What is Vaginismus?

In Latin, the suffix ‘-ismus’ implies a spasm or contraction. Therefore, vaginismus is an involuntary contraction of muscles around the vagina in response to penetration or fear of penetration. This can include sexual penetration, tampon insertion, finger insertion, and vaginal medical examinations.

In order for something to be inserted into the vagina, the muscles around the vagina need to be relaxed. For people with vaginismus, the muscles tighten up instead, closing the vaginal opening, and making insertion difficult and often painful.

Before we get into the different types of vaginismus, we have to differentiate it from dyspareunia and vulvodynia. Dyspareunia is pain during sex. Though it can include pain with penetration, it is often related to deeper pain and can have a number of different causes. Vulvodynia is a chronic pain syndrome of the vulvar area without an identifiable cause. These all fall within the Genito-pelvic pain/penetration disorder category, and though some of the symptoms overlap, it’s important to differentiate them because the type of treatment will depend on it.

The main symptoms of vaginismus according to the NHS are:

you find it hard inserting a tampon into your vagina
you struggle with vaginal penetration during sex
you feel burning or stinging pain during sex

Types of Vaginismus

Vaginismus can be categorized based on history and situation:

Primary vaginismus - This occurs in people who’ve never been able to tolerate any form of penetration.
Secondary vaginismus - This occurs in people who’ve previously experienced pain-free penetration. Sometimes childbirth, an infection, or a traumatic event (such as a sexual assault) could trigger secondary vaginismus.
Global, general, or total vaginismus - Pain or discomfort is felt whenever anything enters the vagina.
Situational vaginismus - The symptoms depend on which type of penetration is occurring. For example, pain can be severe during sex, but nonexistent during a vaginal examination.

Why does it happen?

Usually, the cause of vaginismus is unknown, but there are a number of different factors that can contribute to it. People who suffer from primary vaginismus are often young. Sometimes growing up in a conservative setting or believing that sex is shameful or wrong can cause anxiety and increase muscle tension. Alternatively, anxiety in general, a negative sexual experience, difficult childbirth, a prolonged infection, or vulvodynia can cause secondary vaginismus. It’s also possible for menopause to play a role. As estrogen levels decrease, the vaginal walls may become more sensitive and less pliable. This can make you tense up, the muscles may involuntarily contract, and penetration can become difficult to tolerate.

Sometimes after the first experience of pain, a fear of anticipated pain develops. That fear and anxiety cause muscles to reflexively become tense, leading to a vicious cycle of pain and tightening.

Getting Diagnosed

Exactly how many people suffer from vaginismus is unknown due to the sensitive nature of the issue. Many people are held back by fear or embarrassment and don’t seek help. But many benefit from treatment, so if you’re experiencing pain or discomfort, it’s worth opening up about it. If it helps, you can ask to be examined by a female doctor. First, the doctor will rule out any physical causes of your pain or discomfort and any organic pathology. Afterward, the doctor may refer you specialist such as a sex therapist who will perform a full psychosexual history. According to the British Medical Journal, “the degree of distress, anxiety, and self-reported interference with penetration is more central to the diagnosis than is muscle tone.”

Getting Treated

Generally, the treatment focuses on relaxing the muscles and decreasing anxiety and fear. Here is a list of possible treatments:

Psychosexual therapy - This is one type of talking therapy. The goal is to help you understand your feelings about sex.
Reverse Kegel Exercises - While Kegel exercises are meant to strengthen your pelvic floor muscles, reverse Kegel exercises will help you relax them. A pelvic floor physical therapist can guide you through squeezing and releasing exercises to help you gain control over your muscles.
Relaxation techniques - There are many strategies to help change how your brain works in relation to your vaginal muscles. Mindfulness, breathing, gentle touching exercises, sensate focus, or relaxation exercises during sex are some examples
Vaginal trainers - These are tampon-shaped objects in different sizes. By starting with a small size and gradually increasing, you can train your muscles to become less sensitive and to relax during penetration. Your doctor may recommend at-home vaginal dilators
Take it slow - If you are sexually active, both you and your partner need to be patient. Try different treatment options before attempting sex. Don’t rush into penetration, and use lots of lubricant when you do try. You can also try controlling the tempo yourself by holding the penis or penetrative object yourself so that you have control over its insertion.

If you’re experiencing any of these symptoms and think you might be suffering from vaginismus, we encourage you to seek help. Your doctor won’t force you to do anything you’re uncomfortable with, and just talking about it is a great start! It’s important to not self-diagnose yourself as there might be a treatable underlying reason or pathology that’s causing the pain. There’s no reason you shouldn’t have fulfilling penetrative sex, comfortably wear tampons, or get regular gynecological examinations without fear, anxiety, or pain.

Article written by

Dama Awadallah, Medical Doctor

Research assistant for the Mary S. Easton Center for Disease Research

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References :

https://www.nhs.uk/conditions/vaginismus/
https://www.bmj.com/content/338/bmj.b2284.long
https://www.health.com/condition/sexual-health/vaginismus