What Is Vaginismus?

Introduction

Vaginismus is a distressing and often misunderstood condition that primarily affects individuals with vaginas. It causes involuntary muscle contractions and spasms around the vaginal entrance. This can prevent vaginal penetration including sexual intercourse, tampon insertion and pelvic examination. This condition, often classified under dyspareunia (pain during sexual intercourse), can significantly affect a person’s and their significant others' intimate life and overall well-being. It comes in two forms: 

• Primary (lifelong)
• Secondary (acquired)

The cause of vaginismus is varied, and spans psychological, physical, and relational factors. Being a relatively unknown medical condition for many healthcare professionals, understanding of vaginismus is essential for effective treatment and support. 

What is Vaginismus?

Vaginismus is a type of sexual dysfunction. It is characterised as recurrent or persistent involuntary spasm of the muscle surrounding the vaginal entrance, making any form of vaginal penetration- including sexual intercourse, tampon insertion, even a pelvic exam- extremely painful or even impossible.¹ As vaginismus leads to painful sexual intercourse, it is classified within the medical condition known as dyspareunia, a term used to describe ongoing discomfort that occurs prior to, during, or following sexual intercourse. Despite the individual’s desires and attempts to engage in these activities, the involuntary spasms occur, and it can lead to physical discomfort and emotional distress.  

There are two main types of vaginismus:

• Primary vaginismus: Typically experienced by individuals who have never been able to engage in vaginal penetration, including penetrative sex. Even attempts to insert a tampon and gynaecological examination can trigger intense pain or muscle contractions. It is also called lifelong vaginismus.
• Secondary vaginismus: Occurs when an individual who has previously been able to engage in vaginal penetration experiences a sudden onset of vaginismus symptoms. It is also known as acquired vaginismus.

Causes

Vaginismus can affect approximately 5% to 17% of women in clinical settings.² However, this may not be a true represensative as making a diagnosis can be difficult due to the condition’s combination of physical and psychological components, with its symptoms varying in severity.  The causes can be grouped into three main categories: 

• Psychological 
• Physical 
• Relationship factors

Due to the possibility of factors interacting and overlapping, it makes it challenging to pinpoint a single cause in many cases. These categories can be broken down further. 

Psychological factors

• Anxiety and fear: Fear of pain or negative experiences related to vaginal penetration, often stemming from past traumatic events, can trigger vaginismus. Anxiety about sex, performance, or concerns about getting pregnant can also contribute.
• Past trauma or Abuse: Experiences such as sexual abuse, rape, or childhood trauma can lead to vaginismus by creating a strong psychological aversion to vaginal penetration.
• Negative beliefs about sex: Cultural or religious upbringing, as well as societal taboos and misconceptions about sex, can instil guilt, shame, or fear regarding sexual activity, contributing to vaginismus.

Physical factors

• Infections: Vaginal infections or urinary tract infections (UTIs) can lead to discomfort and pain during intercourse, which may trigger vaginismus if the individual starts associating sex with pain.
• Medical conditions: Conditions such as endometriosis, fibroids, or pelvic inflammatory disease can cause pelvic pain, potentially leading to vaginismus.
• Menopause and hormonal changes: Hormonal changes associated with menopause, breastfeeding, or certain medications can lead to vaginal dryness and discomfort during sex, contributing to vaginismus.

Relationship factors 

• Relationship issues: Problems in a romantic relationship, such as communication difficulties, trust issues, or unresolved conflicts, can lead to emotional distress and trigger vaginismus.
• Sexual trauma within the relationship: Experiences of sexual coercion or abuse within a relationship can lead to vaginismus as a protective response.

