What is the difference between primary and secondary vaginismus?

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 are able to tolerate years of uncomfortable but bearable intercourse, until eventually a point is reached where intercourse becomes no longer possible. 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.”

Are there varying degrees of symptoms with vaginismus?

Vaginismus manifests itself through several symptoms and degrees of intensity in different women. Symptoms range from vaginal tightness that causes minor discomfort, to total closure of the vagina with impossible penetration. To some extent, the degree of symptoms depends upon the type, causes, and possible complications present in each case of vaginismus.

In addition, symptoms are not age-specific, as vaginismus affects women from all stages of life—young or old, sexually inexperienced or experienced.

Fortunately, the treatment method for vaginismus is nearly the same and equally effective for all, regardless of cause or symptom intensity.

Will vaginismus go away on its own?

Vaginismus is an involuntary, self-perpetuating condition that must be addressed and treated to break the cycle of pain and be fully resolved.

The cycle of pain triggered by vaginismus usually continues indefinitely (and oftentimes worsens) until the woman either chooses to avoid sex altogether or learns how to control and override the pelvic floor muscle reaction that tightens the vaginal opening. As much as she may like to do so, a woman cannot simply “will” vaginismus away, and it will not go away on its own.

Fortunately, vaginismus treatment has high success rates, with the normal outcome being pain-free intercourse.

How many women have vaginismus?

The frequency of vaginismus among women is largely speculative, with reported estimates ranging from 0.2% to 17%. The lack of an exact statistic is not surprising, considering the hesitance on the part of many women to address the issue out of feelings of shame, embarrassment, fear, or other emotions contributing to avoidance. 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 the prevalence of vaginismus is unknown, but adds that approximately 15% of women in North America report recurrent pain during intercourse (2013). Additionally, it would appear that vaginismus is fairly common, in light of the frequency of patients being referred to sexual dysfunction clinics, sex therapists, and counselors.

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

Why does this happen to some and not others?

For most women, vaginismus comes as a complete surprise, as they are sexually responsive to make love with their partner, but their bodies’ involuntary reaction toward potential 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. Considering the fact that the vaginal muscle-tightening is rooted in the area of the brain—the limbic system, which controls some of our most primitive human responses, the answer to this question can be complex.

Every individual has different perceptions about sex, resulting from their various experiences, attitudes from their upbringing, and genetics. Generally speaking, 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.

Could vaginismus just be “all in my head”?

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.

Is it possible that my vagina is too small? Could it be smaller from lack of experience?

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. Problems with penetration or sexual tightness at any stage in life, sometimes preceded by difficulties inserting tampons or a doctor’s speculum during pelvic exams, are most commonly due to vaginismus (although age-related issues may contribute).

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 type of rare exception is a disorder called Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, or "vaginal agenesis". This condition, which affects approximately one in 4000 – 5000 women, 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.

Could my hymen be the problem?

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.

Can my problem still be vaginismus if I’ve had pleasurable intercourse before, but now it hurts?

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. Like primary vaginismus, symptoms may vary widely, from mild discomfort or burning sensations upon penetration to intense tightness.

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

I can’t seem to have orgasms. Could this be related to vaginismus?

Vaginismus may impede a woman’s attainment of orgasm in several ways.

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.

In addition, any emotional issues connected to the pain or penetration challenges of vaginismus may impair a woman’s ability to relax and allow the arousal cycle to build to orgasm.

Finally, some women have connected anxieties related to being naked or vulnerable during intercourse, which may impede their ability to become aroused to the point of orgasm. It should be noted that difficulty achieving orgasm is not universal among those suffering from vaginismus. Many women with vaginismus have no trouble achieving orgasms outside of intercourse.

Also, be encouraged that overcoming vaginismus effectively neutralizes the limbic response, opening up the restored potential for enjoyable intercourse and orgasm.

Can vaginismus truly be overcome?

Yes, vaginismus can generally be fully resolved, no matter the severity level. Clinical studies have proven this, with participants able to engage in comfortable sexual intercourse in nearly all cases (rates falling under 100% are mainly attributed to participant dropout or lack of consistency in following the resolution process):

 **Clinical studies, including Schnyder, Schnyder-Luthi, Ballinari & Blaser (1998) and Lankveld, Everaerd & Grotjohann (2001), have also shown the effectiveness of the self-help approach.

Does the resolution approach work for severe cases?

Yes. Patients 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 patients.

Can sex feel good again after vaginismus?

Yes. One can realistically expect to achieve or be restored to pain-free, pleasurable intercourse after treatment.

Is it too late for vaginismus treatment?

Vaginismus has high treatment success rates, even after long periods of time with the condition. In fact, many women overcome vaginismus surprisingly quickly 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.

Do I need to identify the original cause of vaginismus in order to get over it?

Surprisingly no, not normally. Vaginismus recovery is successful even in the absence of a clear understanding of the original cause 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.

Should I work with treatment specialists, physical therapists, psychologists, etc.?

Getting additional support from a specialist is a case-by-case decision, affected by each woman’s specific needs and medical history. While the self-help approach is very effective, specialist care can often be of great assistance in working through areas of particular difficulties causing any progress delays.

Can vaginismus recur once it is successfully treated?

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.

Can you overcome vaginismus if you are single?

Yes. If you are single and experiencing the effects of vaginismus, you may be worrying yourself with questions such as: "How can I get over vaginismus when I do not have a partner? How can I start a new relationship, knowing that I have vaginismus? Will I be alone forever? How can I break out of this cycle?" Perhaps you have even been in a relationship that did not survive this condition.

Whatever your relationship status, overcoming vaginismus is possible and important. 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.

You may also find that the increased sexual confidence and improved self-image you gain from vaginismus recovery are conducive to attracting and participating in a new relationship.

As a doctor, how will your program help my patients?

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

• Easy-to-understand format with detailed illustrations.
• Patients can progress in the comfort and privacy of their home under consultation as required.
• "Guess-work" is largely eliminated.

The program materials encourage untreated women to confidently move toward resolution via the practical methodology presented.

I can’t even look at myself and feel queasy just thinking about any type of vaginal insertion. How will I ever be able to make it through treatment?

The human mind has an amazing capacity to grow past challenges. Knowledge with an affirming program go a long way in reducing and overcoming paralyzing fears.

Our program is presented in a progressive format, successful even for those with strong aversions in most cases. Positive encouragement and troubleshooting strategies are offered throughout each phase of the process.

What if my partner isn’t supportive?

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 patients to move forward with treatment regardless of negative partner attitudes. Active progress stirs hopefulness; many partners become more willing to get involved later.

In some cases professional counseling may be required to work through upset feelings and disappointment; and partners need grace and understanding as well. If your partner is apathetic, pushes too hard, makes mistakes, or does not listen to implicit instructions, he may need your forgiveness, additional encouragement, communication, and more chances to improve.

We understand that disappointment and frustration over vaginismus can wear away at the very foundation of a relationship. Sometimes, it may seem easier to tolerate the condition itself than to deal with the emotional and physical effort required to seek out and work toward a solution. Yet, untreated vaginismus will likely result in eventual deterioration of the relationship, as the physical and emotional needs met by sexual intimacy are not fulfilled. Resolving vaginismus usually brings the couple closer again.

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