Answers to commonly asked questions about vaginismus!

Vaginismus is vaginal tightness causing discomfort, burning, pain, penetration problems, or complete inability to have intercourse. Vaginismus is also referred to as a genito-pelvic pain/penetration disorder.

Vaginismus [vaj-uh-niz-muh s]

Vaginismus is a condition where there is involuntary tightness of the vaginal muscles (also known as pelvic floor muscles) during attempted intercourse. 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.

In some 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. In other cases, vaginismus tightness may begin to cause burning, pain, or stinging during intercourse. The pain of vaginismus ends when the sexual attempt stops, and intercourse may be halted due to pain or discomfort.

The frequency of vaginismus among women is largely speculative, with reported estimates ranging from 0.5% to 17%. The lack of an exact statistic is not surprising, considering the hesitance on the part of many women to seek help, due to shame, embarrassment, and uncertainty. In addition, healthcare providers do not normally keep statistics on the number of women specifically seeking help for vaginal penetration problems.

The DSM-5* states that approximately 15% of women in North America report recurrent pain during intercourse. Based on conservative estimates, hundreds of thousands of women experience some form of vaginismus.

*The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a diagnostic guide used by medical, mental health, and academic communities.

Both sexually experienced and inexperienced women can develop vaginismus. This chart outlines some of the general differences between the categories.

Primary Vaginismus
• sexually inexperienced
• penetration problem apparent at first attempt
• sexual penetration may seem physically impossible
• unconsummated couples
• sometimes difficulty inserting tampons/undergoing pelvic exam

Secondary Vaginismus
• sexually experienced
• previously normal sex life
• ongoing vaginal tightness, discomfort, pain with intercourse
• usually precipitated by medical condition, menopause, traumatic event, childbirth, surgery, etc.
• sometimes difficulty with pelvic exam

Primary vaginismus refers to the condition occurring with first-time intercourse attempts. Typically, a woman with primary vaginismus becomes aware of the issue when she tries to have sex for the very first time. Her spouse or partner is unable to achieve penetration; for him, it seems like there’s a wall where the vaginal opening should be, which makes consensual sex impossible or extremely difficult. Some women with primary vaginismus may experience earlier symptoms, including difficulty with tampon insertion or challenges in gynecological exams.

The term secondary vaginismus applies to the condition that occurs later in life, after the woman has been enjoying pain-free intercourse, but now experiences tightness and discomfort during intercourse. A variety of medical conditions, such as yeast infections, cancer, or thinning of the vaginal walls due to hormonal changes at menopause, can trigger secondary vaginismus. A diagnosis of vaginismus should be considered when a woman continues to experience ongoing vaginal tightness and sexual pain, even after her initial medical problem has been fully resolved.
It should be noted, however, that despite these classifications of the condition, variations occur. For example, some women tolerate years of uncomfortable but bearable intercourse, until eventually a point is reached where intercourse becomes no longer tolerable. Other women may experience years of intermittent difficulty with penis entry or movement, rendering them constantly wary and vigilant to try to control and relax their pelvic area when it suddenly “acts up.”

Vaginismus is an involuntary, self-perpetuating condition that normally needs to be addressed and treated to resolve.

The cycle of pain and tightness triggered by vaginismus usually continues indefinitely (and oftentimes worsens) until the woman either chooses to avoid sex altogether or addresses it by learning how to control and override the pelvic floor muscle reaction that tightens the vaginal opening. Fortunately, vaginismus treatment has high success rates, with the normal outcome being pain-free intercourse.

Some additional causes of painful intercourse are listed below. It is important to note that vaginismus can coexist with these medical conditions or continue to be present even after the condition has been resolved.

Eczema/Dermatitis (Vulvar): A skin condition that is often characterized by unbearable itchiness. The patches of skin often become thickened, inflamed, and develop thin cracks. There are several different types of eczema, with varying causes and treatments.

Endometriosis: A condition in which tissue from the lining of the uterus (endometrial tissue) grows outside the uterus and attaches to other organs in the abdominal cavity—most often the ovaries and fallopian tubes. Symptoms may include painful menstrual periods, heavy menstrual bleeding, pain during and after sexual intercourse, and infertility. Endometriosis is a common cause of pelvic pain.

Interstitial Cystitis: The chronic and often severe inflammation of the bladder wall. The cause is usually unknown, but symptoms include high frequency and urgency of urination, sometimes accompanied by pelvic pain.