Symptoms

Symptoms of vaginismus can vary depending on its severity. A distinctive symptom of vaginismus is the involuntary spasms or contractions of the muscles surrounding the vaginal opening. As a result, causing the vagina to become narrow making penetration painful or even impossible. Other symptoms include:²

• Difficulty and discomfort with vaginal penetration
• Inability to have pelvic exam
• Struggling to insert a tampon when on period

In addition to physical symptoms, individuals with vaginismus can also experience psychological symptoms such as fear, anxiety, shame and embarrassment.  These feelings can occur due to a variety of factors, such as the anticipation of vaginal pain, difficulties with vaginal penetration, as well as negative beliefs surrounding penetration.²,³

Diagnosis

When exhibiting symptoms of vaginismus, it is recommended to consult a healthcare professional. During the appointment, they will inquire about your symptoms and take a detailed medical and sexual history. Additionally, they will perform a pelvic examination to rule out other potential conditions such as infections. Based on history and examination, the Lamont-Parick scale can be used to determine the severity of symptoms:²

• Grade 1: This is the mildest form and you are able to relax during examination.
• Grade 2:  You are unable to relax during examination.
• Grade 3: Throughout the examination, you raise or pull hips to the side trying to avoid examination.
• Grade 4: During examination, you lift your hips, pull yourself back, close legs tightly together preventing examination.
• Grade 5: In addition to avoiding the pelvic exam, this includes severe reactions such as hyperventilation, crying, nausea and vomiting, palpitation, trembling and fainting. 

Impact on sexual intercourse and relationships 

Vaginismus can lead to a reduced quality of life and contribute to marital and relationship difficulties. Research has shown a connection between sexual disorders and psychological issues, including low self-esteem, depression, and anxiety. It not only affects the individual experiencing vaginismus but can also result in psychological and/or physiological repercussions for their partner.⁴ 

It is essential to note that vaginismus does not affect sexual arousal, further exacerbating frustration. Without a proper diagnosis, individuals may feel abnormal or embarrassed due to their inability to engage in intercourse, which can deter them from seeking the necessary help. However, it is crucial to understand that vaginismus is a treatable condition and can be successfully addressed with the right support and treatment provided.

Treatment

Due to a variety of factors involved in vaginismus, a multidisciplinary approach is used to treat the disorder.² This approach aims to manage both physical and psychological factors, addressing feelings towards penetration and exercises to help facilitate penetration. While a systematic review of multiple studies indicates that no single treatment option offers a clear advantage or benefit over others, treatment results should be interpreted with caution.⁵ 

Treatment initiated under the guidance of specialist therapists with focus on the patient’s needs and, if in a relationship, their partner’s can be beneficial and partner. Possible treatment options include: ^2,6,7,8

• General psychotherapy such as cognitive behavioural therapy (CBT), relaxation therapy and hypnotherapy
• Pelvic floor exercises
• Sensate focus - This is a programme offered to those in relationships. It is a technique used to help couples overcome anxiety and to build trust and physical intimacy
• Vaginal trainers - these are smooth plastic rods (tampon-shaped) with varying sizes and length to help get used to vaginal penetration
• Topical therapy - topical anaesthetics such as lidocaine can be applied to help alleviate pain
• Botox - this may be useful however there are currently no studies available to assess its efficacy

When should I see the doctor or sexual health clinic?

You should see your doctor or healthcare professional if you experience:

• Difficulty inserting a tampon into vagina;
• Struggling with vaginal penetration during sex (painful intercourse - dyspareunia);
• Burning or stinging sensation during sex;

Vaginal infections can be associated with vaginismus and should be assessed by doctors. Symptoms of vaginal infections can include:

• Itching and irritation
• Painful urination (dysuria)
• Unusual or foul-smelling vaginal discharge
• Vaginal redness, soreness or swelling

Conclusion

Vaginismus is a sexual condition marked by painful muscle contractions and spasms during vaginal penetration. This condition affects a significant portion of women, with reported prevalence ranging from 5% to 17%. Due to the wide range of factors contributing to vaginismus, it makes diagnosis complex. Symptoms range from physical pain to emotional distress. Treatment involves a multidisciplinary approach, including psychotherapy, pelvic exercises, and more, offering hope for improved quality of life and relationships with professional help.