What Is Vaginismus?

Vaginismus occurs when your pelvic floor muscles involuntarily start to contract when you are anticipating or having vaginal penetration. As a result, this can make vaginal penetration that is painful or even impossible. Vaginismus is a type of penetration and sexual pain disorder, so people with the condition may experience discomfort, anxiety, or pain with:

• Vaginal or oral sex
  
• Fingers
• Tampons
  
• Vaginal dilators
• Pelvic exams

Symptoms of vaginismus range from mild to severe. In severe cases, vaginal penetration is impossible, making it very difficult to receive routine gynecological care like a pelvic exam or have sex, which can lead to emotional and intimacy issues in your sexual relationships.

The good news: treatment for vaginismus can be very successful. Your healthcare provider can help you develop a treatment plan based on the severity of your symptoms and your comfort level.

Types of Vaginismus 

The type of vaginismus you have will depend on the cause of your condition and how or when symptoms appear. There are two main types of vaginismus: primary and secondary. It's important to note, however, these terms are sometimes used interchangeably within the medical community.

With primary vaginismus, a person has experienced pain with vaginal penetration throughout their entire life. Secondary (or, acquired) vaginismus occurs when vaginal penetration was possible in the past but later becomes painful or impossible.

Vaginismus is also described as global or situational. Global vaginismus refers to symptoms that happen in response to any type of vaginal penetration.

Situational vaginismus describes symptoms that happen in response to certain types of penetration but not others. For example, a person may be able to use a tampon, but unable to undergo a pelvic exam.

Symptoms

Symptoms of vaginismus can range from mild to severe. A hallmark symptom of vaginismus is the involuntary contracting (or, tightening) of the pelvic floor muscles that surround the vagina. The muscle contractions cause the vagina to become very narrow which makes penetration painful or impossible. Other symptoms also include:

• Pelvic pain or discomfort with vaginal penetration
• Inability to have vaginal sex or receive a pelvic exam
• Difficulty inserting a tampon during your menstrual cycle

People with vaginismus also experience mental and emotional symptoms such as shame, embarrassment, fear, and anxiety. These feelings can be related to the anticipation of vaginal pain or the inability to experience vaginal penetration.

Causes

Vaginismus occurs when the pelvic floor muscles around your vagina contract or become tight. Your pelvic floor muscles are a group of muscles that form a hammock-like shape across the floor of the pelvis (also known as the hip bone). Pelvic floor muscles hold pelvic organs in place, which allows organs such as the vagina, bladder, and rectum to work properly.

Healthcare providers and researchers are still working to understand what exactly causes vaginismus. Although more research is still needed, some studies suggest different factors may play a role in why a person develops the condition. These factors include:

• Shame and other negative attitudes toward sex or sexuality
• A history of sexual trauma or abuse
• Lack of sexual knowledge or education
• Fear of physical pain, penetration, or pregnancy
• Pelvic floor dysfunction
• Vaginal damage via childbirth

Diagnosis

If you suspect you have vaginismus or are experiencing symptoms, it's a good idea to visit your healthcare provider. During your appointment, your provider will take your medical history and conduct a complete physical exam.

They may ask you personal or intimate questions, such as your sexual history, number of partners, or experience of trauma. While it can be uncomfortable answering these questions, giving honest answers helps your healthcare provider with the diagnosis process. Keep in mind: if your provider is asking a question that you find difficult to answer, it's OK to let them know how the question makes you feel and if they could move on to the next question.

After learning more about your symptoms, your provider will conduct a pelvic exam, which is the most common test providers use to confirm a vaginismus diagnosis. During the pelvic exam, your healthcare provider may use the Lamont-Pacik scale to help determine the severity of your symptoms:

• Lamont grade one: You are able to relax for a pelvic exam
• Lamont grade two: You are unable to relax for a pelvic exam
• Lamont grade three: Your buttocks lift off the exam table and your toes curl upward, as you try to avoid the pelvic exam
• Lamont grade four: Your buttocks lift up and thighs close tightly to prevent a pelvic exam from occurring 
• Pacik grade five: You avoid the pelvic exam and may experience severe trembling and shaking, crying, hyperventilation, nausea, or vomiting

Knowing the severity of vaginismus allows your healthcare provider to create a treatment plan that works best for you.

