Your Guide to Understanding Vaginismus

When S tried to have sex with her boyfriend the first time, it didn't go as expected. She sensed a ‘wall down there’ preventing penetration, leaving her concerned about her body. Battling guilt over the inability to enjoy penetrative intercourse and failing to ‘fix’ herself, she eventually sought help at a gynaecologist's clinic.

During the consultation, she found out she had nothing to be ashamed of — it was not her; it was vaginismus.

What is vaginismus?

Vaginismus refers to the involuntary tightening of vaginal muscles, which prevents penetration and interferes with sexual intercourse. It can manifest regardless of prior sexual experience. For some, even inserting a tampon/menstrual cup or having a pelvic exam can be painful. Vaginismus is associated with a high level of distress for those affected, and it can have a profound impact on how the woman feels about herself, her partner, and their relationship.

Vaginismus is a condition characterised by involuntary tightening or spasms of the vaginal muscles that make penetration painful, difficult, or sometimes impossible. It can be broadly classified into two main types — primary and secondary — with some variations in how the condition presents and affects individuals.

Types of vaginismus 

1. Primary vaginismus:

• This type refers to cases where an individual has never been able to experience pain-free vaginal penetration.

• It means that from the very first attempt at any form of vaginal penetration (such as tampon insertion, sexual intercourse, or a pelvic exam) there is persistent pain, discomfort, or a reflexive tightening of the vaginal muscles.

• The vaginal muscles contract involuntarily, often without the person’s conscious control, as a protective mechanism against penetration. This can lead to anxiety or fear around penetration, further worsening the muscle response.

2. Secondary vaginismus:

• This type occurs when an individual previously experienced pain-free vaginal penetration but, at some point later in life, began to experience tightness, pain, or discomfort during penetration.

• Common triggers for secondary vaginismus include physical changes or medical issues such as:

• Yeast infections or other vaginal infections causing irritation and pain

• Medical procedures, especially gynaecological procedures, causing scarring or nerve changes

• Childbirth trauma, which can affect vaginal muscles or nerves

• Hormonal changes during menopause cause thinning and drying of vaginal walls (atrophy), making penetration painful

Secondary vaginismus can also be situational, where some types of penetration might be possible without pain (like tampon use) while others (like penetrative sex) cause pain and muscle tightening.

3. Global vaginismus (a subtype mostly linked with primary):

In cases where any attempt at vaginal penetration is impossible due to severe muscle spasms or pain, it is sometimes called global vaginismus.

This means penetration is not possible with any object or during intercourse, leading to significant distress and impairment in sexual function and gynaecological health.

How common is it?

Given the shame and social stigma associated with sex, vaginismus remains a widely underdiagnosed and underreported condition. That’s why the exact number is challenging to pinpoint. However, it is estimated that around 1%-7% of the global population is affected.

Causes of vaginismus

The exact cause of vaginismus is not fully understood. However, research suggests that it is usually the result of a combination of physical and psychological factors that trigger an involuntary tightening of the vaginal muscles. This automatic response can make penetration painful or, in some cases, impossible.

Some of the contributing factors may include:

• Traumatic experiences: Past experiences such as sexual assault, abuse, or even a painful gynaecological examination may lead to a conditioned fear response. The body reacts defensively, tightening the vaginal muscles as a way of protecting itself.

• Cultural or religious influences: Strict cultural or religious beliefs surrounding sex, modesty, or virginity may create feelings of shame, guilt, or fear associated with sexual activity. These deep-seated attitudes can sometimes contribute to vaginismus.

• Fear of penetrative sex: Anxiety about penetration, whether due to fear of pain, lack of trust, or uncertainty, can cause the body to respond automatically with muscle spasms. Even anticipation of discomfort can be enough to trigger this reaction.

Symptoms of vaginismus

The symptoms of vaginismus can differ from one individual to another, both in intensity and in the way they present. However, there are certain common signs and experiences that are often used as diagnostic markers:

• Difficulty or inability to have penetrative sex: Many women with vaginismus find vaginal penetration either extremely painful or altogether impossible, despite a strong desire for intimacy. This difficulty is not due to a lack of arousal but rather the involuntary tightening of the vaginal muscles.

• Painful intercourse (dyspareunia): Sexual activity may be accompanied by varying levels of pain, ranging from mild discomfort to severe pain. This pain is often described as a feeling of tightness, burning, or stinging within the vagina.

• Involuntary muscle spasms: During attempted penetration, the muscles of the vaginal wall may contract or spasm involuntarily. These spasms are beyond the person’s conscious control and can make penetration very difficult or impossible.

• Discomfort with tampon use or gynaecological examinations: Individuals with vaginismus may also experience pain or an inability to insert tampons, or significant discomfort during routine pelvic or gynaecological examinations, despite the absence of any underlying physical abnormality.

Frequently Asked Questions 

1. How is vaginismus diagnosed?

Your doctor will conduct a pelvic exam and take your medical and sexual history. They may also ask if you have experienced sexual trauma or abuse. A proper evaluation and diagnosis will help to differentiate whether you are suffering from vaginismus or dyspareunia and will aid in appropriate management.

2. Can vaginismus go away on its own?

Vaginismus does not usually resolve on its own because it is an involuntary, automatic response of the body. However, with the right support and treatment approach, like pelvic floor physiotherapy, counselling, or a combination of these, most individuals are able to overcome vaginismus successfully.

3. Is vaginismus curable?

It is a highly treatable condition, even if detected later in life. The primary line of treatment for vaginismus focuses on gradually reducing the automatic tightening of the vaginal muscles and removing the fear of pain.

Therapists use a variety of techniques like breathing, relaxation, local tissue desensitisation, use of physical vaginal dilators, pelvic floor biofeedback, and manual therapy techniques. This is done through vaginal dilation to familiarise the muscles with pressure. Initially, you may be asked to use a physical dilator and lubricant.

Vaginismus treatments include taking medications to manage anxiety and a variety of psychological treatments with the help of sex therapists — also known as sexologists. The sexologists conduct an elaborate investigation of the couples' marital and sexual history.

Methods used for alleviating fear and anxiety associated with vaginismus include interactional sessions for relationship enhancement of the couple; some severe cases may also demand hypnosis therapy.

The basis of psychological treatment for vaginismus stems from the notion that the problem usually arises due to marital conflicts, fear of sexual intercourse, social stigma, history of sexual abuse in the past or childhood, or a lack of sexual education. Therapy sessions can be conducted individually or in a couple’s therapy format.