Vaginismus: why it happens and how you can deal with it

If you have vaginismus, it can affect your self esteem, body confidence and sex life. As well as feeling embarrassed to talk to a doctor, you may also find it hard to deal with the problem with your partner.

It’s important to know you’re not alone – lots of women have the condition and get treatment that sorts it out. Some studies suggest up to 6% of us struggle with the condition at some point - that’s thousands and thousands of women. Sadly, many women feel embarrassment about seeking help, so this figure is likely to be even higher.

Read on to discover what causes vaginismus (sometimes called genito-pelvic penetration disorder), how it can be treated and where you can find the support you need to help restore your physical and emotional wellbeing. There is hope, and it is possible to overcome vaginismus if you get the help you deserve.

What are the symptoms of vaginismus?

The main symptom of vaginismus is pain when something is put into your vagina. This could be a tampon, a penis, a finger or a medical device, like a speculum used during a cervical smear (also called a

Other symptoms can include:

• finding it physically hard to have penetrative vaginal sex or use a sex toy
• stinging, stabbing or burning pain during penetrative sex
• finding it hard to insert a tampon into your vagina

Find useful information on other areas of vaginal health with our

What causes vaginismus?

There isn't always one obvious cause of vaginismus – symptoms and types of pain differ from person to person. Vaginismus isn’t related to sexual desire – it can happen even if you’re aroused and want to have penetrative sex. Often, the pain you feel is caused by an automatic tightening of the muscles in your vagina linked to a subconscious fear of something being put into your vagina. It can happen the first time you have sex, or after years of sex without any problems. Some women never have penetrative sex because of vaginismus and, for this reason, it can also be a cause of fertility problems.

Psychological factors that can cause vaginismus

There’s often a fear of something going into your vagina due to emotional and psychological issues, such as:

• a bad first or early sexual experience
• previous sexual assault
• feeling anxious or scared about having sex or a vaginal or cervical examination
• cultural or religious beliefs that make you feel ashamed to have sex or fearful of getting pregnant
• being afraid that your vagina is too small (if you’re worried about this, read more about
  what’s normal
  )

Physical and medical problems that can cause vaginismus

• an infection or injury of your vagina, cervix and/or womb – for example after childbirth
• low oestrogen levels during or after the
  menopause
• trauma from previous surgery or a bad experience during a medical examination
• radiotherapy
  near or around your vagina
• female genital cutting or mutilation

Even if the original cause has gone – for example your infection or wound has healed – vaginismus can still happen. So the fear of pain can cause you to tense up, sometimes without you even being aware you’re doing it, and make sex painful.

Talking to your partner

Discussing vaginismus with your partner can seem daunting and you might feel embarrassed. Here are some tips that might help you start a conversation:

• tell your partner that you’d like to talk about something – set aside a time that is good for you both, when you won’t be distracted
• write down the points you want to cover before talking, so you have an idea of what you’d like to say
• be prepared to explain what vaginismus is and the possible causes so they can understand it properly – you could even send them this article!
• share ways you feel they can support you. This could be talking about it more often or them going with you to a doctor’s appointment
• tell your partner that you’re sharing the issue so you can work on it together and reassure them you don’t want vaginismus to get in the way of your relationship
• pscyhosexual counselling is available for couples as well as individuals, so it might be something you could do with your partner

Finding emotional support

Having vaginismus can be hard to deal with and can put a strain on relationships. Reach out for support if it’s having a negative effect on any part of your life.

In addition to asking your doctor or sexual health clinic for help, there are online support groups and resources that you may find useful:

• [Hope&Her](
  https://hopeandher.com/
  is run by people who have experienced vaginismus
• The Vaginismus Network
  aims to educate and share stories

When to see a doctor about vaginismus

How is vaginismus diagnosed?

If you’re having trouble or are worried about having sex or inserting a tampon into your vagina, and think you have vaginismus, it’s best to see a doctor or go to a sexual health clinic for a diagnosis to rule out other causes of your symptoms.

