Vaginismus (the Latin equivalent of the word Vaginism) is a condition which affects a woman’s ability to engage in any form of vaginal penetration, including sexual penetration, insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a conditioned reflex of the pubococcygeus muscle, which is sometimes referred to as the “PC muscle”. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration—including sexual penetration—either painful or impossible.

A vaginismic woman does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus and the pain during penetration, including sexual penetration, varies from woman to woman.

Experience of vaginismus

The conditioned reflex can create a vicious circle for vaginismic women. One example: if a female learns that the first time she engages in penetrative sex that it will be painful, she may develop vaginismus because she expects pain. If she then attempts to engage in penetrative sex, the muscle spasm will make penetrative sex painful. This and each further attempt at sexual penetration confirms her fear of pain and may worsen the condition. Naturally, penetration may be painful without vaginismus or psychological prerequisite as well.^{[citation needed]}

Primary vaginismus

Primary vaginismus occurs when a woman has never been able to have penetrative sex or experience any kind of vaginal penetration. It is commonly discovered in teenagers and women in their early twenties, as this is when many young women in the Western world will initially attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women who have vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should be naturally easy, or she may be unaware as to the reason for her condition.^{[citation needed]}

Some of the things that may cause primary vaginismus are:

• sexual abuse
• having been taught that sex is immoral, vulgar, or demoralising
• the fear of pain associated with penetration, particularly that of breaking the hymen upon the first attempt at sexual penetration

Secondary vaginismus

Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a yeast infection or trauma during childbirth, or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.^{[citation needed]}

Prevalence

The prevalence of vaginismus has been reported to be 6% in two widely divergent cultures, Morocco and Sweden. The prevalence of manifest dyspareunia has been reported as low as 2% in elderly British women, yet as high as 18–20% in British and Australian studies.^[1]

By another study vaginismus rates of between 12% and 17% have been reported in women presenting to sex therapy clinics (Spector and Carey 1990). National Health and Sexual Life Survey, which used random sampling and structured interviewing, report that between 10% and 15% of women reported having experienced pain during intercourse during the last 6 months (Laumann et al. 1994).^[2]

The most recent study estimates of vaginismus range from 5% to 47% of people presenting for sex therapy or complaining of sexual problems, with significant differences across cultures (see Reissing et al. 1999; Nusbaum 2000; Oktay 2003). Unlike other sexual dysfunctions or genital problems, vaginismus prevents both intercourse and the ability to conceive, it seems likely that society’s expectations of women’s sexuality may particularly impact on these sufferers.^[3]

Treatment

There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful.

The condition will not necessarily become more severe if left untreated, unless the woman is continuing to attempt penetration, despite feeling pain. Some women may choose to refrain from seeking treatment for their condition.

According to the Cochrane Collaboration review of the scientific literature, “In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies.”^[4]

Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90–95% and even 100%. For an example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see Reissing’s literature review (links below).

Psychological treatment

According to Ward and Ogden’s qualitative study on the experience of vaginismus for women (1994), the three most common contributing factors to vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature).

It is important to address the psychological aspects of the problem as well as the actual muscle spasm. A woman may choose to address the issue on her own terms, or she may avail the help of a therapist.

Many people—even some professionals—are not aware of the emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and depression.

Physical treatment

Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and desensitization with vaginal dilators. Dilating involves inserting objects, usually phallic in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the woman progresses. Medical dilators may be obtained online, though they may be expensive.

Sexuality

If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women may come to believe that vaginismic women do not want to engage in penetrative sex at all, though this may not be true. Many vaginismic women do wish to engage in penetrative sex, but are deterred by the pain and emotional distress that comes with each attempt.

Masturbation

Many women do not realize that it is normal, even in patients who do not suffer from vaginismus, for a woman to experience pain or discomfort if she attempts sexual penetration without first being sufficiently aroused. Most women acknowledge sexual arousal as vital to achieving comfortable penetration, so self-exploration of the vaginal area through masturbation can be beneficial in addressing vaginismus.

One of the problems that can come with vaginismus is that a woman may be fearful to engage in sexual activity, due to the fear of pain with any kind of vaginal penetration. Solo masturbation, with or without penetration, can alleviate this fear, as well as the psychological pressure to “perform” sexually or become aroused quickly, with a partner.

Despite popular belief, orgasm need not be the goal of masturbation. The reason may be to simply increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the vulva, as well as in the vaginal lubrication produced. As a woman becomes more aware of her individual sexual response, she can learn which sensations are best for bringing her to a state of arousal. She will then be better equipped to teach her partner which sensations feel best for her.

Emotional experiences

A wide range of emotions may surface during masturbation and other forms of genital exploration. Some women have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Especially in the case of a vaginismic woman, feelings of shame, inadequacy or of being “defective” can be deeply troubling. If multiple attempts to penetrate are made before treating vaginismus, it may lead to fear of sexual intercourse. Relaxation, patience and self-acceptance are vital to a pleasurable experience.

Vaginismus [vaj-uh-niz-muh s]¹

Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse. The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. The woman does not directly control or ‘will’ the tightness to occur; it is an involuntary pelvic response. She may not even have any awareness that the muscle response is causing the tightness or penetration problem.

In some cases vaginismus tightness may begin to cause burning, pain, or stinging during intercourse. In other cases, penetration may be difficult or completely impossible. Vaginismus is the main cause of unconsummated relationships. The tightness can be so restrictive that the opening to the vagina is ‘closed off’ altogether and the man is unable to insert his penis. The pain of vaginismus ends when the sexual attempt stops, and usually intercourse must be halted due to pain or discomfort.

Vaginismus Involuntary Tightness – In the diagram on the left, the effects of vaginismus are illustrated with the tightening of the pelvic floor muscles and the resulting tightness of the vagina. On the right, the pelvic floor is relaxed and intercourse is possible without pain.

Types of vaginismus

When a woman has never at any time been able to have pain-free intercourse due to this muscle spasm her condition is known as primary vaginismus. Some women with primary vaginismus are unable to wear tampons and/or complete pelvic exams. Many couples are unable to consummate their relationship due to primary vaginismus. [see Symptoms]

Vaginismus can also develop later in life, even after many years of pleasurable intercourse. This type of condition, known as secondary vaginismus, is usually precipitated by a medical condition, traumatic event, childbirth, surgery, or life-change (menopause). [see Causes]

Examples of Vaginismus – In the vaginismus condition, as the man approaches the woman, her PC muscle group (darkly shaded) involuntarily tightens the vaginal entrance making intercourse painfully impossible or penetration may be successful but may result in burning, discomfort, and pain.

Vaginismus is treatable

Vaginismus is highly treatable and a full recovery from vaginismus is the normal outcome of treatment. Successful vaginismus treatment does not require drugs, surgery, hypnosis, nor any other complex invasive technique. Following a straight-forward program, pain-free and pleasurable intercourse is attainable for most couples.