Vaginismus FAQ

What is vaginismus?

Vaginismus is vaginal tightness causing discomfort, burning, pain, penetration problems, or complete inability to have intercourse. It affects a wide spectrum of women, ranging from young girls to older women due to a variety of reasons. Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse.

The tightness is actually caused by involuntary contractions of the muscles surrounding the vagina. The woman does not directly control or will the tightness to occur; it is a limbic system reaction to penetration. She may not even have any awareness that the muscle response is causing the tightness or penetration problem.

In some cases, vaginismus tightness may begin to cause burning, pain, or stinging during intercourse. In other cases, penetration may be difficult or completely impossible.

Vaginismus is the main cause of sexless marriages. 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. The pain of vaginismus ends when the sexual attempt stops, and, usually, intercourse must be halted due to pain or discomfort.

Examples of Vaginismus

In the vaginismus condition, as the man approaches the woman, her vaginal muscles (darkly shaded) involuntarily tightens the vaginal entrance making intercourse painfully impossible or penetration may be successful but may result in burning, discomfort, and pain.

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How do I know if I have vaginismus?

Women often suspect they have vaginismus simply from their symptoms.

Medical Diagnosis:

No definitive medical test exists for the diagnosis of vaginismus so it often takes a number of visits to several physicians or specialists before a medical diagnosis is obtained. Medical diagnosis is typically determined through patient history and description of problem/pain, gynecological examination and the process of ruling out the possibility of other conditions.

In some cases and locations, a solid medical diagnosis is not always available or possible. Sexual pain disorders like vaginismus are commonly misdiagnosed or left unaddressed, especially in nations with fewer health care options. Often women need to strongly advocate for themselves and be very courageous in persevering until their concerns are given due attention and a reliable medical diagnosis is reached. For tips on how to communicate with your health care professional when seeking a diagnosis for sexual pain, see our sample script.

What is the difference between primary and secondary vaginismus?

Vaginismus can be experienced by women at any age or time in life. It has two major classifications: primary vaginismus and secondary vaginismus. The medical community typically uses these terms to indicate the time of onset. These labels assist the medical community and researchers in diagnosis and classification. For the individual woman, the distinction between the two types tends to be of less importance. Whether primary or secondary, both are highly treatable.

Primary Vaginismus

Primary vaginismus usually refers to the experience of vaginismus with first-time intercourse attempts. Typically, primary vaginismus will be discovered when a woman attempts to have sex for the very first time. The spouse/partner is unable to achieve penetration and it is like he “bumps into a wall” where there should be the opening to the vagina, making entry impossible or extremely difficult. Primary vaginismus is the common cause of sexless, sexless marriages. Some women with primary vaginismus will also experience symptoms of having problems with tampon insertion or gynecological exams.

Secondary Vaginismus

Secondary vaginismus usually refers to the experience of developing vaginismus a little later in life, after a period of pain-free intercourse. Medical conditions such as yeast infections, cancer, or thinning of the vaginal walls due to menopause can trigger the vaginismus condition. Vaginismus should be considered when a woman continues to experience ongoing sexual pain after her medical problem has been treated and healed. A woman’s ability to experience orgasms can also be affected as a sudden pain spasm may abruptly terminate the arousal buildup toward orgasm. Some women with secondary vaginismus may also experience difficulty with gynecological exams or tampon insertion due to involuntary tightness.

Variations in the Classifications

Note that these definitions can be a bit restrictive in some cases. For example, some women are able to tolerate years of uncomfortable but bearable intercourse with gradually increasing pain and discomfort that eventually becomes so pronounced that sex is no longer possible. Women may also experience years of intermittent difficulty with entry or movement and have to constantly be on their guard to try to control and relax their pelvic area when it suddenly “acts up.” Vaginismus has a wide range of manifestations, from impossible penetration, to intercourse with discomfort, pain or burning, all resulting from involuntary pelvic tightness (see symptoms).

Are there varying degrees of symptoms with vaginismus?

Vaginismus manifests itself in varying symptoms and degrees of intensity in different women. Fortunately, the treatment method is almost the same regardless of the intensity or specific variation. The symptoms range depending upon type, causes, and complications present. It broadly affects women from all stages of life in that it can be triggered in both younger and older women; in those with no sexual experience and those with years of experience.

It can also be triggered by other pain conditions, surgery, or giving birth, and can pose confusing complications to other pelvic pain problems.

Depending on the intensity, vaginismus symptoms range from tightness causing minor discomfort to total closure of the vagina with impossible penetration. The extensiveness of vaginismus varies from woman to woman.

Will vaginismus go away on its own?

Vaginismus is a self-perpetuating condition that requires treatment to break the cycle of pain and fully resolve.

Since vaginismus is an involuntary, self-perpetuating condition, it will not normally spontaneously resolve unless properly addressed. The cycle of pain that is triggered with vaginismus usually continues indefinitely (and typically worsens) until the woman learns how to control and override the pelvic floor muscle triggers that tighten 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. A full recovery from vaginismus is the normal outcome of treatment, with pain-free intercourse restored.

How many women have vaginismus?

Roughly 2 women in 1000 have vaginismus.