Lichen Sclerosus: A painful skin disorder that typically affects the vulva and/or anus in women. Symptoms include itching and/or burning, thinning skin, white patches of skin, sores or ulcers from scratching, and pain during sexual intercourse. If not treated, lichen sclerosus can lead to fusing of the skin, atrophy, and narrowing of the vagina.

Ovarian Cyst: An ovarian cyst is any collection of fluid within the surface of an ovary. Any ovarian follicle that is larger than about 3/4" [20 mm] is termed an ovarian cyst. Symptoms may include pain or pressure in the abdomen, problems with urine flow, and pain during intercourse.

Pelvic Inflammatory Disease (PID): A general term for infection of the lining of the uterus, the fallopian tubes, or the ovaries. It is a common result of infection with sexually transmitted diseases.

Post-Surgical Trauma/Scarring: Sometimes following vaginal surgery or pelvic surgery, there can be tissue scarring that had been torn or cut during the procedure.

Psoriasis: An itchy skin condition characterized by raised, red patches of skin covered with silvery scales. When located in the vulvar area, however, the skin is usually less scaly or raised.

Sexually Transmitted Disease (STD): Herpes, human papilloma virus (HPV), and other STD’s can cause discomfort and pain during sexual intercourse.

Trauma of the Vaginal Canal & Vulva During Childbirth: Birth trauma, whether due to difficult labor and/or multiple labors, can result in internal vaginal tears, decreased estrogen levels, less lubrication of the vaginal canal, weakening of the pelvic floor muscles, tearing and scarring of the perineum, and sometimes idiopathic deep pelvic pain. Temporary pain during intercourse can be a consequence of any of these conditions, but if the pain continues to be ongoing it is likely due to secondary vaginismus.

Urinary Tract Infection (UTI): Infection of the urinary tract (kidneys, bladder, urethra), usually caused by bacteria.

Vaginal Atrophy (Atrophic Vaginitis): The inflammation of the vagina due to diminishing estrogen levels results in thinning and shrinking tissues, and reduced lubrication of the vaginal walls. Vaginal atrophy is characterized by vaginal dryness, itching or burning, discomfort, and/or painful sexual intercourse. It typically occurs following menopause—when estrogen levels are lower—or in younger women, immediately after childbirth or while breastfeeding. However, it can also occur following chemotherapy or radiation, due to the ovaries not functioning properly from cancer and treatment. See Age Changes for more information.

Vaginal Irritation: Feminine hygiene products, douches, soaps, powders, detergents, and overly tight underwear/pants can all cause irritation of the vaginal area, leading to discomfort and/or pain during sex.

Vaginal Prolapse: The term “prolapse” generally means an organ slipping out of its proper place. Vaginal prolapse can be due to a variety of factors including hysterectomy, menopause, obesity, difficult labor, and/or weak pelvic floor muscles. Symptoms of this condition include urinary incontinence, pain during intercourse, constipation, and/or vaginal heaviness or pain.

Vulvar Cancer: A rare type of cancer in which cancer cells are found in the vulva. It is often misdiagnosed as a yeast infection.

Vulvodynia: Chronic vulvar discomfort or pain, characterized by burning, stinging, irritation, or rawness of the female genitalia when there is no infection or skin diseases of the vulva or vagina that is causing these symptoms. Two subtypes of vulvodynia are:

1. Vulvar Vestibulitis (Vestibulodynia, Localized Vulvodynia, Vestibulitis): This is a type of vulvodynia specifically associated with pain from touching and/or pressure in the vestibule, which is the area within the inner lips surrounding a woman's vaginal opening. There is almost always pain with sexual intercourse. *
2. Dysesthetic Vulvodynia (Generalized Vulvodynia): Pain may be present in the outer lips (labia majora), inner lips (labia minora), and/or the vestibule (area surrounding the vaginal opening). Women have also indicated pain in the clitoris, the mons or pubic mound, the perineum, and/or the inner thighs. The pain can exist in one or all of these areas and may be continual or intermittent. Also, pain from this condition may be experienced even when nothing is touching the area. *
   

*Definitions for vulvodynia are from The International Society for the Study of Vulvovaginal Disease and the National Vulvodynia Association.

