Vaginismus FAQ

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  • Treatment
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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.

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.
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.

How successful is vaginismus treatment?

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 step-by-step process with easy-to-follow, practical treatment solutions. This approach has been used successfully by thousands of women and medical professionals. 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.

How long does treatment take?

Successful resolution of vaginismus in reasonable time is the normal outcome of vaginismus treatment.

Vaginismus can normally be treated and fully overcome in a reasonable time frame. Motivated women without significant complications usually find that a month is adequate to resolve their sexual pain or penetration problems.

Research has shown that even two-week time frames are potentially realistic where there is an intense “full-time” effort, professional assistance, and no significant complications. Masters & Johnson were original pioneers of the two-week intensive therapy window concept for successfully treating conditions such as vaginismus.

Will sex ever feel good?

Pain-free, pleasurable intercourse is achievable for most women overcoming vaginismus, as vaginismus has high treatment success rates. Pleasure is not really achievable when pain is present. Eliminating the pain is a necessary first-step in the process of receiving sexual pleasure.

Sometimes, it is hard to imagine sex as pleasurable when tightness, pain, burning, or impossible penetration is experienced. Every story of recovery is different, but most often there will be a transitional phase as couples first transition to intercourse without pain and then on to intercourse with growing pleasure.

Note that it is important that couples practice intercourse regularly following vaginismus treatment. This gives the woman’s mind and body the necessary opportunity to develop entrenched muscle memories.

Maintaining regular intercourse also helps couples fine-tune their sexual experience to improve and enhance the ongoing experience of pleasure.

Is there any further support with the vaginal dilator sets?

Virtual Support Group
Our new virtual support group is is a safe place for women and couples to receive practical information, solid advice, and encouragement from experts in vaginismus and marriage, as well as other people going through the self-help program.
Any person who subscribes to the support group can openly participate. Some members may silently watch others for encouragement, while others become active participants in the many encouraging and informative topics.
The primary goal of the group is to provide a network of support for women who are actively working to overcome vaginismus.
Examples of topics covered in our group include questions specific to each step of the self-help program, relationship issues, emotional issues, pregnancy, personal stories, gynecological exams, age-related issues, and many other vaginismus-related focuses.
Private Facebook Community
The private Facebook community is a place for women and couples to connect on a more personal level. Women from around the world can talk about their lives or ask questions about treatment. We find that even online, as women begin to open up about their problem, they become more positive about the condition of vaginismus because they no longer feel as isolated.
Live Chat and Phone Support
Where other support methods are insufficient, we provide phone-based guidance and support.
Email Support
We strive for the highest possible quality email support. Couples can email us anytime with any questions, concerns, or feedback.
In keeping with our mission, we do not charge for any of these support methods and provide free ongoing help for those going through vaginismus treatment to the best of our abilities.

Is there a difference between the treatment for primary and secondary vaginismus?

Treatment differs only slightly, depending upon the type and causes. There are only minor differences in the treatment of primary and secondary vaginismus. Women undergoing treatment for secondary vaginismus may find they can bypass certain sections, especially those dealing with emotional triggers, and possibly shorten overall treatment duration.
With secondary vaginismus, the treatment focus is mainly on learning conscious control of the vaginal muscles to eliminate tightness, although other steps are involved. There are usually fewer emotional triggers and so less necessity to work through psychological or emotional issues, unless the circumstances that preceded the vaginismus included experiences of that nature (such as rape or other sexual trauma).

Should i stop trying to have intercourse during vaginismus treatment?

Failed intercourse attempts further complicates treatment. 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 limbic system’s negative reaction toward penetration. In addition, there may be increased emotional anxieties, fear of more pain, feelings of disappointment, physical complications or other setbacks.
In the meantime, we strongly encourage couples to continue showing affection toward one another while the program is completed 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.

Is it too late for vaginismus treatment?

Success is the normal outcome of treatment regardless of the number of years the condition has been present. Vaginismus has high treatment success rates, even after long periods of time. Many women overcome vaginismus surprisingly quickly once treatment begins, even after decades of struggling with vaginismus. The process is generally the same whether a woman has suffered for one year or forty years, with usually only minor variations for age-related complications.

Does the self-help approach only work for mild or marginal cases of vaginismus?  Will it work for severe cases as well?

Countless numbers of women with acute, severe vaginismus (such as where the women are unable to insert anything into their vaginal opening—not a finger, tampon, or even something as small as a cotton swab) completely overcome their condition by simply working through program steps at home.
Note also, that the apparent severity of vaginismus does not correlate with how long treatment will take. The motivation level and consistency in effort are much more important factors in how quickly treatment is completed and intercourse is restored.

Do you recommend working with treatment professionals such as physicians, therapists, psychologists, counselors, or others?

Treatment professionals may be helpful in working through challenging areas of vaginismus treatment.

While the vaginismus self-help program was designed to be used with or without ongoing professional assistance, areas of difficulty may certainly be easier to get through when working with an experienced specialist. Since every person’s specific needs and medical histories vary, specialists can often be helpful in the process of overcoming vaginismus.

Can Vaginismus reoccur once it's successfully treated?

