What is Vaginismus?

What is vaginismus?

In rare cases, some women may experience involuntary and persistent contractions of their vaginal muscles when they attempt to insert something into their vagina. It is called vaginismus and can occur when one partner is trying to penetrate the other, when a woman inserts a tampon, or when a lady gets touched in the genital region., e.g., during gynecologic exams. This is an unconscious reaction to the anticipated penetration of the vagina.

These muscle spasms then make it painful for anything to be inserted into the area. This can have detrimental effects on a person's physical and mental well-being.

The pain during sexual intercourse caused by vaginismus is medically termed dyspareunia. At least three out of four women have dyspareunia at some point.

Vaginismus is a female sexual dysfunction that may prevent penetration but doesn't interfere with sexual arousal from clitoral stimulation. There are treatments available to lessen the severity of vaginismus, allowing people to regain control, comfort, and pleasure.

Types of vaginismus

There are four identified classifications of vaginismus.

Primary vaginismus

• Also called lifelong vaginismus, spasming starts when an individual attempts to have sex or insert an object like a tampon into the vagina. This makes undergoing a gynaecological exam difficult. 

Secondary vaginismus

• This type of vaginismus develops after a person had already experienced the expected sexual function or when vaginal penetration is achieved with no pain but is no longer possible. It is potentially due to gynaecologic surgery, trauma, radiation, infection, menopause, a medical condition, or childbirth.

Global vaginismus

• Global vaginismus is characterised as either primary or secondary. This refers to cases when the symptoms occur in response to any vaginal penetration.

Situational vaginismus

• Situational vaginismus can also be either primary or secondary. The symptoms happen in reaction to some types of penetration (e.g. inserting a tampon or other menstrual product) but not others (penetrative sex).

Risk factors of vaginismus

Around one to six per cent of people experience vaginismus, but doctors consider it a relatively common condition. The condition can be underdiagnosed as many people having it are reluctant to discuss their symptoms with their health care provider (HCP).

Symptoms of vaginismus may appear when a woman tries to insert something into the vagina for the first time. This may be their first use of a tampon, during a pelvic exam or during their first moment of intercourse. However, some people may develop vaginismus later in life. 

People with libido/sexual arousal disorder are predisposed to experience vaginismus. In addition, communities known for their strict religious orthodoxy seem to have more cases of vaginismus. Still, these claims need to be validated by further research.

Learn more about vaginal health on our Women's Health Blog.

What causes vaginismus?

The exact reason why some women experience vaginismus remains obscure. Certain conditions aggravate vaginismus pain, including bladder infections, UTIs, and yeast infections. There is also the theory that vaginismus can be brought on by either physical or mental stress or a combination of the two. It can even become anticipatory, where its occurrence is due to the person expecting it to happen.

Physical triggers

• childbirth injuries, such as vaginal tears

• inadequate foreplay or insufficient vaginal lubrication

• infection, such as bladder infections, urinary tract infections, or yeast infections

• menopause

• prior surgery like pelvic surgery

• side effects from taking certain medications

Emotional triggers

Psychological factors such as negative feelings about sex are significant reasons vaginal penetration is sometimes hard to achieve. Such negative emotions can root from:

• Events that occurred throughout childhood, such as being exposed to sexual imagery or depictions of sex while growing up

• Apprehension (such as those caused by labour pains or pregnancy), anxiety over one's performance, or guilt

• Relationship issues, such as having an abusive spouse or feeling like a vulnerable person in the relationship

• Catastrophic life situations, including current or previous instances of sexual assault or abuse

While vaginismus is attributed to women, sexual problems can affect people of all genders. Treatments are available and can help overcome the symptoms.

Conditions that may be confused with vaginismus

Some symptoms of other types of conditions may feel like vaginismus. They include:

• infection (STI)

• vulvar vestibulitis (provoked vestibulodynia) - characterised by pain during sex or insertion of an object like a tampon. The pain usually occurs in the vulva and may happen from initial penetration throughout the entire experience.

Learn more about the most common STIs at Welzo.

Symptoms of vaginismus

Vaginismus symptoms vary between individuals and generally include the following:

• Difficult to impossible penetration

• Dyspareunia, with burning or stinging pain

• Generalised muscle spasm during attempted intercourse

• Persistent sexual discomfort, whether or not there is an identifiable cause

• Ache throughout the process of inserting the tampon

• A painful experience during the gynaecological exam

Pain can range from being hardly noticeable to excruciating and may also present as a burning feeling. There is no evidence that vaginismus prevents persons from experiencing sexual arousal; they can still experience an orgasm from clitoral stimulation.

Learn the signs and symptoms of a problem down there.

How is vaginismus diagnosed?

A doctor will typically begin the diagnosis of vaginismus by asking you to describe your symptoms and to answer questions such as:

• when you first observe a problem

• how frequently it happens

• and what appears to be the cause of it

Your health professional will also inquire about your medical and sexual history to know whether you've experienced sexual trauma or abuse. This may be accompanied by a physical pelvic exam.

It's not uncommon for many women with vaginismus to be nervous about pelvic exams. Still, they can discuss ways with their doctors to ensure that you have a test experience that is as stress-free as possible. Once recommended, the doctors perform the exam as gently as possible. To make the examination less uncomfortable for you, they may administer a topical numbing ointment to the exterior of the vagina before beginning the procedure.