Yeast Infection (Vulvovaginal Candidiasis): Vaginal infection characterized by severe itching, vaginal discharge, soreness or irritation, burning sensation, and pain during sexual intercourse. There also may be burning discomfort during urination.

The muscle response that characterizes vaginismus can be attributed to a limbic system reaction and is not under the immediate direction or control of the woman. Therefore, regardless of the causes of vaginismus, there is always a real, sexually crippling, physical side to the condition.

Fortunately, women are able to overcome the vaginismus penetration problem without fully knowing what originally triggered it.

When a young woman experiences penetration difficulties or vaginal opening tightness during intercourse, it is rarely due to a small or abnormal vagina, and nearly always due to vaginismus.

When these issues first become apparent, it is very common for women to wonder if their vaginas are too small for intercourse or have become smaller due to lack of use. In the vast majority of these cases, involuntary constriction of the vaginal muscles (vaginismus) is the primary cause of the problem.

One rare exception is a disorder called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome also known as vaginal agenesis. This condition results in the vagina and uterus being either absent or underdeveloped, even though external genitalia are normal. Stretching the vaginal space with vaginal dilators is often prescribed as treatment.

In older women, hormonal changes due to menopause can result in a condition called vaginal atrophy. The vagina in essence shrinks by becoming narrower and shorter as well as drier and less elastic. As result, sexual intercourse may become more difficult and uncomfortable. See Vaginal Atrophy page for more info.

Yes, it is possible, but very unlikely. The hymen almost never causes penetration difficulties. It is a thin, stretchy membrane that normally pulls apart or simply stretches out of the way. What some might suspect to be a hymen penetration problem is almost always unrecognized tightness from vaginismus. Vaginismus is the common cause of penetration difficulties, and the symptoms are almost identical to those one might associate with a hymen problem.

We encourage women who suspect they have issues with their hymen to complete a gynecological exam by a knowledgeable medical professional so that issues like this can be discussed. In very rare situations, surgery for an overly thick or rigid hymen may be warranted, but it is certainly wise to seek a second opinion before having the procedure.

Vaginismus can, and frequently does, occur later in life following years of pain-free or pleasurable intercourse. The late onset of this condition is called secondary vaginismus. Symptoms may vary widely, from mild discomfort or burning sensations upon penetration to intense tightness.

Review Causes to learn about factors that may contribute to developing secondary vaginismus.

For most women, vaginismus comes as a complete surprise. They are sexually responsive to make love with their partner, but their bodies’ involuntary reaction toward intercourse prevents them from satisfying this natural drive. This can result in extreme frustration for women and their partners.

Many women with vaginismus wonder why their internal alarm is overreacting when it seems like everyone else is having sex without issue. The answer is that the vaginal muscle-tightening is rooted in the limbic system—which controls some of our most primitive human responses—and the causes are complex.

Every individual has different perceptions about sex, resulting from their various experiences, attitudes from their upbringing, and genetics. Generally, for women with vaginismus, there are unhealthy messages related to sex that are interpreted by the limbic system as threatening.

Sometimes, vaginismus can be tied to a combination of apparent experiential and mental/emotional causes, such as a traumatic experience (rape, abuse). On the other hand, there may seem to be no direct cause for the vaginismus, and frequently, contributing factors can be so subtle and numerous that they are never completely identified by doctors or specialists.

Yes, vaginismus may impede a woman’s attainment of orgasm. Intercourse is not normally necessary for a female to achieve orgasm, with clitoral stimulation being a more significant factor in this regard. Yet, for those with vaginismus, the arousal process leading to orgasm can be interrupted early by a limbic response.

The body, simply anticipating the potential for pain or concern, can trigger a fight-or-flight reaction that shuts down the arousal cycle and ends the build up toward orgasm. If any sexual stimulation causes direct discomfort or pain, the limbic response similarly will bring a swift end to the escalation of excitement and arousal preceding orgasm.

Vaginismus is highly treatable. When a robust program is followed, treatment outcomes are nearly always positive and successful, with full resolution.

Vaginismus Treatment | Success Rates
Rate | Independent Study Cited
100% | Biswas & Ratnam, 1995
Nearly 100% | Butcher, 1999
98-100% | Masters & Johnson, 1970
97.7% | Schnyder, Schnyder-Luthi, Ballinari, & Blaser, 1998
95% | Katz & Tabisel, 2002
91.42% | Nasab & Faroosh, 2003
87% | Scholl, 1988
75-100% | Studies cited in Heiman, 2002

Treatment Success
Vaginismus is considered the most successfully treatable female sexual disorder. Many studies have shown treatment success rates approaching nearly 100%. The self-help approach is based on extensive research into the causes and treatment of vaginismus and includes a complete step by step process with easy-to-follow, practical treatment solutions. This approach has been used successfully by thousands of women and medical professionals.

