What is vaginismus?
Vaginismus is when the muscles around the vagina tighten involuntarily whenever there is an attempt to penetrate it.
The symptoms can vary from one woman to the next. Some women are unable to insert anything into their vagina because it closes up completely, some women can insert a tampon but are unable to have sex, and others are able to have sex but find it very painful.
Read more about the symptoms of vaginismus.
As vaginismus can disrupt or completely stop your sex life, it often causes distress and relationship problems. It may even prevent you starting a family.
It can also make gynaecological and pelvic examinations difficult or impossible. In some cases, an anaesthetic (painkilling medication) may be needed before a doctor can carry out an examination.
If you've never been able to have sex because of the condition, it's referred to as primary vaginismus. If you've previously been able to have sex but now find it difficult, it's referred to as secondary vaginismus.
What causes vaginismus?
A number of things can cause vaginismus, although it is not fully understood why the condition happens.
For some women, it may be caused by a traumatic past experience, such as a difficult childbirth or sexual abuse. They may associate sexual activity with pain and avoid having intercourse as a way of preventing further pain.
A condition called vestibulodynia is a very common cause of vaginismus. It is thought to be caused by oversensitive nerves at the opening of the vagina, and causes pain or discomfort when penetration is attempted.
Some women with vestibulodynia also experience pain when using tampons.
Vaginismus can also sometimes be caused by inflammation or an injury to the vagina or vulva.
Read more about the causes of vaginismus.
Vaginismus can be treated. How it is treated will depend on what's causing it.
If there is an obvious physical cause, such as an injury or infection, it can be treated with appropriate medication.
If the cause is psychological, sex therapy may be recommended. A sex therapist can help you to overcome the condition using vaginal trainers and relaxation techniques.
Vaginal trainers are smooth, penis-shaped cones of different sizes that can be used in the privacy of your own home.
Read more about treating vaginismus.
The symptoms of vaginismus can vary in severity from one woman to the next.
Some women are unable to insert anything into their vagina. Others can insert a tampon and are able to have a gynaecological exam, but sex is not possible.
Some women with vaginismus are able to have sex but find it very painful. In some cases, the tightness and pain can prevent orgasm.
Sometimes, a woman may experience years of occasional difficulty when having sex, and have to be ready to control and relax their vagina when symptoms occur.
The symptoms of vaginismus may include:
- difficult or impossible penetration because the muscles in the vagina have tightened
- burning or stinging pain and tightness of the vagina when penetrated by a tampon, finger or penis
- fear of pain
- intense fear of penetration and avoidance of sex
- loss of sexual desire if penetration is attempted
The symptoms of vaginismus are involuntary and you cannot do anything to stop them. The body has learned to associate penetration with pain. Whenever penetration is expected, the vaginal muscles tighten as a protective reaction.
It is not true that women with vaginismus do not like or do not want to have sex. Many women with the condition enjoy closeness and share sexual pleasure with their partner. They can achieve orgasm during mutual masturbation, foreplay and oral sex. It is only when sexual intercourse is suggested or attempted that their vagina tightens to prevent penetration.
There are many reasons why the vaginal muscles contract (tighten) against a woman's will. But it isn't always clear each time why this might happen.
Vaginismus is often associated with past sexual experiences or other sexual issues.
For example, an unpleasant sexual experience at a young age, such as a clumsy, painful sexual encounter or examination, can make the body respond in a protective way to prevent further pain.
Sexual abuse, assault or rape could also cause vaginismus.
Having difficulty understanding sex, or having feelings of shame or guilt around sex, could also contribute to vaginismus. For example, you might feel uncomfortable with sex if you:
- have had a very strict upbringing where it was never discussed
- have been told that sexual desire is wrong or sex is painful
- are affected by cultural or religious taboos around sex
Other possible causes of vaginismus include:
- fear that your vagina is too small for sexual intercourse
- fear of getting pregnant
- the after-effects of childbirth
- relationship problems
- tiredness or depression
Causes of pain during sex
If you sometimes experience pain during sex (dyspareunia), you may develop a fear of painful sex. Research suggests that the fear of painful sex may be an important contributing factor to vaginismus.
The following may all cause painful sexual intercourse:
- vestibulodynia – oversensitive nerves at the opening of the vagina
- previous surgery to the genital area
- an infection of the genital area, such as candidiasis (thrush) or trichomoniasis, which is a sexually transmitted infection (STI) caused by a parasite
- radiotherapy to the pelvic area
- vaginal dryness, which can sometimes occur when taking the oral contraceptive pill or after the menopause
- lack of sexual arousal
- side effects of some medicines
- small tears at the opening to the vagina
See your doctor if you have the symptoms of vaginismus.
They may be able to make a diagnosis based on your symptoms, medical history and, if possible, a physical examination.
Your doctor may need to ask you some personal questions to find out more about your condition. These might include:
- Can you tolerate anything penetrating your vagina, such as your finger or a tampon, and is this painful?
