What is vaginismus?
Vaginismus is described as the involuntary cramping, tensing or contracting of the pelvic floor muscles around the vagina.[ii] The muscle tightening is an automatic reaction from the body which stems from a stress response in relation to partial or full penetration. In some cases, even just the mere thought of it can trigger a response. These contractions can become very painful and often happen after a clinical vaginal examination, when a partner attempts penetration, the insertion of a tampon, menstrual cup, sex toy or when the area near the vagina is touched. Common symptoms involve painful intercourse and sometimes the inability to have sex entirely, which can lead to additional symptoms including fear of vaginal penetration and decreased sexual desire.[iii] There are two types:
Primary vaginismus: Any kind of painful vaginal penetration. The cause is unknown.
Secondary vaginismus: Painful vaginal penetration following an external influence. The cause may be linked to injury during an accident, surgery, childbirth trauma or repeated infections such as STDs.
What causes Vaginismus?
Vaginismus can be caused by a plethora of physical, psychological and social factors, but we can distil the causes down into three distinct groups:
Physical: Surgical, (especially C section), spinal injury, poor posture, chronic constipation, constant holding on to go to the bathroom, childhood or adulthood sexual trauma, sedentary lifestyles, constantly holding in the belly, oblique dominance, breathing ailments, jaw clenching, and chronic pain of any kind.
Psychological: Perfectionism (unattainable expectations of yourself and others), depression, fear of the unknown, poor body awareness, shame concerning sex, anxiety, and fear of pregnancy.
Social: An unsupportive partner, pressure of doing something when you are not ready or willing, reduced foreplay, over-use of Kegels, and overusing a vaginal EMG pelvic floor stimulator.
Any of these reasons can lead to vaginismus, creating a vicious circle of ‘tension, pain and fear.’ Stimulation around the vagina or anxiety stemming from penetration causes the limbic system to sound an internal alarm, alerting the body of potential harm. The body then automatically tightens the vagina muscles to brace for danger. This tightening makes penetration very painful or impossible and creates a negative experience that then reinforces the limbic system’s reaction and causes the body to brace for pain on an ongoing basis.
Unfortunately, the longer vaginismus is not treated, the stronger this negative association becomes. Many people living with the condition do not seek treatment because they feel embarrassed or ashamed. Some may attempt to minimise the severity of the condition in the hope that it will go away.
The first step – and often the hardest – is to speak to a medical professional.
Diagnosis
Correct diagnosis is key to treating vaginismus. Other conditions such as dyspareunia, which has a different set of causes but can co-exist with vaginismus, mean identifying the issue isn’t always straightforward. Your clinical practitioner can carry out a medical examination to identify if there are any other physical implications that could be resulting in the pain, such as infection or an allergic reaction to specific products. A therapist can work with you to study the psychological aspects that may be inducing the pain or discomfort.
Talking about pelvic health conditions can feel daunting. The truth is that medical professionals hear about these kinds of issues every day and can help steer you in the right direction to resolve them.
Once the assessment is complete and your condition is diagnosed as vaginismus, your medical professional will map out the physical, psychological, and social factors contributing towards the issue and create a personalised treatment plan with you.
Expert advice on dealing with vaginismus
You have the right to validate the pain you feel during any kind of vaginal penetration with a diagnosis and treatment. The main motivation to overcome this should be you and nobody else.
Vaginismus can make you feel isolated within your own body. It can make you repellent of having internal examinations due to the experience of pain, fear sex, and eventually lead to negative psychological issues like low self-esteem.
In some cultures, women are made to feel shame and negativity around sex which lends itself not only to physical pain, but also mental suffering if they are unable to have penetrative intercourse. Often, their prime motivation to overcome vaginismus is to please their partner. This should never be the main motivation.
What are the treatment options?
Whilst treatment options vary depending on your specific needs, they generally involve different breathing techniques, pelvic floor down-training exercises and vaginal dilator therapy. The first approach is often framing the diaphragm to react with the pelvic floor through breathing exercises to stop the involuntary tightening and relax the vaginal muscles. These exercises engage the parasympathetic nervous system – a specific part of your nervous system that helps to relax and destress the body. From here, pelvic floor relaxation training can be introduced to help gain more control and flexibility.
The psychological causes of vaginismus must also be considered as effective treatment can only be achieved through addressing them as well. The NHS advises that this can be done through psychosexual therapy, a type of talking therapy that aims to help you understand and change your feelings about your body and sex, nurturing a positive body image and sexual confidence.[iv]
From here, the next step is one of the most effective in treating vaginismus, progressive desensitisation. In this therapy, you use your fingers or introduce vaginal dilators to gradually become more comfortable with touching around the vagina, as you begin to understand what feels comfortable.[v]
Vaginal dilators are tube-shaped devices that come in different sizes and are used to gently create a reaction and response of the vaginal muscles. Dilators are designed to help you familiarise yourself with your body and build your confidence until you feel able to progress to natural penetration with your partner. The various sizes allow you to start small and gradually move up the range at a pace that is comfortable and safe for you.
Combining dilators with breathing exercises that engage the parasympathetic nervous system can help to significantly improve the symptoms of vaginismus. The brain sends messages to the pelvic floor to close when it feels the body needs protecting. Using dilators and breathing exercises helps to train the brain to disconnect from this defensive response.
Using a dilator for the first time
Dilators are a proven way of treating vaginismus but using one for the first time can feel daunting. It’s important to remind yourself that you are in full control of how you use them.
Never rush the process. Start off with baby steps, first just massage the labia with the smallest dilator and when you are ready progress towards the entrance. See how that feels for you. Remember you have all the time in the world and taking your time to feel comfortable is key to your success with overcoming vaginismus.
Work up to inserting the dilator to the hymen and always focus on your breathing to relax your body. Week by week or even month by month slowly progress to the larger dilators. Remember if you don’t feel ready, go back to the smaller dilator. There is no rush.
Conclusion
Vaginismus is nothing to be embarrassed about. Like so many other intimate conditions, it’s completely normal, clear to identify and treatable.
The subconscious brain listens and learns from your actions, and by giving yourself experiences of pain-free penetration, you will teach that part of the brain to realise penetration is not putting you in danger. You are in a safe environment and dilators can help you on this path to recovery.
It is important to normalise the discussion and break the taboo of the condition so that you can speak freely about it, better identify the issues that come with it and easily access the specific treatment that will work for you. Making a commitment to yourself to communicate your needs to your partner and your doctor is the first step to regaining control of your body.
[i] Armstrong, C. (2011) ACOG guideline on sexual dysfunction in women, American Family Physician. Available at: https://www.aafp.org/pubs/afp/issues/2011/0915/p705.html (Accessed: February 8, 2023).
[ii] Siang, D.Y.W. (2022) How do I know if I have vaginismus?, DTAP Clinic. Available at: https://dtapclinic.com.my/how-do-i-know-if-i-have-vaginismus/ (Accessed: February 8, 2023).
[iii] Cleveland Clinic. (2020) Vaginismus: Dyspareunia, causes, symptoms, treatment. Available at: https://my.clevelandclinic.org/health/diseases/15723-vaginismus#symptoms-and-causes (Accessed: February 8, 2023).
[iv] National Health Service (UK) (2021) Vaginismus, NHS choices. NHS. Available at: https://www.nhs.uk/conditions/vaginismus/ (Accessed: February 8, 2023).
[v] National Health Service (UK) (2021) Vaginismus, NHS choices. NHS. Available at: https://www.nhs.uk/conditions/vaginismus/ (Accessed: February 8, 2023).
