Vaginismus

Vaginismus is when the muscles of the pelvic floor, around the vagina, involuntarily contract when it is about to be penetrated. This prevents penetrative intercourse, gynaecological examinations, and the insertion of a tampon or menstrual cup. This is an involuntary reaction, often related to a fear of penetration rather than issues with muscle tone.

Vaginismus can be categorised by when it began to occur:

  • Primary vaginismus is when you have never been able to have penetrative intercourse or, if you have, it has been extremely painful.
  • Secondary vaginismus is when you have previously had comfortable penetrative intercourse, however that is no longer possible.

Vaginismus is not a common condition, reports suggest it affects only 0.5 - 1% of women globally. As with most intimate conditions, however, it is likely to be under reported as women do not always seek treatment for fear of embarrassment. Another reason this figure is likely to be higher than reported, is due to mistakes in diagnosis. Even within research studies, vaginismus is often incorrectly diagnosed as other intimate conditions.

Vaginismus can have a negative impact on your quality of life, straining your relationships and lowering your self-esteem. It can even result in practical infertility as you are unable to have penetrative intercourse to be able to conceive.

This does not need to be the case though. The conservative treatments for vaginismus are often very effective and improvements can be seen within just a few weeks. Many of the treatments can be completed in privacy, therefore 10% of sufferers see improvement from treating themselves, after learning techniques from a medical professional.


What are the Symptoms of Vaginismus?

If you are suffering from vaginismus, you may still be able to be sexually aroused and be able to enjoy non-penetrative sex. Vaginismus may not always be an issue, and occasionally you may have comfortable penetrative sex. However, it is often present and you may become more aware of it during your period and when you attempt to have sex. Symptoms include:

  • A burning / stinging sensation during sex (dyspareunia)
  • An inability to have penetrative sex
  • An inability to be aroused
  • Vaginal dryness
  • An inability to insert a tampon or menstrual cup, and often an inability to remove them
  • An inability to orgasm
  • Fear and anxiety around vaginal penetration - Often misinterpreted as pain.
  • An inability to tolerate a gynaecological examination

Conditions with similar symptoms include vulvodynia, some sexually transmitted diseases (STD's) and vestibulodynia. These often have visual signs that lead to their diagnosis.


What Causes Vaginismus?

Vaginismus can occur for a number of reasons. Some physical such as an infection, and some psychological such as a a belief that sex is shameful or wrong.

Physical Causes of Vaginismus

  • Irritation from an infection - Such as thrush, which is more tender when your vagina is relaxed.
  • Drug or alcohol abuse - Which often leads to sexual dysfunction as it impairs your bodies responses.
  • vulvodynia - chronic pelvic pain felt in the skin at opening of the vagina, including that felt in the labia, vestibule, urethra and clitoris.
  • Conditions which reduce sexual arousal - Such as; multiple sclerosis and spinal cord injury.
  • Hormonal changes such as the menopause - NOTE few studies have confirmed this.

Psychological Causes of Vaginismus

  • Fear that your vagina is too small for penetration
  • Fear that you are not desirable - And negative attitude towards your sexuality.
  • Previous bad sexual experiences - Not necessarily assault or rape.
  • Previous unpleasant medical examinations
  • A belief that sex is shameful or wrong - Often due to an upbringing of strict religion and/or strict sexual beliefs.
  • Depression
  • Relationship problems
  • Not aroused enough to have penetrative intercourse

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


How to Treat Vaginismus

To design a treatment plan, your GP will determine at which point of attempted vaginal penetration your muscles contract, and when pain is felt. They will also look to see whether you can voluntarily relax your muscles after the initial involuntary contraction. Treatment will always aim to meet your personal objectives; whether it be to be able to have a painless vaginal examination, or if you wish to have painless penetrative intercourse, and/or conceive.

Your GP may refer you to a Sex Therapist to support you in your treatment, and help relieve any associated fear and anxiety you may have. Most treatments can be practised at home once the correct methods have been learned. You can choose whether to involve your partner in any of these treatments.

IMPORTANT: Surgery is not an appropriate treatment for vaginismus. Unfortunately the condition is often mistaken for a physical problem which leads to unnecessary pelvic surgery. Undergoing a pelvic surgery increases your risk of developing other pelvic floor disorders as nerve and muscle damage is common. Therefore it is always important to ensure you have a correct diagnosis before proceeding with a pelvic surgery.

Treatments for Vaginismus

  • Kegel (pelvic floor) exercises - To regain control over your vaginal muscles you can complete Kegel exercises. Once you are able to complete these manually, and you are able to insert things into your vagina, you may consider introducing a vaginal cone into your exercises. Vaginal cones sit within the vagina as you exercise and acts as resistance to make each squeeze even more beneficial. The Kegel8 Vaginal Cones also come with a unique indicator tail, which helps you know when you are contracting the correct muscles. If you wish to enhance your exercises further and see even quicker results, you can use an electronic pelvic toner. These have a vaginal probe or electronic pads for the skin, which are perfect for seeing quick improvements whilst you are still unable to place anything into your vagina. Read more about the benefits of Manual Exercises Vs Electronic Pelvic Floor Exercises.
  • Vaginal trainers - To reduce your sensitivity to vaginal penetration and help get you used to it, smooth plastic rods/dilators are used. These come in gradually larger sizes and are inserted into the vagina with lubricating gel. This treatment has a high success rate, as often once penetration is achieved, the sufferer has a 'flipped switch' moment where they realise vaginal penetration is possible. This helps them relax for further training.
  • Relaxation - There are many relaxation techniques which you can do before vaginal penetration occurs to help you learn to relax in the situation. These include breathing and gentle touching around the intimate area of the vagina.
  • Personal counselling - Psychosexual therapy can help you understand your feelings about your body, sex and any concerns you have regarding vaginal penetration. Cognitive behaviour therapy and hypnotherapy may also be offered.
  • Counselling with your partner present - Talking about your concerns and increasing physical intimacy slowly, with an initial 'ban' on penetration, can help you ease into sex.
  • Exercises to increase your sex drive - Sensate focus exercises are designed to help you relax during sex, and increase your libido. They are usually completed with your partner present and aim to increase your awareness of your own needs, as well as those of your partner.
  • Pain medications - Lidocaine is occasionally prescribed to remove pain as an issue.
  • Hormone replacement therapy (HRT) - For women that have had a hysterectomy or are approaching menopause (perimenopausal), it is thought that HRT can benefit. NOTE few studies have confirmed this.
  • Botulinum toxin (Botox) injections - There is a small amount of evidence that injections of Botox can numb the muscles around the vagina, temporarily preventing involuntary contractions. After several rounds of injections, there is evidence that you can be pain free for a year before needing a further course. However, Botox injections are not permanent.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.


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