The chart above lists some of the published clinical statistics for the success of vaginismus treatment. Clinical statistics for treatment success vary from study to study, but nearly all independent studies show high success rates. Clinical treatment methodology primarily involves using a combination of desensitization exercises and behavioral instruction. The percentages listed represent the portion of women able to engage in pain-free penetrative sexual intercourse following treatment. Though there are some failures, these are usually attributed to couples dropping out or not completing treatment. For couples who complete treatment, outcomes are nearly always positive and successful, with full resolution.

References

• Biswas, A., & Ratnam, S. (1995). Vaginismus and outcome of treatment. Ann Acad Med Singapore, 24(5), 755-758.
• Butcher, J. (1999). ABC of sexual health: Female sexual problems II: Sexual pain and sexual fears. BMJ, 318, 110-112.
• Heiman, J. (2002). Sexual dysfunction: Overview of prevalence, etiological factors, and treatments. J Sex Res, 39(1), 73-78.
• Katz, D., & Tabisel, R. (2002). Private pain: It's about life, not just sex. Plainview, NY: Katz-Tabi Publications.
• Masters, W., & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown & Co.
• Nasab, M., & Farnoosh, Z. (2003). Management of vaginismus with cognitive-behavioral therapy, self-finger approach: A study of 70 cases. IJMS, 28(2), 69-71.
• Schnyder, U., Schnyder-Luthi, C., Ballinari, P., & Blaser, A. (1998). Therapy for vaginismus: In vivo versus in vitro desensitization. Can J Psychiatry, 43(9), 941-44.
• Scholl, G. (1988). Prognostic variables in treating vaginismus. Obstet Gynecol, 72, 231-35.

Successful resolution of vaginismus in reasonable time is the normal outcome of using an effective program for vaginismus treatment. Motivated women without significant complications usually find that 3-8 weeks is adequate.

An advantage of a self-help approach is that you can work at a pace which is comfortable and private. For those who are highly motivated, treatment may be fast-tracked (Masters & Johnson supported two-week intensive therapy for treating vaginismus).

Factors affecting vaginismus recovery time
A program | Using a developed program instead of 'winging-it'
Avoidance | Persisting through recovery in a consistent manner
Motivation | Maintaining motivation and remembering goals
Physical health | Overall health and fitness, particularly pelvic floor
Medical complications| Medical or physical conditions that complicate progress
Daily life demands | Competing demands, distractions of career, family, school, etc.
Emotional barriers | Depression, apathy, anxiety, fears, or other emotional barriers
Personal history | Abuse, family dysfunction, trauma, other personal challenges
Partner support | A supportive, cooperative partner involved in the treatment process as needed
Professional support | The direct guidance and support of professionals if needed
Other support | Connecting with other women going through recovery (see Support)

Treatment duration is not necessarily correlated to the severity of the condition. However, if recovery extends beyond 2-3 months, we strongly encourage seeking additional support from professionals specialized in vaginismus treatment, or in the areas of specific challenge, such physical therapists with a specialization in pelvic floor therapy, sex therapists, psychologists/counselors versed in intimacy issues, and gynecologists experienced in female sexual pain issues.

The self-help program has been instrumental in assisting women through the process of recovery - see Reviews for practical, real-life examples.

When used properly, vaginal dilators can be very effective tools in helping to eliminate vaginal muscle tightness, burning, and penetration difficulties. Dilators provide a substitute means to trigger the vaginal muscle reflex in a sex-like context while allowing women to have precise control over the size, speed, and angle of insertions.

New muscle memories are created as women learn how to override the involuntary muscle contractions while simultaneously desensitizing their vaginal muscles, body, and mind to the sensation of having something in their vagina. Vaginal dilators help women retrain their bodies to respond correctly to penetration and to transition to pain-free intercourse.

Contrary to popular belief, the focus of dilator use in treating vaginismus is not to simply stretch the vaginal tissues or vaginal opening, but rather to assist women to gain control of their pelvic floor.