Management and treatment of vaginismus

Vaginismus is a treatable disorder that may require assistance and guidance from medical professionals. This will depend on the underlying reason, but generally, vaginismus treatment includes education, counselling, and exercises. These exercises will focus on the muscles that tense up to reduce the reflexive tensing that occurs. Your doctor might suggest the following:

• Topical therapy - The discomfort associated with vaginismus may be alleviated with topical lidocaine or compounded creams.

• Physical treatment for the pelvic floor - You will learn how to relax with the help of a physical therapist and regain control of your pelvic floor muscles and encourage you to learn about deep relaxation techniques. Typical exercises include Kegel exercises.

• A vaginal dilator therapy - Vaginal dilators are tube-shaped devices with the primary purpose of stretching the vagina. Your doctor or counsellor may recommend learning to use vaginal dilators as supervised by a professional and with a topical numbing cream applied, which may lessen the pain and improve the insertion method.

• Cognitive behavioural therapy (CBT) trains you to analyse how you think, affecting your emotions and behaviours. 

• Progressive desensitization - is considered the most effective therapy for vaginismus. This method involves the individual gradually lessening the acute symptoms of vaginismus through the use of physical therapy. It may involve using the fingers or a product like a vaginal dilator to lessen the unease surrounding physical touch in the area around and in the vagina. It can also be beneficial to practise relaxation techniques. This is especially useful if you are aware of a trigger, such as anxiety or stress.

• Sex therapy and counselling - Trained sex therapists assist people with their relationship to intimacy and pleasure. A standard part of education is studying one's anatomy and the physiological processes during sexual arousal and interaction with others. This information can assist you in comprehending how the many components of the body work together, as well as how your body is reacting. This type of therapy may involve you alone or with your partner present. It's possible that working with a therapist who specialises in sexual issues might be beneficial. Hypnosis and other relaxation methods may also help promote relaxation and make you feel more at ease while interacting with others.

Other uncommon methods of managing vaginismus

• Botox – There is a possibility that Botox will improve the symptoms. However, to corroborate this assertion, further study is required.

• Pulsed radiofrequency (PRF) is a relatively recent therapy used to manage nerve pain. Only a small study has been done on this treatment, although it has shown promise for improvement.

• Surgery- This procedure is typically only required in exceptional circumstances, such as when an issue with the vagina produces symptoms similar to vaginismus.

What are the complications of vaginismus?

Vaginismus can negatively affect your sex life and relationships with your partner. It can affect your mental health, which can lead to increased anxiety. It may be difficult for those who want to get pregnant.

Does vaginismus lead to other health issues?

Vaginismus may root in anxiety disorders and lead to anxiety symptoms simultaneously, as people with vaginismus see themselves negatively. Generally, they carry a lot of pressure with the idea of penetration, which causes panic attacks in some people when engaging in intercourse.

Vaginismus impedes conception and increases fertility issues and caesarean section rates. People with vaginismus are also afraid of internal pelvic exams; thus, they are less likely to seek medical assistance. This puts them at risk for undetected conditions such as cervical cancer, STIs and more.

Living with vaginismus

Sexual dysfunction can influence sex life, relationships, and self-confidence negatively. It may seem impossible to be intimate when coping with a situation that stops you from appreciating and enjoying the penetration.

Communicating with your partner and doctor takes bravery, and treatment takes patience. Motivation and determination to learn about the condition and eventually acquire knowledge about its treatment can save a marriage or relationship.

Living with vaginismus can be a challenging experience. Still, it is essential to remember that you are not alone and that there are ways to manage and cope with the condition. Here are a few tips for living a fulfilling life with vaginismus:

1. Seek support: It is essential to have a supportive network of friends, family, and healthcare professionals who can provide emotional and practical support. Consider joining a support group or seeking therapy to help you live with vaginismus.

2. Educate yourself: Learning about vaginismus and how it affects the body can help you understand the condition and feel more in control. Be aware of the different treatment options and how they may help you manage your symptoms.

3. Practice self-care: Be mindful of your physical and mental health is essential for managing vaginismus. This might involve practising relaxation techniques, getting enough sleep, eating a healthy diet, and finding ways to manage stress.

4. Set realistic goals: It can be frustrating to deal with the challenges of vaginismus, but it is important to set realistic goals for yourself and be patient with your progress. Remember to celebrate small victories and to be kind to yourself.

5. Seek medical treatment: If you are experiencing discomfort or difficulty with sexual activity or other activities due to vaginismus, it is vital to seek medical treatment. Various treatment options, including physical therapy, medication, and counselling, can help you manage your symptoms and improve your quality of life.

Remember, living with vaginismus does not define you, and it is possible to live a fulfilling and enjoyable life despite the challenges. It is crucial to be proactive in managing your condition and to seek support and treatment when needed.

Final words

Your primary care physician or therapist should be able to provide you with treatment options for vaginismus. Many individuals make full recoveries and go on to lead healthy, sexually fulfilling lives. It may be worthwhile to schedule treatment sessions with a sex therapist and use lubrication or adjusted sexual positions for more comfortable sexual intercourse. Explore what works for you, your partner, and your relationship. You can regain control of your body and enjoy your private moments with your beloved partner again.

For more in-depth reading about vaginal infections and how to alleviate their symptoms, we encourage you to read thoroughly in our women's health hub by clicking this link.