Treatment

The main goal of vaginismus treatment is to manage the mental and physical factors that prevent comfortable vaginal penetration from occurring. Several providers may help you receive the treatment you need, including a gynecologist, physical therapist, and sexual therapist/counselor.

Your healthcare team will create a treatment plan based on the severity of your symptoms and your individual comfort level. Treatment for vaginismus may include:

• Pelvic floor physical therapy
• Pharmacological treatments
• General psychotherapy
• Sex or cognitive behavioral therapy 

Keep in mind: vaginismus cannot be treated with surgery.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy aims to help you develop awareness and control of your pelvic floor muscles. This treatment can also relax your muscles, relieve pain, and help you overcome vaginal penetration anxiety.

With the help of a physical therapist, you’ll engage in Kegel exercises and vaginal dilation. Kegel exercises help strengthen pelvic muscles. During vaginal dilation, your physical therapist will use different-sized plastic dilators to gradually widen the muscles surrounding the vagina over time.

Pharmacological Treatments

In some cases, your healthcare team may recommend prescription gels or injections to help decrease sensitivity and relax muscles in the vaginal area.

Lidocaine gel is a local anesthetic that can numb pain and ease vaginal penetration. Your providers may also recommend Botox (onabotulinumtoxinA) shots to prevent your pelvic floor muscles from moving for a limited period of time, which can help decrease muscle tightness.

General Psychotherapy

General psychotherapy is typically used when your healthcare provider suspects an underlying psychological issue that is causing your vaginismus. Your primary care provider will likely refer you to a mental health professional and you can choose to attend therapy alone or with your sexual partner.

Individual therapy addresses personal psychological issues that may be related to vaginismus. Couples therapy focuses on a couple’s sexual history and relationship issues that may play a role in your condition.

Sex Therapy 

Sex therapy often includes a combination of sex education, cognitive behavioral therapy, and physical therapy with vaginal dilation. You’ll work with a trained sex therapist to specifically address sexual dysfunction related to vaginismus.

How to Prevent Episodes of Vaginismus 

Because the cause of vaginismus is not clear, it’s hard for healthcare providers to know exactly how to prevent the condition. However, there are ways to relieve the pain and discomfort that comes with a sexual pain disorder like vaginismus:

• Use water-based lubricants
• Try sexual activities that feel less painful than vaginal penetration, such as oral sex
• Have an honest conversation with your sexual partner about activities that cause pain and pleasure
• Set aside time for sex when neither you nor your partner is tired or anxious
• Get sensual massages or other intimate activities that do not require vaginal penetration 

Related Conditions

There is a lack of awareness about vaginismus amongst healthcare providers. This can often make it hard to find or receive the treatment you need to help you manage the condition. Vaginismus can affect your social life, personal well-being, and physical health. As a result, it's important to know that you may also experience the following concerns:

• Depression and feelings of isolation
• Anxiety
• Marital issues due to lack of sexual connection
• Increased risk of not following up with prenatal care during pregnancy
• Trouble conceiving

Living With Vaginismus

Vaginismus is rarely taught in medical school, residency training, or professional medical meetings. Unfortunately, as a result, the condition is poorly understood among healthcare providers.

There has been a push to better understand and define vaginismus, from diagnosis to treatment. Recent vaginismus research includes:

• Challenging past definitions and causes of vaginismus
• Properly defining symptoms of severe vaginismus
• Outlining a well-rounded treatment approach
• Understanding how treatment success varies with treatment type

Research shows the severity of your symptoms may affect treatment. Milder cases of vaginismus can be treated successfully with the help of treatments such as physical therapy or psychotherapy. However, treatment options for severe symptoms may involve multiple therapies, including Botox injections.

Remember, it may take some time to see results from treatment. You might even have anxiety about telling your provider about your condition and finding treatment options—and that's OK. The important thing is to be patient with yourself during this process and have honest conversations with a healthcare provider that you trust about your progress.