Women with penetration difficulties related to vaginismus often mistakenly assume that dilators are used to stretch the vaginal opening so that it will be larger, when in fact, the penetration problems are not related to the size of the vagina but rather to problems with involuntary tightness of the pelvic floor. Dilators together with pelvic floor exercises are used to gain control over the involuntary tightness.

The name vaginal dilator is actually a bit of a misnomer, since dilator use is not normally focused on dilation (which means to make wider or larger). For this reason, some specialists refer to them as vaginal trainers or spacers.

For some women, especially those who are recovering from pelvic surgery or suffering from hormone changes like menopause, the dilators serve a dual purpose—both for the gentle stretching of vaginal tissues (vaginal atrophy) and in relieving the vaginal tightness of vaginismus.

Continuing failing intercourse attempts may cause further complications and setbacks. Couples are encouraged to continue pleasuring each other in non-penetrative ways while working to resolve vaginismus.

During the initial steps of the vaginismus treatment process, we recommend that couples discontinue penetrative intercourse attempts. When intercourse is attempted prematurely, resulting in pain and discomfort, it may further entrench the vaginismus response of involuntary pelvic tightening. In addition, there may be increased emotional anxieties, fear of more pain, feelings of disappointment, or other setbacks. For these reasons, until control of the pelvic floor is developed it is wise to avoid potentially painful attempts at intercourse. As the program progresses, there will be a transition to intercourse.

In the meantime, we strongly encourage couples to continue to pleasure each other in non-penetrative ways while the program progresses to maintain closeness. Some couples report that these times have built greater intimacy and ultimately enhanced their lovemaking as they learned other ways to pleasure each other.

Surprisingly no, not normally. Vaginismus recovery is successful even in the absence of a clear understanding of the original causes of the condition. However, if there are co-existing, ongoing medical problems that are triggering a body reaction, for example an untreated sexually transmitted disease that is causing pain, it may become necessary for simultaneous medical care and a more comprehensive diagnosis from your physician.

The book and eBook programs clearly and comprehensively explain how to fully overcome vaginismus:

• The program provides an understanding of successful treatment methodology widely in acceptance and practiced among treatment specialists.
  
• Easy-to-understand format with detailed illustrations.
  
• Step by step practical approach with many tips and treatment strategies provided.
  
• Patients can progress in the comfort and privacy of their home under consultation as required.
  
• "Guess-work" is largely eliminated.

The program materials encourage women to confidently move toward resolution.

See Reviews section for feedback from professionals.

While the self-help approach is very effective, specialist care can often be of great assistance especially in working through any difficult areas causing delays in resolution. Examples of helpful professionals may include physical therapists with a specialization in pelvic floor therapy, sex therapists, psychologists/counselors versed in intimacy issues, and gynecologists experienced in female sexual pain issues.

Once overcome, vaginismus does not normally recur because the process of resolving it teaches the woman permanent control skills over her body that neutralize any symptoms. Having sexual intercourse on a regular basis also helps to maintain positive muscle memory.

Although vaginismus is not considered fully resolved until pain-free sexual intercourse takes place, single women can complete all the exercises taking them to that point. Being proactive by preparing in advance for sexual intimacy by seeking help to resolve sexual pain issues is a sign of emotional strength and maturity. The increased confidence and improved self-image many women gain from addressing their vaginismus is conducive to attracting and participating in a new relationship.

Not everyone has a partner who is sympathetic, understanding, or willing to work together in recovery. Feelings of discouragement or rejection can overwhelm and leave us wondering what to do. Yet, reluctant partners often begin to change when they perceive that progress is beginning to take place, so we encourage moving forward with treatment regardless of negative partner attitudes. Active progress stirs hopefulness; many partners become more willing to get involved later.

Professional counseling may be beneficial to help resolve fractured relationships where unmet expectations and disappointment continue to persist and impede the treatment process.

Even with a wholly unsupportive partner, most women become more confident and stronger in themselves through program completion, benefiting all aspects of their lives.

Yes. Women with acute vaginismus, such as those unable to insert a penis or even a tampon into a vagina, overcome their condition through the same process as less severe cases.

The human mind has an amazing capacity to grow past challenges. Knowledge along with an affirming program goes a long way in reducing and overcoming paralyzing fears. Our program, successful even for those with strong aversions in most cases, is presented in a progressive format where exercises build on one another including preparatory exercises prior to intimate touch and insertions. Positive encouragement and troubleshooting strategies are offered throughout each phase of the process.

