What You Need to Know About Vaginismus

There are several causes for vaginal pain and tightness, one of them being vaginismus. Vaginismus is a psychosexual condition that causes involuntary tightening of the pelvic floor and vaginal muscles whenever entry is attempted. It makes any type of penetration painful and sometimes impossible, meaning it can interfere with your sex life and regular sexual health checkups.

"Vaginismus is the body's automatic reaction to the fear of some or all types of vaginal penetration," said Leila Frodsham, Mb.Ch.B., an OB-GYN, a consultant gynecologist with a special interest in psychosexual medicine, and spokesperson for the Royal College of Obstetricians and Gynaecologists in London.

"It's where the vaginal muscles involuntarily contract and tighten when vaginal penetration is attempted," she said. "Women have no control over it, and it can be painful and distressing. It can be either primary, from birth and often presenting in teenage years when they try tampons, or secondary, occurring after women have achieved painless penetration."

How common is vaginismus?

Vaginismus is often misunderstood despite being considered one of the most common female psychosexual conditions. It's unclear how many people suffer from vaginismus, but a study published in the journal Sexual Medicine reported that it affects 5 percent to 17 percent of women in clinical settings.

Experts believe it might be more common than that estimate indicates. Getting a vaginismus diagnosis can be an uphill battle, and many women don't feel comfortable talking about their symptoms with their doctor.

"It's likely that vaginismus is underdiagnosed as those who experience symptoms can often be too embarrassed to discuss their symptoms with a healthcare professional," Frodsham said. "Some women don't seek help until they are in their late 30s or early 40s, having spent decades experiencing symptoms.

"It's important to raise awareness and increase understanding of vaginismus and the available treatments," Frodsham continued. "Increasing awareness will help to remove stigma and enable women to have open conversations with healthcare professionals about their health. The Vaginismus Network and films such as 'Tightly Wound' and 'My Body Won't Let Me Have Sex' are useful resources to understand how common vaginismus is and how to get help."

Vaginismus causes

Experts don't know for sure what causes vaginismus, but they believe it can have both physical and emotional roots. The causes of vaginismus vary from person to person, and sometimes there may be more than one.

Some of the physical causes of vaginismus include:

• Medical conditions such as sexually transmitted infections (STIs), endometriosis, vulvodynia, pelvic inflammatory disease (PID), and severe yeast or urinary tract infections (UTIs)
• Trauma from a painful or complicated childbirth
• Pelvic floor injuries
• Previous physical or sexual abuse
• Menopause, which can cause vaginal dryness and irritation that makes sex painful

Some of the emotional causes of vaginismus include:

• Fear of sexual intercourse
• Anxiety disorders
• PTSD from past sexual abuse
• A bad or painful first sexual experience or vaginal exam
• Growing up with shame around sex

Symptoms of vaginismus

Involuntary tightening of the vaginal muscles is the main symptom of vaginismus, but other symptoms of vaginismus include:

• Pain or difficulty using a tampon
• Pain during intercourse (dyspareunia)
• Difficulty inserting a sex toy
• Sexual dysfunction, such as difficulty getting aroused or performance anxiety
• Pain or difficulty during pelvic exams, Pap smears and STI tests
• Pain when pressure is applied to the vaginal opening (vestibulodynia)
• Random or triggered vaginal cramps or spasms
• Genito-pelvic pain that can feel like stabbing or burning

These symptoms can range from mild to severe. Some women can have penetrative sex but with some discomfort, while others aren't even able to use tampons.

The symptoms of vaginismus can mirror many other sexual and vaginal health issues, such as vulvodynia and some types of STIs, so it's important to speak to your doctor if you ever experience pelvic pain or pain during sex.

Treatment for vaginismus

The best treatment for vaginismus depends on the cause, but some of the management options include:

• Therapy, including cognitive behavioral therapy (CBT), sex therapy, relaxation techniques and, in some cases, hypnotherapy
• Vaginal dilators or trainers
• Pelvic floor exercises
• Botox
• Medications, including antidepressants and anxiolytics
• Using lubricant and topical numbing creams during penetration

Some research suggests a combination of all of the above is the best way to treat vaginismus.