What is Vaginismus? Symptoms, causes & treatments explained

What is vaginismus?

Vaginismus was first coined as a term in 1862 by Marion Sims, an American Gynaecologist¹. 

It is an involuntary (meaning you have no control over it) reaction of the vagina, with the muscles tightening in response to any form of penetration. This can be before penetrative sex, while inserting a tampon/finger or during a pelvic examination².

Vaginismus can either be classified as primary or secondary. When penetration has never been achieved it is considered primary vaginismus. If penetration was once successful, however, is no longer possible, it is called secondary vaginismus². 

How common is vaginismus?

The prevalence of vaginismus is not exactly known but studies have estimated it can affect anywhere between 5% to 76% of the population at some point in their life³. It is more common in women in their late teens to early 30s¹. Anyone with a vagina regardless of age, background or sexual orientation can experience vaginismus.

Vaginismus symptoms 

If you are asking yourself “What does vaginismus feel like”, see if you relate to any of these symptoms¹:

• Painful sexual intercourse 
• A burning or stinging sensation
• Inability to insert anything (tampon, finger, menstrual cup) into the vagina without tightening up 
• Inability to stop yourself from tensing 

During penetration it can feel like:

• “Hitting a brick wall” 
• “There is not enough space”

Vaginismus causes

There are multiple causes behind vaginismus, but sometimes the cause is not clear to the person or the medical professional. Vaginismus might be due to¹:

• Worries/anxiety around sexual intercourse
• Previous painful/traumatic sexual experience
• Sexual assault or abuse
• Birth trauma 
• Difficult gynaecological examination 
• The stigma around sexual intercourse being shameful/forbidden (for exmaple in strict religious upbringing)
• Vulvodynia

Vaginismus diagnosis

If you are struggling with the symptoms of vaginismus, the first step is to speak to a medical professional. They will ask you about symptoms and how they are impacting you. They might ask if they can examine you, but if this brings you too much anxiety, you can decline. If you feel more comfortable, you can ask for a female professional and have a safe companion with you during the consultation. The doctor will also ask about any other medical conditions you have and rule out any other conditions which could be causing your symptoms¹. 

Once a diagnosis is made, your doctor can refer you to a specialist who can offer you a treatment plan to work through the vaginismus. 

How to treat vaginismus

Vaginismus treatment requires patience and expertise. We recommend pelvic floor physiotherapists as the experts in treating vaginismus, alongside coaching from either a women’s health coach or sex coach to work with you over your treatment plan. Treatment may take some time, but studies have shown around 80% of people will be able to have penetrative sex after treatment.⁴

Pelvic floor and breathing exercises

Pelvic floor exercises are squeezing and releasing movements of the muscles which support your vagina and other organs in your pelvis. If you do them properly and consistently, they can strengthen your vaginal muscles, and help them relax. Conducting breathing exercises, such as mindfulness, while partaking in sexual activities can also help you relax your vaginal muscles and achieve penetration¹.

Dilators 

Vaginismus dilators are tampon-shaped devices of varying sizes. Starting from the smallest size, the dilators are inserted into the vagina, gradually working up to the biggest size. The aim is to acclimatise the body to having something inserted into your vagina¹. 

Vibration therapy

Using external vibrators may be useful for vaginismus and is often supported by pelvic health physios. Vibration therapy is thought to desensitise the area from pain and help relax the muscles. Small trials are starting to look into the benefits of using vibrator therapy for vaginismus.⁵

Botox 

You might know botulinum neurotoxin, also known as botox, is used in cosmetic procedures to reduce wrinkle lines around the forehead and eyes. Botox blocks signals to muscles, preventing them from contracting. In vaginismus, this could reduce muscle spasm in the vagina, hopefully making penetration easier. It can also reduce sensation in the area, making sex less painful. Botox for vaginismus was first used as a treatment option in 1997⁶. 

Vaginismus therapy

This can either be psychosexual or psychological therapy. Psychosexual therapy aims to work through any negative feelings around your body and sex. This can be useful if you are scared to have sex or have a bad body image. Psychological therapy will help you break down traumatic events like sexual abuse or a difficult birth which is underlying your vaginismus². 

While these practices will be guided by a specialist team, they will need to be completed over time and at home. Sometimes, you can involve your sexual partner in these activities. 

Pregnancy with vaginismus

Due to the nature of vaginismus, it might lead to worries about infertility, however, there have been cases where pregnancy has been achieved with external ejaculation. 

Pregnancy can also aggravate any symptoms of vaginismus, especially if medical practitioners are not sensitive to the condition during examinations. If you are suffering from vaginismus and are pregnant, advocate for yourself and let your maternityl team know about your condition so work together to make yourself comfortable during your pregnancy journey⁷. 

Giving birth with vaginismus

Vaginal birth with vaginismus can be very scary due to the number of pelvic examinations needed to check how you are progressing through labour. A Swedish study found that people with vaginismus were more likely to request cesarean delivery. You have choices. If you are worried that vaginal delivery is not suitable for you, discuss the option of cesarean delivery with your maternity team. This is a surgical delivery of your baby, bypassing the vagina. You do not need to be in labour to be eligible for a cesarean delivery and this can be planned ahead of time⁸.  Otherwise, if you want to have a vaginal delivery, this is possible with support from your midwife and obstetrician, communication throughout your pregnancy is key.

Summary 

Vaginismus can be a daunting condition and might seem scary to talk about. It is important to remember there are compassionate and caring medical professionals who will listen and not belittle your experience, just like the doctors at the Lowdown. We will listen attentively and you can work with our pelvic physio and clinical sexologist to develop the right treatment plan for you.