What Is Vaginismus?

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on November 19, 2017Written by Jaime Herndon on August 7, 2012

Overview

For some women, the vaginal muscles involuntarily or persistently contract when they attempt vaginal penetration. This is called vaginismus. The contractions can prevent sexual intercourse or make it very painful.

This can happen:

  • as the partner attempts penetration
  • when a woman inserts a tampon
  • when a woman is touched near the vaginal area

Vaginismus doesn’t interfere with sexual arousal, but it can prevent penetration.

A gentle pelvic exam typically shows no cause of the contractions. No physical abnormalities contribute to the condition.

Sexual dysfunction can occur in both males and females and can usually be treated. It’s not your fault, and it’s nothing to be ashamed of. Nevertheless, these disorders can interfere with your relationships and your quality of life.

Experts don’t know exactly how many women suffer from vaginismus, but the condition is considered to be uncommon.

Types of vaginismus

Vaginismus is classified into two types:

  • primary vaginismus: when vaginal penetration has never been achieved
  • secondary vaginismus: when vaginal penetration was once achieved, but is no longer possible, potentially due to factors such as gynecologic surgery, trauma, or radiation

Some women develop vaginismus after menopause. When estrogen levels drop, a lack of vaginal lubrication and elasticity makes intercourse painful, stressful, or impossible. This can lead to vaginismus in some women.

Dyspareunia

Dyspareunia is the medical term for painful sexual intercourse. It’s often confused with vaginismus, but dyspareunia could be due to cysts, pelvic inflammatory disease, or vaginal atrophy.

Causes of vaginismus

There’s not always a reason for vaginismus. The condition has been linked to past sexual abuse or trauma, past painful intercourse, and emotional factors. In some cases, no direct cause can be found.

To make a diagnosis, your doctor will do a physical exam and ask about your medical and sexual history. These histories can help give clues to the underlying cause of the contractions.

Symptoms of vaginismus

Involuntary tightening of the vaginal muscles is the primary symptom of vaginismus, but the severity of the condition varies between women. In all cases, constriction of the vagina makes penetration difficult or impossible. If you have vaginismus, you can’t control or stop the contractions of your vaginal muscles.

Vaginismus can have additional symptoms, including fear of vaginal penetration and decreased sexual desire related to penetration. Women with vaginismus often report a burning or stinging pain when anything is inserted into the vagina.

If you have vaginismus, it doesn’t mean that you’ll stop enjoying sexual activities altogether. Women who have the condition can still feel and crave sexual pleasure, and have orgasms. Many sexual activities don’t involve penetration, including oral sex, massage, and masturbation.

Diagnosis of vaginismus

Diagnosis of vaginismus usually begins with describing your symptoms. Your doctor will likely ask when you first noticed a problem, how often it occurs, and what seems to trigger it. Typically, your doctor will also ask about your sexual history, which may include questions about whether you’ve ever experienced sexual trauma or abuse. In general, diagnosis and treatment of vaginismus requires a pelvic exam.

It's common for women with vaginismus to be nervous or fearful about pelvic exams. If your doctor recommends a pelvic exam, you can discuss ways to make the exam as comfortable as possible for you. Some women prefer not to use stirrups, and to try different physical positions for the exam. You may feel more at ease if you can use a mirror to see what your doctor is doing.

When a doctor suspects vaginismus, they will generally perform the exam as gently as they can. They may suggest that you help guide their hand or medical instruments into your vagina to make penetration easier. You can ask your doctor to explain every step of the exam to you as they go along.

During the exam, your doctor will look for any sign of infection or scarring. In vaginismus, there is no physical reason for the vaginal muscles to contract. That means, if you have vaginismus, your doctor won’t find another cause for your symptoms.

Treatment options for vaginismus

Vaginismus is a treatable disorder. Treatment usually includes education, counseling, and exercises.

Sex therapy and counseling

Education typically involves learning about your anatomy and what happens during sexual arousal and intercourse. You’ll get information about the muscles involved in vaginismus too. This can help you understand how the parts of the body work and how your body is responding.

Counseling may involve you alone or with your partner. Working with a counselor who specializes in sexual disorders may be helpful. Relaxation techniques and hypnosis may also promote relaxation and help you feel more comfortable with intercourse.

Vaginal dilators

Your doctor or counselor may recommend learning to use vaginal dilators under the supervision of a professional.

Place the cone-shaped dilators in your vagina. The dilators will get progressively bigger. This helps the vaginal muscles stretch and become flexible. To increase intimacy, have your partner help you insert the dilators. After completing the course of treatment with a set of dilators, you and your partner can try to have intercourse again.

Kegel exercises

To perform Kegel exercises, repeatedly tighten and relax your pelvic floor muscles, which control your vagina, rectum, and bladder.

You can locate these muscles when you’re urinating. After you begin to urinate, stop the stream. You’re using your pelvic floor muscles to do this. You may feel them tighten and move. These muscles move as a group, so they all contract and relax at the same time.

Practicing these exercises helps you control when your muscles contract and relax. Follow these steps:

  1. Empty your bladder.
  2. Contract your pelvic floor muscles, and count to 10.
  3. Relax your muscles, and count to 10.
  4. Repeat this cycle 10 times, three times a day.

To successfully strengthen your pelvic floor muscles, don’t engage the muscles of your abdomen, buttocks, or thighs when doing these exercises.

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.

Treatment 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.

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