Vaginismus

Overview

What is vaginismus?

Vaginismus is the involuntary tensing or contracting of muscles around the vagina. The vagina is part of the female reproductive system. It connects the lower part of the uterus (cervix) to the outside of the body.

These unintentional muscle spasms occur when something — a penis, finger, tampon or medical instrument — attempts to penetrate the vagina. The spasms may be mildly uncomfortable or very painful.

How common is vaginismus?

Experts don’t know how many people have vaginismus. Many people may be too embarrassed to talk about the problem with their healthcare providers.

Who might get vaginismus?

Vaginismus symptoms may appear during the late teen years or early adulthood when a person has sex for the first time. The condition can also happen the first time a person tries to insert a tampon or has a pelvic exam at a healthcare provider’s office.

Some women develop vaginismus later in life. It can happen after years without any problems. Spasms or discomfort may occur anytime there’s vaginal penetration. Or you may have them only at certain times, such as during sex or pelvic exams.

Symptoms and Causes

What causes vaginismus?

Healthcare experts aren’t sure why some people experience vaginismus. It can cause physical, psychological and sexual issues. Bladder infections, UTIs and yeast infections can worsen vaginismus pain.

Factors that may contribute to vaginismus include:

  • Anxiety disorders.
  • Childbirth injuries, such as vaginal tears.
  • Prior surgery.
  • Fear of sex or negative feelings about sex, perhaps due to past sexual abuse, rape or trauma.

What conditions are similar to vaginismus?

These problems can cause symptoms similar to vaginismus:

  • Vaginal atrophy: Lack of estrogen after menopause makes the lining of the vagina thinner and drier (vaginal atrophy).
  • Vulvar vestibulitis (provoked vestibulodynia): This condition causes painful sex (dyspareunia). People may have pain from initial penetration throughout the entire experience.

What are the symptoms of vaginismus?

Signs of vaginismus include:

  • Discomfort or pain during vaginal penetration.
  • Inability to have sex or have a pelvic exam due to vaginal muscle spasms or pain.
  • Painful intercourse.

You should see a doctor if you have painful sex or pain while inserting a tampon. These feelings aren’t normal.

Diagnosis and Tests

How is vaginismus diagnosed?

Your healthcare provider will ask about your symptoms and your medical and sexual history. A pelvic exam can help rule out other problems or confirm the presence of muscle spasms. Your provider may apply a topical numbing cream to the outside of the vagina before the exam to make the process more comfortable for you.

Management and Treatment

How is vaginismus managed or treated?

Vaginismus treatments focus on reducing the reflex of your muscles that causes them to tense up. Treatments also address anxieties or fears that contribute to vaginismus.

Your healthcare provider may recommend one or more of these treatments:

  • Topical therapy: Topical lidocaine or compounded creams may help with the pain associated with this condition.
  • Pelvic floor physical therapy: A physical therapist will teach you how to relax your pelvic floor muscles.
  • Vaginal dilator therapy: Vaginal dilators are tube-shaped devices that come in various sizes. Their primary purpose is to stretch the vagina. People with vaginismus use dilators to become more comfortable with, and less sensitive to, vaginal penetration. Your provider may recommend first applying a topical numbing cream to the outside of the vagina to make insertion easier.
  • Cognitive behavioral therapy (CBT): CBT helps you understand how your thoughts affect your emotions and behaviors. It’s an effective treatment for anxiety, depression and post-traumatic stress disorder (PTSD).
  • Sex therapy: Trained sex therapists work with individuals and couples to help them find pleasure again in their sexual relationships.

What are the complications of vaginismus?

Vaginismus can affect your sex life and relationships with your partner. It can affect your mental health, leading to increased anxiety. If you’re trying to become pregnant, vaginismus may make it more challenging to conceive.

Prevention

How can I prevent vaginismus?

We don't know what causes some people to develop vaginismus. There also isn’t any known way to prevent it.

Outlook / Prognosis

What is the prognosis (outlook) for people with vaginismus?

Many people with vaginismus no longer experience the problem after treatment. But successful treatment takes time, so you’ll need to be patient. Remember that it’s possible to have fulfilling and pleasurable sexual interactions by doing other things that don’t trigger vaginismus.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • Why am I experiencing pain with penetration?
  • What is the best treatment for me?
  • How can I make sex more pleasurable?
  • Is vaginismus likely to get better or worse with time?
  • Will mental health support, like counseling, help me?

A note from Cleveland Clinic

If you experience muscle spasms or pain that makes intercourse uncomfortable or impossible, don’t be embarrassed to talk to your healthcare provider. You don’t have to keep suffering. Many problems, including vaginismus, can cause painful intercourse. Almost all of these problems are treatable. A lot of people see significant improvements in their sex lives and their mental health after vaginismus treatments.

Last reviewed by a Cleveland Clinic medical professional on 10/28/2020.

References

  • The American College of Obstetricians and Gynecologists. . Accessed 10/29/2020.When Sex Is Painful (https://www.acog.org/patient-resources/faqs/gynecologic-problems/when-sex-is-painful)
  • International Society for the Study of Vulvovaginal Disease. . Accessed 10/29/2020.Vaginismus (https://www.issvd.org/vaginismus/)
  • Merck Manual. . Accessed 10/29/2020.Provoked Vestibulodynia (https://www.merckmanuals.com/home/women-s-health-issues/sexual-dysfunction-in-women/provoked-vestibulodynia-vulvar-vestibulitis)
  • Merck Manual. . Accessed 10/29/2020.Vaginismus (https://www.merckmanuals.com/home/women-s-health-issues/sexual-dysfunction-in-women/vaginismus)
  • National Health Service (UK). . Accessed 10/29/2020.Vaginismus (https://www.nhs.uk/conditions/vaginismus/)

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