Vaginismus: causes, symptoms and treatment

Vaginismus: causes, symptoms and treatment

Vaginismus is a condition that can make sexual intercourse, gynecological exams and even tampon insertion painful, if not impossible.

The condition occurs when inserting an object such as a tampon, penis or speculum into the vagina.1,2

The pain experienced during vaginismus is caused by the involuntary contraction of the pelvic floor muscles - specifically the pubococcygeus (PC) muscle group - leading to generalized muscle spasm and temporary cessation of breathing. Secondary to pain, women may be unable to insert tampons or undergo gynecologic exams1,2

It is important that vaginismus is treated to prevent worsening of the condition.2

This Knowledge Center article will explain what vaginismus is and what its symptoms and causes are, as well as what forms of treatment are available for the condition.

You will also see introductions at the end of some sections to any recent developments that have been covered by's news stories. Also look out for links to information about related conditions.

Here are some key points about vaginismus. More detail and supporting information is in the main article.

  • There are many different forms of vaginismus; symptoms vary from person to person
  • Pain caused by vaginismus can range from mild to severe, and cause different sensations
  • Vaginismus can be caused by emotional factors, medical factors or a combination of both
  • Vaginismus is a leading cause of unconsummated marriages
  • The condition can be treated with a combination of physical and emotional exercises
  • Vaginismus is typically curable.

What is vaginismus?

Vaginismus is a common pain manifestation affecting a woman's ability to have successful vaginal intercourse and is the leading cause of unconsummated marriages.2

Vaginismus can be a lifetime condition or one that only develops after a specific event.

The most common muscle group affected is the pubococcygeus (PC) muscle group; these muscles are responsible for urination, intercourse, orgasm, bowel movements and childbirth.2

Pain elicited by vaginismus varies, ranging from mild to severe in nature and from discomfort to burning in sensation.1,2

There are a number of different types of vaginismus that can affect women in any age category.2 The classifications of vaginismus include:

  • Primary vaginismus: a lifetime condition in which the pain has always been present1,2
  • Secondary vaginismus: occurs following a normal sexual function and has not always been present1,2
  • Global vaginismus: is present during all situations with any object1
  • Situational vaginismus: is present only in certain situations; for example, with sex but not during gynecological exams or tampon insertion.1

Primary vaginismus is often experienced by women during their first attempt at intercourse; the male partner is unable to insert his penis into the vagina and describes "hitting a wall" at the vaginal opening.1,2 This classification of vaginismus not only affects sexual intercourse but can also affect a woman's ability to use tampons and undergo gynecological exams.2

In addition to pain, women may also experience generalized muscle spasms and temporarily stop breathing, symptoms that are reversed when the attempt at vaginal entry is stopped.2

Secondary vaginismus can be experienced at any stage of life and can affect those who have never experienced symptoms of vaginismus before.1,2 Most often, this type of vaginismus is caused by a specific event; an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery or childbirth, for example.2

Unfortunately, even after the underlying medical condition is corrected, pain can continue due to the body's conditioned response which results in the symptoms of vaginismus.2

Symptoms of vaginismus

The symptoms of vaginismus vary person to person and may include:2

  • Painful intercourse (dyspareunia), described as burning, stinging or tightness causing pain
  • Penetration is difficult or impossible
  • Long-term sexual pain with or without a known cause
  • Pain during tampon insertion
  • Pain during gynecological examination
  • Generalized muscle spasm or breathing cessation during attempted intercourse.

Vaginismus does not prevent people from becoming sexually aroused. However, the symptoms may lead people to become anxious about sexual intercourse, instilling a desire to avoid sex or vaginal penetration.3

Causes of vaginismus

Vaginismus is a condition which can be caused by physical stressors, emotional stressors or a combination of the two, and can become anticipatory.2

Emotional triggers of vaginismus

  • Fear - of pain or pregnancy, for example
  • Anxiety - performance anxiety, guilt
  • Issues with a sexual partner - an abusive partner, feelings of vulnerability
  • Traumatic life events - rape, history of abuse
  • Childhood experiences - upbringing, exposure to sexual images.

Vaginismus can be triggered by common infections such as urinary tract infections or yeast infections.

Physical triggers of vaginismus

  • Infection - such as urinary tract infection (UTI) or yeast infection
  • Disease conditions - such as those of cancer or lichen sclerosis
  • Childbirth
  • Menopause
  • Pelvic surgery
  • Inadequate foreplay
  • Decreased vaginal lubrication
  • Medication side effects.

Many people - both males and females - are affected by sexual dysfunction; it is not something that is the individual's fault, nor is it something to be ashamed of. In the majority of cases and with the help of specialists, sexual dysfunction can be resolved successfully.

Tests and diagnosis of vaginismus

Diagnosing vaginismus is a complicated process and may include one or more specialists, including gynecologists, physical therapists, sex therapists, psychologists and counselors.2 During physical evaluation, a medical history and pelvic exam will be performed.2

Making sure that any underlying cause of pain is treated is vital in the diagnostic process for vaginismus, as the condition is commonly diagnosed through the process of elimination.2

Treatments for vaginismus

Vaginismus can be treated successfully with the help of sex therapy specialists.

Surgery will not cure vaginismus and may even worsen the condition.2 In addition, not treating the condition can worsen it, leading to a longer duration and increased intensity with PC muscle contraction.2

The good news is that vaginismus is nearly 100% curable.1-3

Treatment for vaginismus typically includes a combination of:2,3

  • Pelvic floor control exercises: including muscle contraction and relaxation activities (Kegel exercises) to improve control of the pelvic floor muscles
  • Insertion or dilation training: supervised exercises using plastic dilators can help make a patient less sensitive to penetration
  • Education and counseling: information can be provided about the sexual anatomy and sexual response cycle, helping patients to understand their pain and the processes their body is going through
  • Emotional exercises: allowing the patient to identify, express and resolve any emotional factors that may be contributing to their vaginismus.

The time it takes for vaginismus to be successfully treated will vary depending on the individual.1 If you have symptoms relating to vaginismus, speak with your health care provider for evaluation.

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Section Issues On Medicine: Women health