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2nd June, 20218 min read

Vaginismus: Symptoms, causes and treatment

Medical reviewer:Dr Ann Nainan
Author:Dr Lauretta Ihonor
Last reviewed: 12/04/2021
Medically reviewed

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our safety page, or read our editorial policy.

What is vaginismus?

Vaginismus is when the muscles around the entrance of your vagina tighten when you or someone else tries to put something into it. This could be a tampon, penis, finger or medical device, like a speculum used during a cervical smear (Pap) test.

This muscle tightening is an automatic reaction, which means you don’t have control over it. Vaginismus isn’t related to sexual desire – it happens even if you’re aroused and want to have sex. Instead, it’s a fear of something being put in your vagina, which may be linked to an upsetting sexual experience or vaginal/cervical exam in the past.

While vaginismus often feels painful or may make you feel anxious about activities like sex, it can usually be treated.

What are the symptoms of vaginismus?

The main symptom of vaginismus is pain when something is put in your vagina. But everyone is different, and the type of pain and activities that cause the pain or tightening can differ from person to person.

If you have vaginismus, it’s common to have vaginal pain and tightening from the first time you have sex, but it’s also possible for these symptoms to develop after having no problem with having penetrative sex in the past.

Other symptoms of vaginismus include:

  • finding it hard to have penetrative vaginal sex
  • finding it hard to put a tampon into your vagina
  • stinging or burning during penetrative sex

Because vaginismus only involves tightening of the vaginal muscles, it’s common to have no problem having other types of sex.

When to see a doctor about vaginismus

See a doctor (or go to a sexual health clinic) if you have any of the symptoms listed above. They will be able to check if you have vaginismus and recommend the best treatment for you.

While pain during sex can be caused by vaginismus, it can also be a sign of other conditions that need more urgent medical attention. See a doctor urgently if you have pain when putting something into your vagina and:

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

What causes vaginismus?

The exact cause of vaginismus isn’t known, but it’s been linked to a variety of mental and emotional factors, physical changes and medical conditions, including:

  • a bad first or early sexual experience
  • feeling anxious or scared of sex or a vaginal or cervical examination
  • sexual assault
  • a bad experience during a medical examination
  • cultural, religious beliefs about sex, like it’s shameful or wrong
  • female genital cutting or mutilation
  • being afraid that your vagina is too small. Read more if you’re worried about whether your vagina is ‘normal’
  • an infection or inflammation of your vagina, cervix and/or womb
  • low oestrogen levels after menopause
  • trauma from previous surgery
  • radiotherapy near or around your vagina

It can also have no obvious cause.

How is vaginismus diagnosed?

There aren’t any tests to diagnose vaginismus. Instead, a doctor will usually ask you about your symptoms and sexual history, and then do a physical exam 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.

You usually won’t need to have an internal vaginal exam, but the doctor may want to check if the entrance of your vagina tightens during the exam.

If a doctor thinks you have vaginismus, they may refer you to a sex therapist.

What is the treatment for vaginismus?

Vaginismus treatment is usually focused on helping your vaginal muscles relax when something is put into your vagina, and reducing any anxiety or fear you have about the activities that trigger your symptoms.

This includes:

  • treating any medical condition you have that may be causing your symptoms or making them worse – such as low oestrogen, or an infection like a urinary tract infection (UTI) or thrush (candidiasis) that may make the pain worse
  • relaxation techniques to help your vaginal muscles relax
  • exercises to help your vaginal muscles relax
  • tampon-shaped devices called vaginal trainers or dilators – these are put into your vagina to help you get used to having something in there
  • pelvic floor exercises – to give you better control of your vaginal muscles
  • talking therapies – to explore and tackle any feelings that may make you anxious when something is put into your vagina
  • touch-based exercises (called sensate focus) to make you feel more comfortable and relaxed about penetrative sex

If you’re in a relationship, you can involve your partner in some of these treatments, like sensate focus, talking therapies or using vaginal trainers.

Can vaginismus be cured?

It can take a few weeks of treatment to notice results, but many people with vaginismus get better with treatment. And in some cases, vaginismus gets better on its own without treatment – although it’s best to see a doctor to rule out other causes of your symptoms.

Having vaginismus can be emotionally hard to deal with and can put a strain on relationships, so speak to a doctor or sexual health professional if your symptoms are having a negative effect on any part of your life. They can advise you on how to deal with this and may be able to put you in touch with support groups that may be helpful.

Other sexual health problems

Aside from vaginismus, there are other unexpected signs and symptom a person may notice when having penetrative sex. These include pain and/or bleeding during or after sex. While these symptoms can be upsetting or difficult to talk about, it’s important to speak to a doctor if you have any unexpected symptoms when having sex. They can help find out the cause of your symptoms and suggest ways to improve them.

Read more about why some people bleed after the first time they have sex and the common causes of bleeding during sex.

Your questions answered

Is vaginismus a mental thing?

While vaginismus can be caused by medical conditions and physical changes in your vagina – for example, having surgery or radiotherapy – it’s commonly linked to mental and emotional events, like an upsetting first sexual experience or pelvic exam.

But this doesn’t mean it’s an imagined problem – it isn’t. Vaginismus is a legitimate medical condition that happens when your vaginal muscles tighten automatically when you try to put something into your vagina.

Why do I have lower abdominal pain when using a tampon?

Many things can cause lower tummy pain when you use a tampon. These include an infection or inflammation of your womb, cervix and/or vagina. Vaginismus may also cause vaginal and lower tummy pain when you try to use a tampon, but this pain usually doesn’t continue after you’ve successfully put in the tampon. If using a tampon causes any type of pain including vaginal pain, see a doctor urgently. They will be able to advise you on the most likely cause. Learn how to use a tampon safely and effectively.

Why does it hurt to put a tampon in all of a sudden?

It shouldn’t hurt when you put in a tampon or while it's in. If it suddenly becomes painful, see your doctor, as it could mean there may be a more serious cause for your pain such as a sexually transmitted infection (STI), inflammation of your cervix or vagina, endometriosis, or vaginismus. – Answered by Dr Audrey Menezes from the Healthily Medical Team

Key takeaways

  • vaginismus is when the muscles around the entrance of your vagina tighten up when you or someone else tries to put something into it
  • it can happen when you try to have penetrative sex, use a tampon or have a pelvic exam
  • its exact cause isn’t known, but it’s linked to mental and emotional, physical and medical factors, including a bad first sexual experience or pelvic exam
  • treatment for vaginismus includes talking therapies, touch therapy, exercises to help you relax and using devices to help you get used to putting something in your vagina
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