Sex should be enjoyable, but vaginismus takes that pleasure away from some women. Vaginismus is an uncomfortable medical condition. The vaginal muscles involuntarily spasm during penetration. It can make sexual intercourse, gynecological exams, and tampon insertion difficult and painful.
It’s not as rare as you may think, either. Vaginismus may affect as many as one in 100 biological females. If sex is painful or a partner has described intercourse like “hitting a wall,” you may suffer from vaginismus.
Vaginismus may be a symptom of underlying psychological problems, a physical issue or a combination of the two.
This article will discuss the symptoms, causes, and treatments of vaginismus and similar conditions.
What’s in this article?
Vaginismus Symptoms
Vaginismus is vaginal muscle spasming that causes painful, even impossible, sexual intercourse. This can often have a negative influence on one’s quality of life. The symptoms can vary in presentation and intensity, from occasional mild distress to severe pain. It can even change depending on the woman, history of sexual experience, or what triggers it.
The symptoms of vaginismus that a woman may experience:
Minor discomfort
Total closure of the vagina resulting in impossible penetration
Vaginal spasm with penetration regardless of the object
Specific pain with tampon placement or sexual intercourse
Pain during the first attempt at sexual intercourse
Pain following a traumatizing episode or medical condition
Vaginismus Causes
There are many causes of vaginismus that range from emotional to physical. The major reasons include:
Sexual Assault
Lack of sexual education
Fear that your vagina cannot accommodate the object
A traumatizing sexual or childbirth experience
An unpleasant pelvic exam
The religious or moral belief that sex is shameful
Infection
A physical medical condition
Fear of pregnancy
Anxiety
Relationship problems
Menopause
Pelvic pain or surgery
Medications
Inadequate sexual arousal or lubrication
Studies have indicated that the emotional component may play an even bigger role than expected. Many women with vaginismus expressed feeling anxiety or anger directly before having sex.
What is my pelvic floor?
The pelvic floor is made up of muscles that support your bladder, uterus, and rectum. Like any muscle, they can be very tense or weak. Vaginismus can also occur when your pelvic floor is too rigid. Kegel exercises contract those pelvic floor muscles to become stronger. Other exercises focus on relaxation for those that are tense.
If your symptoms are not improving after tackling possible causes, your pelvic floor may be excessively tight and cause the spasming or painful sexual intercourse. Always seek an experienced clinician for guidance.
Global Vaginismus vs. Situational Vaginismus
Global vaginismus is when sexual dysfunction is always present, and ANY object in any situation where vaginal penetration occurs will trigger it. Situational vaginismus occurs in specific cases like only during intercourse, tampon introduction, or speculum insertion.
Primary Vaginismus vs. Secondary Vaginismus
Primary vaginismus occurs when a woman has never been able to experience vaginal penetration or sexual intercourse. The diagnosis typically occurs in one’s 20s to 30s upon attempted menstrual cup or tampon insertion, intercourse, or masturbation that is unsuccessful.
Secondary vaginismus is the inability to undergo vaginal penetration that occurs after one has experienced a healthy sex life. Secondary vaginismus occurs with changes in life like menopause, a traumatic event, injury, or infection. Women who suffer either type of condition are more likely to come from a conservative family background (70%) where they received no sex education.
Vaginismus Treatment
Regardless of the specific type of vaginismus, the management options remain the same. The treatment of vaginismus depends on the root problem. If the causes are physical, then the medical condition should be addressed. If the reason is psychological, then management of the emotional issues looks different.
You should start by seeking the help of a doctor or clinician experienced in the diagnosis of vaginismus.
Vaginismus is typically treated with a combination of exercises to encourage pelvic floor relaxation and counseling to correct underlying issues. The first step in healing vaginismus is to become educated in normal sexual anatomy. Next comes identifying, discussing, and resolving any emotional factors at play. The final step is reducing the sensitivity to vulvar touch or insertion.
Will vaginismus go away without treatment?
Usually not. Treatment options include a variety of options.
Treatment Options
Method
Psychosexual Therapy
Talk therapy aimed to help understand and adapt your feelings about sex
Relaxation
Mindfulness, breathing, and gentle touch to relax the vaginal muscles
Pelvic Floor Exercises
Kegel exercises, reverse Kegel exercises
Sensate Focus
Exercises to encourage relaxation during sex and to improve libido that increase interpersonal awareness of the self and other’s needs
Vaginal Dilators
Smooth oblong-shaped objects in various sizes to allow the gradual accommodation of an object inserted into the vagina
Does vaginismus require surgery?
Absolutely not. There are very few cases that require surgery.
Learn To Use Vaginal Dilators Safely
Vaginal dilators allow women to get used to vaginal penetration in the safety and privacy of their own homes. These tools encourage you to become accustomed to objects in and around the vagina. You start with a small vaginal dilator. The dilators move from very small to more substantial, based on comfort. They will gradually prepare your vagina for larger sizes.
How do you use vaginal dilators?
Create a relaxing environment in your bedroom or another safe space. Some prefer dimming the lights and lighting candles. Others prefer to put on calming music or use aromatherapy like a diffuser. Start by touching the vagina, then spreading the labia (vaginal lips). Once you are comfortable with that, you should introduce the vaginal dilators. Take some deep, calming breaths before you begin.
Lie on your back, in a comfortable position, with your feet flat and your knees bent.
Continue those breaths and relax your pelvic floor.