There aren’t any specific tests to diagnose vaginismus. Instead, a doctor will usually ask you about your symptoms and sexual history, and if needed may do a physical examinaton of your vagina. This typically involves looking at your vagina for signs of other causes of your symptoms (like an infection), and feeling the muscles around your pelvis.

If you feel embarrassed about the problem and are nervous to see a doctor it might help to:

• ask for a phone appointment first, to talk through your symptoms at home
• ask for a female doctor or nurse if you’re having a face-to-face appointment
• if you have a doctor you normally see and trust, request to have the appointment with them
• make a list of your symptoms and how long you’ve had them before the appointment to hand to your doctor
• think about any questions you’d like to ask before you see the doctor
• say that you’ve read this article and think that the problem might be vaginismus
• be ready to say what you think the cause might be, if you know
• bring someone to the appointment with you, even if they stay in the waiting room while you talk to the doctor
• if you’re nervous talk to someone you trust on the phone before you appointment to help you stay relaxed

Vaginismus is a condition that there's not much awareness of, although there are brave women and organisations trying to change this. If your GP doesn't have lots of experience in helping women with vaginismus don’t be disheartened. You can instead access help through a sexual health clinic or ask if they could refer you to see a specialist.

How is vaginismus treated?

If you’re diagnosed with vaginismus there are a number of treatments you can try that may help you. Treatment is usually focused on helping your vaginal muscles relax when something is put inside. The aim is to reduce any anxiety or fear you have that may be triggering your symptoms.

Your doctor may suggest some self-care solutions, like:

• relaxation techniques such as
  mindfulness
  – this can allow your vaginal muscles to relax by helping to manage your fear and anxiety around pain during penetration
• pelvic floor exercises
  – practising these regularly can help you gain more control of your vaginal muscles and so teach you how to relax them
• talking therapies
  – to explore and tackle, with or without your partner, any feelings that may make you anxious when you try to put something into your vagina - psychosexual therapists specialise in this
• touch-based exercises (called sensate focus) – can help you feel more comfortable and relaxed about penetrative sex

They may also suggest other treatments, such as:

• treating any medical condition you have that may be causing your symptoms or making them worse, such as low oestrogen levels, a
  urinary tract infection
  (UTI) or
  thrush
• gradually widening (dilating) your vagina with a set of tampon-shaped vaginal trainers. Over time, these gradually increase in size and length to help you get used to having something in your vagina. This may seem daunting but you’re in control of this treatment, so it can be done at a pace your feel comfortable

It can take a few weeks or even months of treatment to notice results, but many people with vaginismus get better with treatment. If you’re still having trouble, your doctor may refer you to a physiotherapist who specialises in vaginismus and may be able to help further.

Can surgery cure vaginismus?

As the root cause of vaginismus is often psychological it very rarely needs surgery. Often, surgery to treat vaginismus results from a misdiagnosis and is therefore unnecessary.

There is some evidence that botox (botulinum toxin) might improve symptoms in women with vaginismus, although more research needs to be done.

When to see a doctor as soon as possible about vagina pain

While pain during sex can be caused by vaginismus – and you should see a doctor to rule out other causes – it can also be a sign of other conditions, which may need more urgent medical attention.

See a doctor as soon as possible if you have pain when putting something into your vagina, and:

• it continues after you’ve removed it
• the pain is very bad or getting worse
• you have abnormal vaginal bleeding, for example, between your periods or after sex
• you have vaginal redness, soreness and/or itching
• you have
  vaginal discharge
  that smells or is coloured
• you have tummy or pelvic pain
• it hurts when you pee or you need to pee more often
• you have a rash, blisters or a lump on your vulva
• you feel sick (
  nausea
  ) or are being sick (
  vomiting
  )
• you have a
  fever

Your health questions answered

Can I still have sex if I have vaginismus?

Vaginismus only involves tightening of the vaginal muscles – you can still be sexually active, you just might have to try things that don’t involve penetrative sex, like:

• the mouth
• the hands
• a vibrator
• orgasms
• ejaculation

Sex with penetration can also be less painful if you use plenty of lubrication, or if the women is on top, as it gives them more control over the penetration.