Definition

Vaginismus is the uncontrolled tightening or contraction of the muscles around the vagina. The vagina is part of the female reproductive system and connects the lower part of the uterus (cervix) to the outside of the body. This unwanted muscle spasm occurs when something (like a penis, finger, tampon, or other medical instrument) tries to enter the vagina. This spasm can cause pain or discomfort.

The prevalence of vaginismus is unknown because most people are too embarrassed to discuss the issue with their doctors. Vaginismus symptoms can appear in late adolescence or early adulthood when a person engages in sexual activity for the first time. The condition can also occur for the first time when inserting a tampon or undergoing a pelvic exam.

Vaginismus has two types, primary and secondary. Primary vaginismus occurs when a woman experiences pain every time something tries to enter the vagina, including a penis (sexual penetration), or when they cannot insert anything into the vagina. This is also known as lifelong vaginismus. Secondary vaginismus occurs when a woman previously had pain-free sexual intercourse but then finds it difficult or painful to have sex.

Causes

The exact cause of vaginismus is currently unknown. It can be due to physical, psychological, and sexual problems. Bladder infections, urinary tract infections, and yeast infections can exacerbate the pain of vaginismus. Vaginismus is often associated with anxiety or fear during sexual intercourse, although it is not clear which comes first, vaginismus or anxiety.

Risk Factor

Risk factors for vaginismus include:

• Poor health
• Family history of the condition
• History of urinary tract or yeast infections
• Chronic pain syndrome
• Endometriosis
• Anxiety disorders
• Trauma from childbirth, such as vaginal tearing
• Previous surgeries

Psychological and social causes and symptoms include:

• Trauma from sexual violence or childhood sexual abuse
• Trauma from gynecological or other medical examinations involving vaginal penetration
• Other types of trauma related to economic or social factors
• Fear of sexual intercourse or negative feelings towards it, possibly due to past sexual violence, rape, or trauma
• Physical or sexual violence, including from a partner or family member
• Emotional problems

Symptoms

The primary symptom of vaginismus is pain during sexual intercourse (dyspareunia). This pain occurs only during penetration and usually subsides afterwards, but not always. Some women describe the pain as a burning sensation or as if the penis is "hitting a wall." Women with vaginismus may also feel discomfort when inserting a tampon or undergoing a pelvic exam. Other symptoms of vaginismus include:

• Discomfort or pain during vaginal penetration
• Inability to have sexual intercourse or pelvic exams due to muscle spasms or pain
• Pain during sex
• Complete inability to penetrate sexually or insert a tampon
• Fear of pain or sex
• Loss of sexual desire

These symptoms occur unconsciously, meaning the woman cannot control them without treatment or therapy.

Diagnosis

To diagnose vaginismus, doctors will conduct medical interviews, physical exams, and possibly additional tests if necessary.

Medical Interview

Doctors will ask about current symptoms, medical history, treatment history, and sexual activity history.

Physical Examination

Initially, doctors will perform a general examination, including measuring blood pressure, respiratory rate, pulse, and body temperature. Next, they will conduct a pelvic exam to help diagnose the condition and rule out other issues, ensuring the presence of muscle spasms. Doctors may apply a numbing cream to the outer vagina before the exam for comfort. During the exam, they will check for signs of injury or infection.

Diagnostic Tests

If necessary, doctors may recommend additional tests such as an ultrasound or CT scan of the pelvis to examine the reproductive organs.

Management

The internal examination for vaginismus is very quick. Doctors usually take a brief look to check for other conditions, like infections. Treatment typically includes education, counseling, and exercises. Treatment focuses on reducing the muscle reflex causing spasms or contractions.

One therapy you can do at home is progressive desensitization. This involves gradual penetration, starting with holding the area near the vaginal opening without causing pain. Once you can touch the area, you can move on to touching and opening the vaginal lips (labia). Then, you can gradually insert a finger. If you can do this without pain, you can insert a dilator and leave it in the vagina for 10-15 minutes until your muscles get used to the pressure.

Other treatments that may be recommended by a doctor include:

• Topical therapy
• Topical lidocaine cream to reduce pain related to the condition.
• Pelvic floor physical therapy (kegel exercises)
• Therapists will teach you to relax the pelvic floor muscles. Kegel exercises involve tightening the muscles used to stop the flow of urine by doing:

• Tighten the muscles
• Hold for 2-10 seconds
• Relax the muscles
• Do this exercise 20 times at a time, as often as you can throughout the day.

• Vaginal dilator therapy
• Vaginal dilators are tube-shaped devices of varying sizes. The main purpose is to loosen the vagina. For those with vaginismus, using a dilator becomes more comfortable and less sensitive to vaginal penetration. Doctors may recommend applying a numbing cream to the outer vaginal area to facilitate inserting the dilator.
• Cognitive behavioral therapy (CBT)
• This therapy helps identify if your thoughts affect your emotions and behavior. CBT is effective for anxiety, therapy, and post-traumatic stress disorder (PTSD).

Complications

Complications from vaginismus can affect your sexual life and relationship with your partner. It can also impact mental health and increase anxiety. If you are trying to conceive, vaginismus can make it more difficult to become pregnant.

Prevention

There is no known way to prevent vaginismus. This is because the exact cause of vaginismus development is not yet known. Consult with a doctor for the therapy and care you need, especially if you are planning a pregnancy.

When to See a Doctor?

Contact a doctor if you experience symptoms such as:

• Irritation or itching in the genital area
• Pain during sexual intercourse
• Pain when urinating (dysuria)
• Unpleasant or abnormal odor from vaginal discharge
• Redness, pain, or swelling in the vagina

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