Spread your legs so they are shoulder-width apart. If this bothers you, use pillows to support your knees.
Make sure you can reach your vaginal opening. If needed, you can use a hand mirror or your phone on selfie mode to help you find it.
If consciously relaxing your pelvic floor muscles does not help, you can try Kegel exercises during the process.
Eventually, you retain the smallest dilator for a more extended period. As you increase the length of time, you can move up in size. Once you have moved to the largest dilator, your partner should attempt to insert the dilator. After that is successful, the partner should place the penis or toy near the vagina but not inside.
After vaginal training and partner exposure has been successful, the couple can try intercourse for a final time. It is crucial that you feel safe and relaxed throughout the process. It’s okay to take a break or stop if it starts to become uncomfortable. The timeline to success varies for each couple.
If you are unable to use the smallest vaginal dilator, you can request assistance from your healthcare provider or pelvic floor pelvic therapist. Additionally, some women will need a local anesthetic (a numbing agent) to use the vaginal trainer.
Tight Vagina – Is Your Vagina Too Tight?
A tight vagina does not exist, but your pelvic floor muscles can be very tight. In fact, during vaginismus, if the penis can enter the vagina at all, it may feel very tight. However, it is just the vaginal muscles spasming on the penis and is not enjoyable for the receiving partner.
If you are experiencing a tight pelvic floor, a pelvic floor physical therapist can work with you. You can also do reverse Kegel exercises where you relax your pelvic floor instead of contracting.
Loose Vagina – What Causes This?
Vaginas cannot be “too loose.” They can stretch to fit the birth of a baby. However, the pelvic floor muscles can become weak due to life changes like pregnancy, childbirth, aging, and weight gain.
Arm yourself with knowledge — vulvas come in all different shapes and sizes. Your vagina is beautiful the way it is! However, if the pelvic floor weakness is affecting your bladder control or sex life, you can exercise your muscles with Kegel exercises.
How To Tighten Up
If you suffer from vaginismus, it’s unlikely that you need to tighten anything further. As your vagina spasms around the penis, the muscle contractions may feel “tight.” However, if you do have true pelvic floor weakness, Kegel exercises will help. Since these same exercises will treat vaginismus, it is an excellent place to start.
Dyspareunia
Pain during intercourse is known as dyspareunia. The pain can occur at the vaginal opening, with every penetration, or during thrusting, and can vary between burning, aching, or throbbing pain. The reasons for dyspareunia are extensive:5
Vaginismus
Medications. You may be on a drug that has considerable benefits in other areas of your life, like depression or anxiety, allergies, blood pressure, sleep, or even birth control. Unfortunately, some of these mediations are known to decrease your sexual arousal or desire, which can make sex painful due to lack of lubrication.
Congenital. Some causes are anatomical. Sometimes a membrane (hymen) completely blocks the vaginal opening (imperforate hymen). Others are born without a fully formed vagina (vaginal agenesis).
Urinary or vulvar. Infection, inflammation, or a skin condition can cause discomfort in the vaginal area, such as a urinary tract infection or eczema.
Pelvic pain. Regardless of the origin, pelvic pain may also affect intercourse.
Surgery. Any surgery like a hysterectomy (removal of the uterus), episiotomy (cut during childbirth of the vaginal opening down into the muscle) or female circumcision can have long-lasting effects.
Hypertonic Pelvic Floor
Hypertonic means tense. A hypertonic pelvic floor is when the muscles are unable to relax. Unfortunately, tight pelvic floor muscles can cause constipation, straining, or incomplete emptying of the bowels, pelvic pain, painful sex (dyspareunia), and urinary urgency.
Relaxing your pelvic floor can be done mindfully. “Down-training” is a technique that targets relaxation or fatiguing the pelvic floor muscles. Try the following:
Relax: Play soft music. Ensure a warm environment.
Lie down: Lie on your back with a pillow under your knees for 20–30 minutes daily. You can use a warm pack over the lower abdomen area.
Breathing: Use yoga breathing known as diaphragmatic breathing. Take deep, slow breaths into your diaphragm.
Picture your pelvic floor muscles relaxing: You may benefit from visualizing a gradual warmth spreading through the region.
Progressively relax the different muscles from the top of your head to your feet. Contract each muscle and fully release it.
Scan your body for any areas of tension and focus on relaxing them.
Vaginismus and Pregnancy
Vaginismus can be a preexisting condition, or it can develop during pregnancy. You may wonder how someone who struggles with vaginismus may get pregnant. Some couples use the “splash method,” where they insert the tip of the penis as close as possible for ejaculation.
Unfortunately, women who suffer from vaginismus during pregnancy are more likely to avoid follow up with an OB provider due to fear and shame of cervical or pelvic exams.
Also, pregnancy is not the only uncomfortable situation for those who suffer from vaginismus. Vaginal childbirth can affect the vaginal tissue and surrounding muscles, particularly during the delivery of the baby’s head.
Conclusion
Sex is typically an enjoyable activity. Unfortunately, those with vaginismus are unable to experience a healthy sex life. If vaginismus is ruining your life, it’s time to address it. As you’ve read, there are many causes, and many low-intervention methods can address most situations.
However, if vaginismus continues to affect your life negatively, reach out to your healthcare provider sooner rather than later. You should not have to live this way.
Caitlin Goodwin MSN, CNM, RN is a Certified Nurse-Midwife of five years and a nurse for 12 years. As a mom and writer, she loves to educate folks about reproductive health.
