Vaginismus

Vaginismus is when the muscles around your vagina tense or contract uncontrollably in response to something trying to go in it. These muscle spasms can cause discomfort and pain.

The DSM-5 combines vaginismus and painful intercourse (dyspareunia) under a condition called genito-pelvic pain/penetration disorder (GPPPD). Your healthcare provider may use this term when talking about vaginismus.

Vaginismus can get in the way of intimacy and other health needs, causing a lot of distress. You don’t have to live this way. It may be difficult to talk about your vagina and sexual history. But doing so can help your healthcare provider diagnose and treat vaginismus.

Symptoms of vaginismus

The main symptom of vaginismus is muscle tightening around your vaginal opening when you anticipate or attempt penetration. The spasms may be mildly uncomfortable or very painful. And you can’t control them.

The tightening could happen when:

• You try to insert a tampon.
• You try vaginal penetration during sex, like with a finger, a sex toy or a penis.
• A healthcare provider tries to insert a medical tool (like a speculum).

Vaginismus symptoms may begin when you try one of these for the first time. Some women develop the condition later in life. It can happen after years of doing these things without any issues.

The spasms or discomfort may occur any time there’s vaginal penetration. Or you may have them only at certain times.

How do I know if I have it?

You know your body best. Based on the symptoms of vaginismus, you may be sure you have it. But many other conditions can cause vaginal pain and painful sex. That’s why it’s best to see a healthcare provider to get an accurate diagnosis.

Vaginismus causes

Researchers don’t know the exact cause of vaginismus. The main theory is that a fear of painful sex causes your pelvic floor muscles to tighten automatically when you attempt penetration. This can create an ongoing cycle of fear, tightening and pain.

Several mental and physical factors may contribute to vaginismus and this cycle, like:

• A negative experience with a pelvic exam or vaginal delivery
• A painful sexual experience
• Anxiety or fears about having sex
• Negative beliefs or feelings about sex
• Pelvic pain, like from a yeast infection or surgery
• Sexual assault or abuse

You can get vaginismus even if you don’t have a psychological explanation for it. Developing vaginismus is out of your control. But you can take back that control by seeking treatment.

Complications of this condition

Vaginismus can affect your sex life and relationships with your partner(s). Vaginismus may also make it more challenging to get pregnant.

It can affect your mental health, too, leading to increased stress, anxiety and/or depression.

How doctors diagnose this condition

To diagnose vaginismus, a healthcare provider (usually, a gynecologist) will ask about your symptoms, like when they happen and when they started. They may also ask about your sexual history. It’s important to be honest about what you’re experiencing.

Your provider may recommend a pelvic exam to help rule out other physical issues that may be causing pain. Vaginismus can make it difficult to have these exams. Some strategies that may help include:

• Talking about the exam before it begins and how you and your provider will communicate during it
• Using a mirror so you can see what your provider is doing and what areas they’re checking
• Placing your hand on your provider’s hand to have a better sense of control

How is vaginismus treated?

Treatment for vaginismus is individualized to address the physical and emotional aspects of the condition. Treatments may include:

• Pelvic floor physical therapy: A specialist can teach you exercises to help relax your pelvic muscles and decrease pain.
• Talk therapy: A psychologist or sex therapist can help you navigate the thoughts and fears you may have about sex or penetration. They can also help you and your partner(s) work out relationship issues that vaginismus may be causing.
• Vaginal dilator therapy: Vaginal dilators are tube-shaped devices of various sizes that help you get used to penetration. Your provider will explain the therapy in detail. You do it at home.

It may take several weeks to months to notice an improvement in your symptoms. But it’s possible. Reach out to your provider if your treatment plan isn’t working.

What can I expect if I have vaginismus?

Vaginismus doesn’t go away on its own. But treatment helps most women. According to one study, 4 out of 5 women (80%) responded well to treatment involving more than one therapy (like talk therapy and physical therapy).

Keep in mind that it may take time. Lean on your healthcare team and partner(s) for support. In the meantime, remember that it’s possible to have fulfilling intimacy by doing other things that don’t trigger vaginismus.