Vaginismus has high treatment success rates, even after long periods of time with the condition. In fact, many women overcome vaginismus surprisingly quick once treatment begins, even after decades of struggling with its painful symptoms. The treatment process is generally the same, whether a woman has suffered for one month or thirty years, with some minor variations possible in cases where there are age-related complications.

Couples that are in the transition phase, or that have overcome vaginismus and are now able to have pain-free intercourse, may find that their passion for each other has disappeared because of the ongoing trials of vaginismus. Couples can be encouraged that the flame of passion can be re-ignited with effort and persistence.

The following ideas are just some of the approaches couples have used to regain lost passion:

Re-igniting the passion

• Talk together about what can be done to enhance the passion in the relationship. Freely discuss ideas and try to follow up with action.
• Passionate kissing - Spend a little time each day kissing passionately (with no pressure to have sex). This doesn't have to take a lot of time, simply 5-10 minutes will do.
• Wake up 10-15 minutes early each morning and spend some time cuddling with each other.
• Spend time with your partner just having FUN together again.
• Spend more time thinking positively about your partner throughout your day. Remember positive moments of love from the past and reflect warmly about him or her.
• Improve or refresh your personal appearance. Could you use a haircut? Lose a few pounds? Update your wardrobe? etc.
• Give yourself permission to fully be a sexual person. Allow your husband to LOVE you. Accept his love (and vice-versa).
• If you are not the one who normally initiates - surprise your mate!
• Go away for a weekend together.
  Spend more time on sensate focus - experiment.
• Spice up your sexual routine with each other, e.g., Wear a new outfit, listen to different music, light scented candles, make love in front of the fireplace.
  

Erection difficulties/dysfunction (ED) are experienced by a significant number of men. In some cases, the problem may result from, or be amplified by, interaction with a spouse who has vaginismus.

It is not unusual for some couples who have struggled to overcome vaginismus to also face erectile difficulties. Going from an environment of ‘"no sex - it hurts” to performance on demand (maintaining an erection and slowly inserting on cue) can be a difficult transition to make. If erectile issues are persistent and do not appear to be resolving on their own, medical attention should be considered.

When erectile difficulties are perceived to be due to the emotional stress of the vaginismus condition, a medical exam is still recommended to potentially eliminate any physical issues that may be contributing. If possible, it may be helpful for men to obtain a referral to a urologist specializing in ED. Counseling with a specialist who is familiar with both vaginismus and ED may also be beneficial.

Careful attention to balancing the needs of each partner will help couples to positively transition through this time. Couples should balance the needs of the male to have a reduction in performance pressure with the needs of the female to practice intercourse to fully overcome vaginismus. Some couples find that temporary use of medication to treat ED and allowing a period (e.g., two weeks) to engage in intimacy free of pressure to have intercourse is helpful in addressing erectile difficulties. Exercising more and reducing overall stress and anxiety may also be helpful.

One of the more heartbreaking complications of vaginismus is the inability to conceive a child. The longer a woman lives with vaginismus, the more she begins to think biological children may never be a reality in her life. The deep longing to have a baby can be overwhelming and if a biological clock is ticking, her longing can turn to desperation. Questions from family and friends like "When are you going to give us a grandchild?" or "Isn't it about time you started a family?" can add pressure and increase a woman's shame. The silence surrounding vaginismus often keeps women from explaining why they are unable to conceive.

We certainly sympathize with those whose biological clock is loudly ticking and support them in their efforts to conceive. If possible, we recommend continuing to work at overcoming vaginismus while exploring pregnancy options. Resolving vaginismus prior to having children allows pregnancy, childbirth, and parenting all to take place without the negativity of vaginismus being present. Overcoming is life-changing and can be a wonderful boost to a marriage that has been beaten down by the challenges of vaginismus.

