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.

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.

There are chiefly two types:

• Primary: If one is unable to insert anything into the vagina or experiences pain every time something is inserted, such as, during penetrative sex or a pelvic exam.
• Secondary: If one has enjoyed pain-free intercourse or penetration in the past but now experiences tightness and discomfort/pain.

Yeast infections, radiation, surgery, childbirth, or hormonal changes during menopause leading to the thinning of vaginal walls can result in secondary vaginismus.It can also be situational, which may allow certain types of penetration (like inserting a tampon) but not others (sex). If penetration of any kind is impossible, then it is classified as global vaginismus.

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 to 7 per cent of the global population is affected.

Currently, the exact cause of vaginismus remains unknown.

Researchers suggest a combination of physical and psychological factors, traumatic experiences (like assault), cultural influences and fear of penetrative sex may result in an automatic response from the body.

Symptoms may vary among individuals. Common diagnostic markers include:

• Inability to have penetrative sex
• Painful sex (mild or severe) accompanied by tightness and a burning/stinging sensation
• Muscle spasm during intercourse
• Experiencing pain when attempting tampon insertion or gynaecological examination without cause

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.

Since it is an automatic body response, it doesn't resolve on its own.

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.

Medically reviewed by:

Dr Shruti Mane, Obstetrician and Gynaecologist