Vaginismus: Causes, Symptoms & Treatment

Vaginismus is an involuntary tightening of the muscles around the vagina in response to vaginal penetration during sex, a pelvic exam, or with a tampon. This unconscious spasming of muscles can result in mild to severe pain during penetration and sex often becomes impossible. There are several forms of vaginismus, and symptoms can vary from person to person. 

The good news is that vaginismus is treatable, with research showing that over 80% of women suffering from vaginismus enjoy pain-free penetration and sex after treatment has been completed. 

Join us as we discuss the causes of vaginismus, the symptoms, and what you can do to treat it successfully. 

Vaginismus Explained

Described as an unconscious spasming of the vaginal and pelvic muscles at the prospect of vaginal penetration, vaginismus is typically triggered by physical pain or a psychological expectation of pain. 

Emotional trauma, physical ailments, or a combination of both, are typically at the base of this condition, where the mind essentially believes that vaginal penetration will hurt. In response to attempted penetration, the brain, therefore, sends signals to the vaginal and pelvic muscles to tighten in protection mode.  

While statistics indicate that vaginismus affects approximately 7% of women, pelvic health experts believe the number to be far higher due to an under-reporting of symptoms. Although anxiety, pain, stress, and relationship issues can cause vaginismus, the condition often causes more of the same if left untreated. 

Common Symptoms of Vaginismus

Although symptoms of vaginismus can vary from one woman to another, the most common symptom is an inability to have sex without pain (dyspareunia). 

While women with vaginismus can still become sexually aroused, it is the act of penetration that typically instigates vaginal tightness, discomfort, or pain. As a consequence, the same discomfort is often experienced when inserting a tampon or undergoing a gynecological exam. 

The pain or discomfort felt upon penetration can range from mild to severe and often manifests as a stinging or burning feeling during intercourse.  

What Causes Vaginismus? 

Although the sensation of vaginismus can seem as if the vagina is too small for intercourse or penetration, this is not the case. The cause of vaginismus is an unconscious tightening of the muscles in and around the vagina, generally including the pelvic floor muscles. 

This involuntary spasming of the muscles is typically linked to an underlying fear that is caused by either emotional or physical triggers.  

Emotional triggers can include:

• Fear of pain during sex or pregnancy due to lack of sexual education
• Performance anxiety 
• Negative beliefs or perceptions of sex
• Fear of sex due to previous sexual abuse or rape 
• Worry that the vagina is too small
• Fear of intercourse due to exposure to sexually explicit images as a child
• Stress 
• Lack of trust in a partner due to emotional or physical abuse
• Other relationship issues that are non-related to sex  

Physical triggers of vaginismus can include:

• Discomfort from vaginal infections like a UTI or yeast infections
• Pelvic conditions, injuries, or surgeries
• Lack of sexual arousal
• Childbirth
• Menopause symptoms like vaginal dryness
• Chronic pain conditions like endometriosis or lichen sclerosis
• Side effects of medication
• Cervical or uterine cancer  

Different Types of Vaginismus

Under the umbrella of vaginismus, there are four different categories, each of which are explained below. 

Primary Vaginismus

With this type of vaginismus, muscle spasms around the vagina typically begin as a teenager when trying to insert a tampon or have intercourse for the first time.  When a gynecologist attempts a pelvic exam to understand the cause, inserting a gynecological instrument or ultrasound wand would also prove uncomfortable for the patient. 

Having sex with primary vaginismus is often impossible and commonly described by patients as if a wall at the vaginal opening prevents the penis from entering.  

Secondary Vaginismus

This form is diagnosed when women who have previously experienced enjoyable sex begin to notice vaginal tightness, discomfort, or pain during penetration. The onset of secondary vaginismus is normally the consequence of an emotional trauma, physical injury, or a medical condition. 

A difficult childbirth could cause secondary vaginismus, for example, as could a pelvic injury, vaginal infection, pelvic surgery, or vaginal dryness during menopause. Emotional trauma that can cause secondary vaginismus include sexual abuse, rape, rough sex, or witnessing sexual abuse. In some cases, both physical pain and emotional trauma can be the cause of secondary vaginismus.   

Global vaginismus, which can be categorized as primary or secondary, is diagnosed when pain is experienced with any form of penetration. 

Situational vaginismus, which can also be categorized as primary or secondary, is when pain only occurs during certain types of penetration. In these cases, women may be able to insert a tampon but could find it impossible to have sex. 

How to Treat Vaginismus?