Alternative methods for conception are possible. There are women with vaginismus who have become pregnant with either partial intercourse or ejaculation at the vaginal entrance, by using medical/fertility procedures such as intra-uterine insemination (IUI), or 'turkey baster' type methods. Compared to normal intercourse, the chances of getting pregnant by these techniques are generally lower. Note that in all cases, we recommend consultation with a physician to discuss pregnancy options and issues

Some, but not all women with vaginismus, will experience vaginal tightness during even simple routine pelvic exams. For this reason, vaginismus may present problems during prenatal care visits, vaginal ultrasounds, or pre/post-delivery pelvic exams. The best solution for these problems is to gain control over the involuntarily tightening of the pelvic floor muscles that make both intercourse and pelvic exams difficult. In many cases, a vaginismus program can be completed while still in the early stages of pregnancy and can improve comfort with physician interaction throughout the entire delivery process. Be sure to consult with your physician for individualized care prior to any forms of vaginismus treatment.

An added benefit of going through the self-help program is that the muscle control exercises will complement and overlap with prenatal Kegel pelvic tone exercises. This will help with the prenatal exams as well as help gain more control over the vaginal muscles to assist with the pushing process during delivery and potentially improve the delivery experience.

For those unable to proceed with treatment prior to delivery, there are some steps that may reduce the impacts of vaginismus. For starters, it is important to let your physician or midwife know you have the condition. There are accommodations that can be made to make you more comfortable including positioning changes and limiting the number of internal vaginal exams to only those which are necessary. Vaginal ultrasounds are not always necessary, and alternatives may be available. Consult with your physician for further details and options.

Unresolved vaginismus will not typically impede the actual vaginal delivery process. Childbirth is experienced normally, the same as it would be for those without vaginismus. There is a flow of hormones released during the birthing process that work together to facilitate labor and delivery. In particular, the hormone oxytocin stimulates powerful contractions that help to thin and dilate the cervix and move the baby down and out of the birth canal. Pain medication, such as epidurals are usually available if so desired.

The birth process does not normally cure or alleviate vaginismus significantly. Some women may experience minor improvement resulting from the birthing process, but others may see their condition worsen because of delivery trauma or recovery pain.

It is important to highlight that vaginismus is not cured or treated by simply stretching the vaginal opening. With vaginismus, the problem is not with the size of the vaginal opening but with involuntary tightness caused by the muscles surrounding the vagina.
The treatment process includes exercises designed to develop control over the pelvic floor musculature to eliminate this tightness.

Childbirth can cause vaginismus, especially if a woman has experienced physical or emotional trauma during the birth process, e.g., from a difficult or prolonged delivery.

Intercourse following childbirth may be uncomfortable or painful as well, due to temporary vaginal bruising, procedures such as episiotomies (surgical incision to enlarge the vaginal opening quickly during delivery), tearing of the perineum (area between the vulva and anus), attempting to have intercourse before healing from childbirth is complete, and/or vaginal dryness due to hormonal changes/breastfeeding. Any of these types of experiences may trigger vaginismus as an ongoing problem.

It is normal to have some vaginal tenderness when having sex after childbirth. However, ongoing penetration difficulties or pain may be due to vaginismus and should be further evaluated by a doctor.

Reducing the likelihood of developing post-natal vaginismus

There are several things that can be done to help reduce the chances of experiencing vaginismus following delivery, and to help make the resumption of intercourse as positive an experience as possible:

• Unless your doctor has told you otherwise, continue having sex throughout your pregnancy.
• Combat any fears regarding the birthing process with facts. Discuss fears or concerns with midwives, nurses, or physicians. Become educated and knowledgeable about the birthing process.
• Most women have positive birth experiences. To help reduce any anticipation of pain fears, avoid listening to or focusing on horror birth stories. If fears of delivery pain loom large, remember that epidurals and other medical intervention is usually available if chosen. Consult with a physician for pain management strategies.
• Keep a positive mind-set and attitude - “Women give birth every day. If they can do it, I can do it.”
• Postpartum wait 6 weeks as recommended by most physicians to resume intercourse. This is important as it allows the vaginal canal to heal so that no physical pain is initially experienced in the transition back to intercourse following delivery.
• Take things slowly - first time sex after delivery should be relaxed with slow movements and lubricate heavily as there are often hormonal changes post-pregnancy especially when nursing, which can cause vaginal dryness.
• Do not be surprised if sex initially seems different than before. Emotional stress and fatigue brought on by demands of parenting along with hormone fluctuations can make a woman feel less than sensuous. Also, making the transition from being mommy to lover may take some adjustment.
• See a physician immediately if there is any post-delivery pelvic pain to avoid triggering vaginismus. There may be the possibility of infection, or some other problem that could be easily resolved without long-term effect.