- Are you worried at the thought of anything penetrating your vagina?
- Have you ever had a traumatic sexual experience?
- Are you in a relationship and are you sexually active with your partner?
A vaginal examination will be necessary to rule out a physical cause of vaginismus, such as an injury, infection, or vestibulodynia (oversensitive nerves at the opening of the vagina). You can request a female doctor if you prefer, and they should explain exactly what they will do.
If your doctor is not sure why sex is painful for you, you may be referred to a doctor who specialises in vulval problems. This may be a gynaecologist (a specialist in treating conditions that affect the female reproductive system), a genito-urinary (GU) medicine clinician, or a dermatologist (a specialist in skin conditions).
If vaginismus is thought to be the cause of the pain, your doctor may refer you to a healthcare professional, such as a sex therapist or gynaecologist.
You may also need to be referred for counselling, and you could suggest it to your partner too.
Read more about treating vaginismus.
Treatment for vaginismus will depend on what is causing it.
If there is an obvious physical cause, such as an injury, infection or vestibulodynia (oversensitive nerves at the opening of the vagina), this can be treated with medication at the same time that the vaginismus is treated.
Read more about the causes of vaginismus.
If the cause is less obvious, you may be taught self-help techniques to try to resolve the problem.
Your doctor will refer you to a healthcare professional who specialises in psychosexual medicine or sex therapy. They can teach you techniques to retrain your vagina to respond normally to penetration.
The specialist may also offer you:
- counselling to address any underlying psychological issues, such as fear or [anxiety]
- cognitive behavioural therapy (CBT) to change any irrational or incorrect beliefs that you have about sex and, if necessary, to educate you about sex
Your treatment plan will be based on your needs. You will be encouraged to take full control of your self-help treatment and to go at your own pace. If you have a partner, they can also be involved in your treatment.
Sex therapy is available privately.
Vaginal trainers can be used to help you relax the muscles in your vagina. These are a set of four smooth, penis-shaped cones in different sizes, which can be used in the privacy of your own home.
The smallest cone is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size and so on.
It is important to go at your own pace and it doesn't matter how long it takes, whether it is days or months.
When you are able to tolerate the larger cones without any pain or feeling anxious, you and your partner may want to try having sex.
It is important to note that in cases of vaginismus, vaginal cones are not used to "stretch" a vagina that is "too narrow". Women with vaginismus have normal sized vaginas. The cones are simply a method of teaching the vagina to accept penetration without automatically contracting the pelvic floor muscles.
If you find you are unable to use vaginal trainers, you could try using your fingers.
Relaxation and touching
If the vaginal trainer method does not work for you, [relaxation] and exploration exercises may help. Having a bath, massage and breathing exercises are good ways to relax while you get to know your body.
Your therapist may also teach you a technique called progressive relaxation. This involves tensing and relaxing different muscles in your body in a particular order. You can then practise tensing and relaxing your pelvic floor muscles before trying to insert your finger or a cone.
If you reach the stage where you can put your finger inside your vagina, you can try to insert a tampon, using lubricant if needed.
Again, it is important to take things slowly and gently and, when you are ready for intercourse, make sure you are fully aroused before attempting penetration.
Pelvic floor exercises
A physiotherapist may be able to teach you some pelvic floor exercises that will help relieve your symptoms of vaginismus, such as squeezing and releasing your pelvic floor muscles. These exercises are recommended while using vaginal trainers.
Biofeedback is a way of monitoring how well you are doing the pelvic floor exercises by giving you feedback as you do them. A small probe is inserted into your vagina. It senses when you squeeze your muscles and sends the information to a computer screen.
However, biofeedback is not available at all centres that treat vaginismus, and some practitioners consider this approach not very useful.
If you are in a relationship, you could try sensate focus. This is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman's breasts).
Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. Explore your bodies, knowing that you will not have sex.
After the agreed period of time has passed, you can begin touching each other's genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. You can also start to use your mouth to touch your partner – for example, licking or kissing them. This can build up to include penetrative sex.
You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT).
Very few cases of vaginismus require surgery as a treatment option. However, it may be useful if another condition that is suitable for surgery is causing pain during sex and is contributing to your vaginismus.
Endometriosis is a possible reason for surgery, although it usually causes pain in the pelvis during sex.
Endometriosis is a condition that causes small pieces of your womb lining to grow outside your womb. Surgery can be used to remove or destroy these areas of tissue.
Read more about treating endometriosis.
Enlarging the vagina
Surgery is sometimes used to enlarge the vagina. This may be necessary if, for example, previous surgery has left scar tissue that either restricts or blocks your vagina.
This can occur if it was necessary to make a cut in the area of skin between your anus and vagina during childbirth (episiotomy).
A small operation called a Fenton's procedure can be carried out to remove the scar tissue. It involves neatly cutting out the scar tissue and sewing together the clean-cut edges using small, dissolvable stitches. The operation can either be carried out under a local anaesthetic or a general anaesthetic.