Treating vaginismus not only centers around treating the pain but also the psychological or emotional connection to the fear or anxiety behind the pain.  

Treat the Cause of the Pain

The first line of treatment for vaginismus is to identify the cause of the pain and treat it. Antibiotics would treat a vaginal infection, for instance, surgery may be required to fix a pelvic injury or personal lubricant & hormone therapy could be diagnosed to alleviate vaginal dryness. If the underlying cause of vaginismus is an emotional trigger such as previous sexual abuse or rape, a therapist or counselor would be recommended to treat the emotional pain.  

That said, even though the pain from a physical or emotional trigger might be relieved, a lingering fear of the pain can still cause the vaginal muscles to tighten upon future penetration. To treat the psychological connection behind the involuntary spasming associated with vaginismus, progressive desensitization is the most highly recommended treatment.  

Progressive Desensitization

Progressive desensitization is a slow and gradual process that gently eases women recovering from vaginismus toward comfortable penetration and sex. This form of therapy encourages patients to use relaxing breathing techniques as they gently touch the area around the vaginal opening.

Once this feels comfortable and pain-free, patients are encouraged to softly explore the outer vaginal lips until such time that the vaginal opening is relaxed enough to insert a finger. From this point, women with vaginismus are encouraged to begin using a set of vaginal dilators (also known as vaginal trainers). 

Vaginal Dilators 

Vaginal dilators are tube-shaped medical devices that are normally sold in sets of progressively increasing sizes, usually ranging from that of a female pinkie finger to the average size of an erect penis. After initial guidance from a pelvic physical therapist or gynecologist, vaginismus patients are encouraged to begin by inserting the smallest dilator into the vaginal opening with a generous amount of lubricant.  

Practicing for 5-10 minutes per day, it could take a few days or a few weeks to comfortably insert the smallest dilator for vaginismus patients. As soon as it can be fully inserted pain-free, the patient moves to the next size dilator, and so on, allowing the vaginal muscles to slowly and gradually adjust to the feeling of penetration. 

Once the dilator that matches the size of one’s partner can be comfortably inserted and left in place for 5-15 minutes, vaginismus patients are normally ready to try some foreplay with their partner and gradually build confidence toward penile or digital penetration and intercourse.  

Kegel Exercises 

As well as progressive desensitization therapy, women with vaginismus can learn to improve the control of their pelvic floor muscles and vaginal muscles by regularly practicing  reverse Kegel exercises and in some cases, kegel exercises themselves.

Through this type of exercise, vaginismus patients can adjust to the feeling of contracting and fully relaxing the muscles used for penetration and intercourse. Knowing what this feels like can help women with vaginismus to relax these important muscles during sex. It is important to not that high volumes of kegels are generally not recommended for this population. 

Therapy & Counseling

When vaginismus is caused by sexual trauma, stress, worry, or anxiety, a form of therapy or counseling is highly recommended. Speaking openly with a professional can often help vaginismus patients understand that they are not to blame or at fault, and with some healing therapy, they can begin to, or re-learn how to, enjoy intimacy with their partner. 

Surgery 

In rare cases, when abnormal tissue growth or scar tissue after pelvic surgery is found to be the cause of vaginismus, surgery is sometimes necessary to remove the obstructing tissue. 

Conclusion

Vaginismus is a painful condition that occurs when the vaginal and pelvic floor muscles involuntarily tighten at the point of penetration with a finger, tampon, gynecological instrument, or penis. The underlying cause is either physical pain, a psychological fear that penetration will cause pain, or both.  

The good news is vaginismus can be treated successfully. This is typically done by identifying and treating the cause of physical pain, addressing the source of the psychological fear of pain, and using progressive desensitization therapy with vaginal dilators to re-adjust to the sensation of comfortable vaginal penetration.  

References 

The American College of Gynecologists and Obstetricians - When Sex is Painful - https://www.acog.org/womens-health/faqs/when-sex-is-painful

Mayo Clinic – Dyspareunia - https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967

Vaginismus Center – Causes of Vaginismus - https://www.vaginismus-center.com/en/causes-of-vaginismus

National Library of Medicine - Effects of predisposing factors on the success and treatment period in vaginismus - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169926/

National Library of Medicine - Vaginismus Treatment: Clinical Trials Follow Up 241 Patients - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440634/

National Library of Medicine - Is "Dilator Use" More Effective Than "Finger Use" in Exposure Therapy in Vaginismus Treatment? - https://pubmed.ncbi.nlm.nih.gov/32052704/