Vaginismus: What It Is and How It Can Be Treated

Many people reach adulthood without ever receiving adequate or accurate information about how their bodies work. As a result, many—women in particular—suffer in silence over symptoms they are embarrassed by. These hidden symptoms are often associated with vaginal, gynecological, and sexual issues. It’s time to remove the cloak of silence from one of these specific issues, called vaginismus.

Vaginismus: What Is It?

Vaginismus is the involuntary tightening of pelvic floor muscles that surround the vagina; this can make penetration very painful, if not impossible. It may prevent people from using tampons or menstrual cups, having a pelvic exam, or engaging in sexual intercourse. Some describe the experience as their vagina turning into a brick wall upon anticipation or initiation of penetration.

Vaginismus is believed to be one of the more common sexual issues a woman may experience (Spector & Carey, 1990). The condition occurs in about 1-6% of women (van Lankveld, Granot, Weijmar Schultz, Binik, Wesselmann, Pukall, Bohm-Starke, & Achtrari, 2010). Vaginismusawareness.com reports that 2 out of every 1,000 women have vaginismus. Many experts in women’s sexual health believe these numbers are underestimated due to the shame surrounding this condition and other difficulties obtaining accurate numbers.

Stigma, Isolation, and Frustration

Often accompanied by emotions such as shame, embarrassment, fear, frustration, and sadness, vaginismus may cause many to put off seeking medical care and live with the condition alone and in silence. Once, a woman shared with me that she felt broken because she wasn’t capable of engaging in one of the most primal of instincts, consensual sex. But those who experience this concern have no need to feel shame or embarrassment. In fact, there is hope for ending vaginismus. Some sources suggest that most of the clinical trials investigating treatments show success rates to be around 95% effective. 

Vaginismus is often characterized by determining if it is primary or secondary. Primary vaginismus occurs when a sexually active individual has never experienced pain-free vaginal penetration. The term “secondary vaginismus” is used when an individual has had vaginal penetration without pain in the past and suddenly develops the condition.

The Society of Obstetricians and Gynecologists of Canada (SOGC) also finds it helpful to determine if vaginismus is situational or global. “Situational” means the issue occurs in certain circumstances only, such as during sexual intercourse but not when using a tampon. “Global” is when the condition is pervasive and occurs in any situation where vaginal penetration is present.

What Can Cause Vaginismus?

Root causes of vaginismus are usually a combination of non-physical and physical triggers. Often, vaginismus involves fear or anxiety that any kind of vaginal penetration will be painful. Medical issues like urinary tract infections, yeast infections, endometriosis, vulvodynia, menopause, vaginal dryness, pelvic surgeries, and childbirth may lead to pelvic pain and vaginismus. Vaginismus can also be caused by traumatic experiences, including sexual abuse and rape.

Once, a woman shared with me that she felt broken because she wasn’t capable of engaging in one of the most primal of instincts, consensual sex. For anyone experiencing this concern, there is no need to feel shame or embarrassment.

The pubococcygeus (PC) muscle group in the pelvic floor plays the biggest role in vaginismus. Typically, a negative feedback loop produces a conditioned response for the PC muscle to tighten or contract when fear of pain is present. The pelvic floor tries to protect from injury by tightening the PC muscle, but in reality, this contraction makes the situation worse. Therapy for vaginismus is, therefore, a combination of mind and body interventions that remove the conditioned, involuntary contraction response of the PC muscle group.

Since vaginismus can have many causes, it is important to see a gynecologist for a proper diagnosis. This will help determine if any medical causes need to be addressed and allow you to develop the best customized treatment plan for pelvic floor healing.

There Is Hope: Treatment and Resources

There are many treatment approaches for vaginismus. These treatments usually take a multi-faceted approach, using methods such as graded exposure with vaginal dilators, physical therapy with or without biofeedback, therapist-assisted relaxation training, cognitive behavioral therapy (CBT), and relationship and sex counseling.

Often, counselors work closely with physical therapists that specialize in dealing with pelvic floor muscles and related issues to treat vaginismus. These specialists are often called pelvic health or women’s health physical therapists (PHPT). Pelvic health physical therapists may use biofeedback, which can help them identify the muscles that are contracting and thereby discover how to relieve the tension. These physical therapists, who often work to treat the entire body with relation to pain, can be invaluable resources in rehabilitating the pelvic floor muscles.

Dr. Peter Pacik designed a treatment program for more severe forms of vaginismus, and it received FDA approval for further study in 2010. He uses a combination of Botox injections to the vaginal muscles affected most and progressive dilation under anesthesia, followed by counseling services. This combined treatment approach has yielded high rates of success.

In addition, the website community Vaginismus.com is dedicated to providing resources and education about vaginismus. Those who prefer to work independently can also find out how to purchase a book on the topic and dilators. However, given the multimodal nature of vaginismus, it is recommended to have some professional supervision as you work on healing.

If you are struggling with painful or difficult vaginal penetration, or if vaginal penetration is impossible, know that there is hope. Although lack of awareness about vaginismus extends from the general public to even a portion of the medical community, there are many medical professionals who are aware of the condition and can help you address it. Above all, it is important to remember: you no longer need to struggle alone. Treatment is available, and there is no reason to feel shame!

References:

1. Spector I. P., & Carey M. P. (1990). Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Archives of Sexual Behavior, 19(4), 389–408. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2205172
2. Vaginismusawareness.com. (n.d.). Retrieved from http://www.vaginismusawareness.com
3. Van Lankveld, J. J., Granot, M., Weijmar Schultz, W. C., Binik, Y. M., Wesselmann, U., Pukall, C. F., Bohm-Starke, N., & Achtrari, C. (2010). Women’s sexual pain disorders. Journal of Sexual Medicine, 7(1), 615–631. doi: https://doi.org/10.1111/j.1743-6109.2009.01631.x
4. When sex hurts–Vaginismus. (n.d.). The Society of Obstetricians and Gynaecologists of Canada. Retrieved from https://sogc.org/publications-resources/public-information-pamphlets.html?id=27

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