Vaginismus is the body’s automatic response to fear during vaginal penetration. When penetration is attempted, the vaginal muscles will stretch on their own. These unintentional muscle spasms occur when something like a penis, finger, tampon, or medical instrument tries to enter the vagina. Spasms can be mildly uncomfortable or very painful. There is no control over it. Women can sometimes experience vaginismus even if they have previously enjoyed painless sexual intercourse. Vaginismus doesn’t necessarily affect your ability to enjoy arousal and other types of sexual intercourse. Since it is difficult for women to talk about this issue, experts do not know exactly how many people have vaginismus.
There are two main types of vaginismus:
- Primary; This is when a woman has had pain every time something entered their vagina, including a penis (called penetrative sex), or when they’re never been able to insert anything into their vagina. It’s also called lifelong vaginismus.
- Secondary; This is when a woman has had sex without pain before, but then it becomes difficult or impossible. This is also called acquired vaginismus.
Painful sexual intercourse (dyspareunia) is usually the first sign of vaginismus. Pain only occurs with penetration. It usually goes away after withdrawal, but not always. Some women describe it as a burning sensation or a feeling like the penis “slams against the wall.” Women with vaginismus also feel very uncomfortable while wearing a tampon or performing a pelvic exam in the doctor’s office.
Other symptoms of vaginismus include:
- Inability to have penetrating sex or insert a tampon
- Fear of pain or sex
- loss of sexual desire
- These symptoms are involuntary, meaning a woman cannot control them without treatment.
The exact cause of vaginismus is unknown. It is often linked to anxiety or fear of sex. However, it is not always clear which comes first, vaginismus or anxiety. Some women have vaginismus in any situation and with any object. Others, only in certain situations, like with a partner, and not in others. Or it could be with sexual intercourse but not with tampons or during a medical examination. Other health problems, such as infections and dryness, can also cause painful intercourse. A doctor should be seen as soon as possible to find out what is causing it.
Your healthcare provider will want to know about your symptoms and your medical and sexual history. A pelvic exam can help rule out other problems or confirm the presence of muscle spasms. Your provider may apply a topical numbing cream to the outside of the vagina before the exam to make the process more comfortable for you.
Dyspareunia is the medical term for painful sexual intercourse. It’s often confused with vaginismus. However, dyspareunia could be due to:
- Pelvic inflammatory disease
- Vaginal atrophy
These problems can cause symptoms similar to vaginismus:
- Vaginal atrophy: Lack of estrogen after menopause makes the lining of the vagina thinner and drier (vaginal atrophy).
- Vulvar vestibulitis (provoked vestibulodynia): This condition causes painful sex (dyspareunia). People may have pain from initial penetration throughout the entire experience.
Vaginismus treatments focus on reducing the reflex of your muscles that causes them to tense up. Treatments also address anxieties or fears that contribute to vaginismus.
The healthcare provider may recommend one or more of these treatments:
- Topical therapy: Topical lidocaine or compounded creams may help with the pain associated with this condition.
- Pelvic floor physical therapy: A physical therapist will teach you how to relax your pelvic floor muscles.
- Vaginal dilator therapy: Vaginal dilators are tube-shaped devices that come in various sizes. Their primary purpose is to stretch the vagina. People with vaginismus use dilators to become more comfortable with, and less sensitive to, vaginal penetration. Your provider may recommend first applying a topical numbing cream to the outside of the vagina to make insertion easier.
- Cognitive behavioral therapy (CBT): CBT helps you understand how your thoughts affect your emotions and behaviors. It’s an effective treatment for anxiety, depression and post-traumatic stress disorder (PTSD).
- Sex therapy: Trained sex therapists work with individuals and couples to help them find pleasure again in their sexual relationships.
Women with vaginismus must do exercises at home to learn to control and relax the muscles around their vagina. This is called progressive desensitization, and the idea is to get comfortable with insertion. First, do Kegel exercises by squeezing the same muscles you use to stop the flow when you’re peeing:
- Squeeze the muscles.
- Hold them for 2 to 10 seconds.
- Relax the muscles.
- Do about 20 Kegels at a time. You can do them as many times a day as you want to.
After a few days, insert one finger, up to about the first knuckle joint, inside your vagina while doing the exercises. You might want to clip your fingernails first and use a lubricating jelly. Or do the exercises in a bathtub, where water is a natural lubricant.
Start with one finger and work your way up to three. You’ll feel your vagina’s muscles clenching around your finger, and you can always take your finger out if you’re not comfortable. After a while, you’ll be able to put cone-shaped inserts into your vagina for 10 or 15 minutes to help your muscles get used to pressure. For women whose vaginismus is linked to fear or anxiety, therapy often helps.
Living With Vaginismus
- Sexual dysfunction can take a toll on relationships. Being proactive and getting treatment can be crucial in saving a marriage or relationship.
- It’s important to remember that there’s nothing to be ashamed of. Talking with your partner about your feelings and fears about intercourse may help you feel more relaxed.
- Your doctor or therapist can provide you with ways to overcome vaginismus. Many people recover and go on to live happy sexual lives.
- Scheduling treatment sessions with a sex therapist may be beneficial. Using lubrication or certain sexual positions can help make sexual intercourse more comfortable.
- Experiment and find out what works for you and your partner.