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Understanding and Treating Vaginismus

Understanding and Treating Vaginismus

Painful sex is often a woman’s first indication she has vaginismus. Some women describe penetration as feeling as if their vagina is tearing or like their partner hits an impenetrable wall. The number of women who currently experience vaginismus is unknown, because those who suffer are often afraid to talk to their health care providers about what they’re experiencing. If you experience vaginal pain with intercourse, tampon insertion, or gynecological exam, there’s help.

Vaginismus Facts

Vaginismus describes the vaginal pain that often keeps women from experiencing successful vaginal intercourse. There are several different forms, and women often describe their symptoms differently. Pain ranges from mild to extreme and presents sensations that vary from person to person. Vaginismus is classified into the following categories:

  • Primary vaginismus. Women report they experienced pain with penetration for as long as they remember. They may not discover it until the first time they attempt intercourse and feel like their vaginal opening becomes a wall.
  • Secondary vaginismus. Individuals say they once experienced penetration without pain, but now exhibit symptoms. Often an infection, menopause, childbirth, or trauma causes the change.
  • Global vaginismus. Pain occurs no matter what object attempts penetration. Whether it’s a penis, a tampon, or a speculum, it hurts.
  • Situational vaginismus. Only certain types of penetration cause pain. A woman may be able to use tampons but not experience intercourse.

Vaginismus is one of the main causes of unconsummated marriages. It can stem from medical conditions, emotional concerns, or a mix of both. The good news is vaginismus is curable in almost all cases. Physicians and mental health professionals treat symptoms with emotional and physical therapies to allow the patient to enjoy activities they once experienced only with extreme pain.

Vaginismus Causes

Doctors aren’t sure what causes vaginismus, perhaps because there can be such a wide range of contributing factors. The condition impacts functioning of the pubococcygeus (PC) muscles. Both genders have these muscle groups that stretch from the tailbone to the floor of their pelvic region. The muscles are involved in urination, bowel movements, vaginal delivery, sexual intercourse, and orgasm.

With vaginismus, women realize they are about to experience penetration and the body anticipates pain, tightening PC muscles. The tightening makes penetration difficult, and continued attempts to force it cause actual pain. The sensations reinforce the idea there was something to be feared, so next time the body’s response is even more intense. Women develop a fear of penetration that becomes more severe with time.

These emotional causes can trigger fear of penetration:

  • Worry they might become pregnant
  • Guilt over participating in intercourse
  • Performance anxiety
  • Having sex with an abusive partner or feeling emotionally unsafe
  • Past trauma like rape or physical abuse
  • An upbringing that either associated sex with shame or contained premature exposure to sexual activity and images

Vaginismus can also be caused by these physical conditions:

  • Urinary tract or yeast infections
  • Endometriosis
  • Pelvic inflammatory disease
  • Cancer or other diseases that make intercourse painful
  • Childbirth experiences that make sex painful, such as an episiotomy that is slow to heal or an extremely painful delivery
  • Vaginal dryness, vaginal atrophy, and other symptoms caused by menopause
  • A lack of foreplay
  • Side effects of prescription medication

For many women, physical and emotional issues create sexual dysfunction. Even after women resolve physical issues, the fear of painful penetration can cause the anxiety to linger.

It’s Not Your Fault

Women often feel shame and embarrassment when they can’t participate normally in sex. Their feelings can keep them from seeking the medical help that makes all the difference. They may try everything they can think of to relax, to ignore their feelings of anxiety only to experience pain again and again. They can feel like a failure when it comes to intimate relationships when the condition isn’t their fault.

Once vaginismus is triggered, the reaction is involuntary. Deciding to relax or work up enough willpower to make it stop is extremely difficult to do. However, with treatment, women can process emotional responses and heal physical conditions to experience pain-free sex.

Vaginismus Diagnosis

When a woman suspects she has vaginismus, the first step is finding a physician familiar with the condition. It can be uncomfortable to talk about what you’re experiencing, but a physician who has successfully treated other women asks compassionate questions to help you express what you feel.

Doctors will evaluate your physical condition to identify contributing factors and rule out other causes. There is no medical test to confirm vaginismus, but qualified physicians diagnose it by gathering your medical history and conducting a gynecological exam.

Vaginismus Treatment

Studies show when women seek treatment for vaginismus, treatment is successful almost 100 percent of the time. Therapy is not invasive and usually doesn’t require drugs or surgery outside of what is necessary for resolving physical issues.

Much of the treatment for vaginismus can occur at home, allowing you privacy and the ability to progress at whatever pace is comfortable for you. It often involves a combination of the following:

  • It helps to understand what different muscle groups are involved in sexual response, so you can evaluate and identify what your body does during intercourse. Topics include conditioned responses, sexual anatomy function, distinguishing normal discomfort, and physical changes caused by arousal.
  • Pelvic floor exercises. Kegels and other muscle contraction activities can increase your control over the muscle groups involved.
  • Insertion training. With guidance, plastic dilators can help you gradually become more comfortable with penetration.
  • Emotional therapy. If something from your past causes you to react negatively to penetration, identifying contributors can help you heal.

Women typically overcome the symptoms of vaginismus within a reasonable time and can enjoy sex with no pain or discomfort. Couples often report their relationship is transformed and the results last a lifetime, but vaginismus only goes away with treatment. Putting off treatment might cause the condition to get worse, take longer to cure, and increase the strength of muscular contraction upon penetration.

At Charlotte Center for Pelvic Health, each staff member makes it a goal to provide compassionate care for the issues affecting women’s health. If you suffer from issues that keep you from enjoying normal sexual intercourse, schedule an appointment to talk with one of our experts today.




Dr. John Hettiarachchi, FACS FPMRS

Dr. John Hettiarachchi, FACS FPMRS