The process of overcoming vaginismus is generally permanent. Learned abilities are lifelong and prevent reoccurrence. The process of overcoming vaginismus normally instills life-long skills that provide permanent pain-free resolution. The body’s tendency to involuntarily tighten the pelvic floor is overcome, and if any vaginismus symptoms ever reoccur, they are typically easily resolved with the skills learned through successfully completing treatment.

Can you overcome vaginismus if you're single?

Fortunately, vaginismus treatment can be completed while single, up to the point of being fully ready to transition to intercourse. Although vaginismus is not considered fully resolved until pain-free sexual intercourse actually takes place, women can complete all the exercises that bring them to the point of readiness. They can go through the program on their own without any partner.

As a vaginismus treatment professional, how does the hope and her program help my patients?

Our program provides a comprehensive framework for treating vaginismus that’s helpful for treatment professionals and their patients.

The program assists busy medical professionals and specialists by providing a reference for the programming and delivery of individualized treatment, including home exercises.
It includes a completestep-by-step animated video series covering all major facets of self-treatment.

The program provides an understanding ofsuccessful treatment methodology widely in acceptance and practiced among treatment specialists.

The program includes a detailed understanding of the vaginismus condition fully addressingphysical and emotional issues where applicable. In particular, the emotional inventories allow women to work through these areas at their own pace and comfort in a more detailed fashion than busy professionals may be able to coordinate.

Treatment methodology is enhanced with empathy, understanding, and key insights gleaned from the experience of actual couples who have experienced and overcome vaginismus.
Treatment exercisesare supplemented with detailed illustrations and strategies to further aid understanding.

The information can assist untreated women in coordinating and obtaining a diagnosis and in moving forward with treatment solutions.

The program includes technical and emotional help in our virtual support group and private Facebook page.
For questions about how our sexual pain products can assist health professionals with treatment and patient care, contact us directly for more information or assistance.

I can't even look at myself "down there" and i feel queasy just considering penetration or any type of vaginal insertion.  How can I make it through treatment? 

The human mind has amazing capability to influence our physical being. Fears are generally diminished and overcome with knowledge and a proactive approach to one’s health. Anxiety related to one’s body often stems from lack of knowledge, inadequate sex education, religious/cultural prohibitions against accepting one’s body and sexuality, painful past experiences, and poor self-body image.
It is important that during the treatment process these issues are confronted and dealt with appropriately. Knowledge, combined with a step-by-step process of self-exploration and working through unhealthy emotions, helps women become more comfortable with their bodies and work toward attainable solutions for their condition.

I can't have intercourse and my biological clock is ticking. Any advice?

Understanding these pressures, we fully sympathize with those whose clocks are ticking loudly and support them in their efforts to conceive. Where possible, however, we encourage women to continue to work at overcoming vaginismus while they pursue pregnancy options. As vaginismus is usually treated successfully within a reasonable time, couples are often able to resolve their vaginismus prior to conception and childbirth.
Beyond obviously assisting with conception, eliminating the vaginismus problem contributes to a more relaxed pregnancy and a healthier couple relationship in which to parent children. The desire to become pregnant can actually be a major motivator for a woman to complete a vaginismus program more rapidly.

Will vaginismus have complications or impede vaginal delivery of a baby?  Will the pelvic floor muscles spasm or cause problems?

Unresolved vaginismus may present some challenges during pregnancy, but will not normally impede the actual vaginal delivery process. Although childbirth is typically experienced naturally, just as it occurs for women without vaginismus, there may be difficulties with pelvic exams and other pre/post-natal procedures or with medical interventions during complications of delivery. Thus, women would be advised to consider resolving their vaginismus prior to delivery.
Please note that a consultation with a physician is necessary to confirm the applicability of treatment options and to ensure that there are no risks posed by any treatment methods.

Can childbirth cause vaginismus?  Can it be prevented?

Fortunately, vaginismus is not a normal outcome of natural childbirth. However, if a woman has experienced trauma, physical or emotional, during the birth process the vaginismus condition may be triggered.
Intercourse following childbirth may be uncomfortable or painful due to temporary vaginal bruising, procedures such as episiotomies, tearing of the perineum, attempting to have intercourse before healing is complete, and/or vaginal dryness due to hormonal changes/breastfeeding.
It is normal to have some vaginal tenderness upon commencing intercourse. However, ongoing penetration difficulties benefit from further investigation and may be due to vaginismus.

Can natural childbirth help relieve pre-existing conditions by stretching the vaginal opening?

Some women may experience minor improvement as a result of the birthing process, but others may see their condition worsen as a result of additional trauma or recovery pain. Usually without treatment the vaginismus remains, although each case is different and it is difficult to determine what a woman’s experience will be.

If I am unable to have pelvic exams due to vaginismus, how will I handle my prenatal care? Untreated vaginismus may present some challenges during pregnancy.

Some, but not all women with vaginismus, will experience pelvic tightness or spasms during even simple routine pelvic exams. For this reason, vaginismus may present problems during prenatal care visits, vaginal ultrasounds, pre/post-delivery pelvic exams, and other procedures. The best solution for these tightness problems is for women to treat the vaginismus so they can eliminate the limbic system response and make both intercourse and pelvic exams possible without pain or difficulty.

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