It is commonly accepted that roughly 2 women in 1000 will experience vaginismus. However, that number could be higher. Gathering reliable statistics for vaginismus occurrence is hindered by many factors such as:

1. Due to shame and embarrassment, many women do not seek help.

2. Some women are given an incorrect diagnosis and are never properly treated (or counted). Sadly, some resign themselves to a life devoid of a sexual relationship falsely thinking they can never be helped.

3. Healthcare providers do not normally keep statistics on the number of women specifically seeking help for vaginal penetration problems.

Could vaginismus just be in my head?

The muscle response 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 distinct, sexually crippling, physical side to the condition. It is a condition in which different physical and/or emotional factors may play contributory roles, and so both should be examined as part of the treatment process.

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

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

When penetration or sexual tightness problems first become apparent, it is very common for women to wonder if their vagina is too small for intercourse or has become smaller due to lack of use. Problems with penetration or sexual tightness may occur at any time in life, and are most commonly due to vaginismus, although age related issues may contribute.

Women with first-time sex difficulties, problems inserting tampons, or difficulties with the insertion of a doctor’s speculum during pelvic exams, often mistakenly believe their vagina is too small. In the vast majority of these cases, involuntary constrictions of the vaginal muscles (vaginismus) is the primary cause of the problem.

Exceptions:

1. A short, small, inelastic or absent vagina is a rare condition experienced by a small group of women. It is a symptom of MRKH and vaginal agenesis. Trainer therapy is often prescribed to help enlarge the vaginal space.

2. Unusually thick orinelastic hymensare rare occurrences that may cause penetration difficulties.

Could my hymen be causing my problem?

Hymen problems rarely cause penetration difficulty.

In very rare cases, women with unusually thick hymens may have penetration difficulties because of it. However, in practice, most women who believe their hymen is causing a penetration problem actually have vaginismus. Vaginismus is a much more common cause of penetration difficulties, and the symptoms can be almost identical to that of a hymen problem.

We encourage women suspecting hymen problems to complete a gynecological exam with a knowledgeable specialist where issues like this can be discussed, and seek a second opinion when necessary.

Can my problem still be vaginismus if I've had pleasurable intercourse before and now it hurts?

Vaginismus can occur later in life following years of pain-free or pleasurable intercourse.

Vaginismus can, and frequently does occur later in life following years of pain-free or pleasurable intercourse. This form of vaginismus is called secondary vaginismus. Symptoms may vary widely from simple discomfort to intense burning sensations upon penetration to inability to penetrate altogether.

Sometimes the cause may not be apparent, other times it may stem from a wide range of medical/physical conditions such as discomfort from inadequate lubrication to more painful experiences such as childbirth, surgery, hormonal changes (vaginal atrophy), or other health issues. It can also be triggered in response to a traumatic emotional situation, such as a spouse’s infidelity.

How does vaginismus affect husbands/partners of women with vaginismus?

Sexual problems due to vaginismus can negatively affect a relationship.

Overcoming vaginismus together can deepen and strengthen couple bonds and bring needed restoration. Although women experience the consequences of having vaginismus most acutely and directly, it is important to acknowledge that their partners will also experience a wide range of impacts.

As the ordeal of untreated vaginismus drags on into weeks, months, or years before solutions are found, frustrations mount and the relationship can undergo severe strain. The impacts of vaginismus on men create unique burdens as they often feel helpless and at the mercy of a situation they can’t control.

Understanding Avoidance

It is important for male partners to understand that vaginismus is not something the woman intentionally caused to avoid having sex. The tightening of the vaginal muscles that causes the vagina to “clamp shut” is an unconscious reaction which is involuntary and happens without control or intention.

What is dyspareunia? What is the connection between dyspareunia and vaginismus?

Any type of dyspareunia (general sex pain) may trigger vaginismus (ongoing sex pain or penetration problem from involuntary vaginal tightness).

Dyspareunia [dis-puh-roo-nee-uh]

Dyspareunia is a medical term that simply means “painful intercourse”. It is a general term used to describe all types of sexual pain. Sexual pain may occur upon penetration, during intercourse, and/or following intercourse. It can exist anywhere in the genital area—the clitoris, labia, or vagina, etc. The pain may be described as sharp, stinging, burning, bumping, or cramping.

The Connection Between Dyspareunia & Vaginismus

There are many causes of sexual pain (dyspareunia) and vaginismus is one of these. Vaginismus is uniquely characterized by involuntary tightness of the vagina due to a limbic system response toward vaginismus. With attempts at intercourse, vaginal tightness may cause sexual discomfort, sensations of burning, tightness, pain or inability to penetrate.

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

Vaginismus may impede orgasm in some cases.

Intercourse is not necessary to achieve orgasms. The key to most orgasms for women is clitoral stimulation. However, for some women with vaginismus, the arousal process is interrupted when the intercourse attempt becomes uncomfortable or painful. If a woman’s body reacts to stimulation by triggering the vaginismus response, the tightened muscles may abruptly end the arousal process.

Also, any emotional issues contributing to the vaginismus response may impair a woman’s ability to relax and allow the arousal cycle to proceed or buildup to orgasm. For example, some women have anxieties related to being naked or vulnerable, and this may impair their ability to become aroused to the point of orgasm. Note that orgasm difficulties are not universal. Many women with vaginismus have no trouble achieving orgasms.