, time and time again no one understood or really knew what was wrong.

I am overwhelmed with gratefulness to God for bringing my daughter to your web site last Sept. That day was the start on her true journey of health. Your “tell it like it is” approach made an huge impact on her moving up the appointment which was really crucial. Oh I’m so thankful!
You all brought light and healing in a frustrating and difficult situation.

A common suggestion that is given for the penetrative ‘pain’ is to apply Lidocaine, a numbing preparation, to the tip of the dilator to neutralize the adverse sensation upon insertion. Often, women are also instructed to use this anesthetic when transitioning to vaginal intercourse or even for ongoing intercourse.

A numbing cream sounds like a good, easy solution, right?

Unfortunately, we do not believe so because it does not address the underlying stress response, which is THE source/cause of the vaginismus. There is also a risk of becoming dependent on it, which does not lend to regular use of the healthy – albeit nervous – vagina.

Choose your options wisely. There is no reason to live with vaginismus.

Oh, had treating & curing vaginismus with a magic pill been the simple answer… Imagine the possibilities and the loud sigh of relief by so many women!

Vaginismus is a psychosomatic reactionary condition, which means that it is always anxiety-based. The only medication route that may be helpful, or needed, would be in those cases when the woman suffers from active Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Depression, and panic attacks. In those situations, when the condition/s negatively affect her everyday life beyond her vagina/sex, medication intervention will pave the way for overall gains, and will facilitate the treatment toward curing her vaginismus.

Medication for Vaginismus? was written by a former patient who was skeptical until she saw the truth.

Yes, we know about your anxiety — most patients are anxious before the first treatment session, including worries about pain and about what will actually happen during the treatment. The treatment process is challenging yet gradual as per each woman’s pace. There are never any physical restraining nor forcing of any sort – it is up to you to want to be treated and be cured.  Our treatment includes anxiety/panic management so rest assured we’ll make you feel empowered instead of frightened if you are willing to follow our instructions. Pain? Not really, and certainly not any worse that you’ve experienced before you came to us!  The anticipatory anxiety is much worse than anything your vagina will experience…

Absolutely. The treatment process is suitable to women who are single as well as to those who have a partner. It is about the woman and her body, not just about sex!

Your body is interested in restoring normalcy, and committing to the treatment regimen will ensure that you complete the process successfully. The dropout rate has to do with women who never came back past the first visit, or those who could not afford the treatment, etc. Click here to visit our Statistics link for further information.

It is quite simple: The 2-week program is for women with vaginismus who either

  • Live too far to come in for treatment on a weekly basis, or

  • Women with limited vacation time.

Women who live close enough to commute to our office — for vaginismus treatment and/or for any other treatment that we offer — are encouraged to opt for weekly sessions.

Not at all. It would be your choice to have him/her join you for the first session, and we will invite him/her to a later session if necessary.

That will be determined once we go through our in-depth evaluation and get a clear understanding of your needs. In other words, different ‘problems’ need different approaches and we will plan out your process as per your particular needs. Our intervention is focused and practical, ensuring that the process is as short as possible, yet solid and restorative. You will realize your progress because changes are expected from one session to the next. Generally speaking, it is rare for our patients to keep coming beyond 10-12 sessions unless they are in psychotherapy.

The treatment is practical, focused, short-term, and individualized. Therapeutic approaches may include any combination of hands-on intervention & pelvic floor rehabilitation, sex therapy, counseling, guidance in the areas of self-care and personal hygiene, urogynecologic/sexual care, patient and partner education, and complementary & alternative medicine. A typical session is approximately 50-55 minutes long, dedicated to one patient at a time. Read about insurance reimbursement.

Peyronie’s disease, a condition of uncertain cause, is characterized by forming a plaque (a hard lump) on the penis, causing it to bend during erection. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both the top and bottom, leading to indentation and shortening of the penis.

The condition is named for Francois de la Peyronie, a French surgeon who, in 1743, described a patient who had “rosary beads of scar tissue to cause an upward curvature of the penis during erection.”

Different treatment modalities have been tried over the years, none successful.  The newest advent (March 2010) is a drug by the name of Xiaflex – you may want to check it out.

Depending on the severity of the condition, the bend in the penis may make sexual intercourse difficult or even impossible:

  • The bend will make the penis “wider” at its tip (a bigger initial penetration) instead of straight and pointy, thus requiring more stretch by the vaginal opening, which is not always possible.
  • During penetration, the bend may rub against the urethra or the rectal canal (depending on the angle of the bend), causing great discomfort/pain to the woman.
  • When inside the vagina, the action of thrusting (the penis’ motion during intercourse) may pose a problem because of the odd shape of the penis and potential discomfort to the woman.
  • Typically, couples will seek a sexual position that will facilitate penile penetration. They may also need to modify penetration depth and intercourse duration to avoid further discomfort and distress to the woman.
  •  

Naturally, such sexual problems will disrupt the couple’s sexual intimacy and lead to lowered self-esteem in the man. Proper medical and mental management for the man are recommended, as is guidance to the woman who often “feels bad” for her partner and will accept vaginal pain/damage attempting penetration.

Vaginal health advocates avoiding injurious activities and emphasize the fundamental belief that “I have the right to say NO.” Unfortunately, women are often blamed for the failure to have penetration and are pressured to “house” the (bent) penis to accommodate the man and his needs.

And about vaginismus: a bent penis WILL NOT cause vaginismus. Vaginismus is about fear of penetration, not about being compassionate and understanding the man who suffers from Peyronie’s Disease. Even failed or painful penetration attempts should not provoke vaginismus, but rather the choice of saying NO to vaginal intercourse, limiting sexual intimacy to outercourse (non-penetrative sexual activities, i.e., oral sex, manual sex, etc.).

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 dysfunction, 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 team member Women's Therapy Center

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.

Subscribe to Our Blog

Loading
Receive updates from the Women’s Therapy Center blog in your inbox.