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Your guide to understanding vaginismus

Vaginismus affect one in 500 women. It is an automatic reaction where your vaginal muscles tighten in response to all or some forms of penetration. We uncover why it occurs, and how it can be diagnosed and treated.

Vaginismus is condition that causes vaginal tightness. This can result in discomfort, pain or a burning sensation when inserting a tampon or attempting sexual intercourse. We take a look at the causes, symptoms and treatments.

Vaginismus occurs when the muscles of a women’s vagina involuntary tighten, causing the entrance to the vagina to spasm. This can cause discomfort and pain, which can range from being mildly uncomfortable to very painful.

The muscle spasm usually occurs in response to the vulva or vagina being touch, such as when inserting a tampon or attempting sexual intercourse.

Vaginismus is thought to be primarily a psychological problem. It can cause distress and have a significant impact on relationships. The condition is fairly common in women who are in their late teens to 30s.

Some women can develop vaginismus after going through the menopause. A fall in the hormone oestrogen can result in a lack of vaginal lubrication. This can make sexual intercourse painful, which can result in vaginismus.

Vaginismus is primarily thought to be a psychological condition. It is not always fully understood what causes vaginismus because there may be many factors that can trigger the condition. These include:
  • Anxiety and depression
  • Childbirth injuries, such as vaginal tears
  • Prior surgery to the organs in the pelvic area
  • Vaginal infection
  • Past sexual abuse, rape or trauma
  • Inflammation of the pelvis or bladder
  • Sexual anxiety

Bladder infections, urinary tract infections (UTIs) and yeast infections can worsen vaginismus pain.

The condition is not brought on by women who don’t want to have sexual intercourse, but only when it is attempted does the vagina tighten to prevent penetration.

Vaginismus is can be split into two categories ¬ primary and secondary.

Primary vaginismus is classified as when a woman feels pain every time something enters their vagina. This is mostly associated with women who have never experienced vaginal penetration. This is sometimes called lifelong vaginismus.

Secondary vaginismus is when vaginal penetration has been achieved in the past but has now become difficult or is no longer possible. This is sometimes called acquired vaginismus.

Usually the first sign of the condition is pain when penetration of the vagina is about to occur. The pain is commonly described as a burning sensation. The muscles spasms cause the vagina to close up to such as extent that an object attempting penetration feels like it is ‘hitting a wall’.

This involuntary tightening of the vaginal muscles is the primary symptom of the condition. If you have vaginismus, you can’t control or stop the contractions. In all cases, constriction of the vagina makes penetration difficult or impossible.

Vaginismus can have additional symptoms. These include:

  • Fear of pain. 
  • Intense fear of penetration. 
  • Loss of sexual desire if penetration is attempted.
  • Pain if penetrated by a tampon, finger or penis. 

Sometimes you may be diagnosed with dyspareunia, which is a medical term used to describe painful sexual intercourse. Although dyspareunia is often a symptom of vaginismus, it can be caused by physical problems in the pelvic area, such as ovarian cysts, pelvic inflammation or vaginal dryness.

An accurate diagnosis of your problem will determine which treatments you are offered.

To diagnose vaginismus, your doctor will want to rule out any physical disorders, such as an injury or an infection, which might be causing or contributing to the condition. The doctor will ask questions about your medical and sexual history before performing a physical examination.

It is normal for women with vaginismus to feel nervous during a pelvic examination, so the doctor may apply a numbing cream to the outside of the vagina to make the process more comfortable for you. If a doctor suspects vaginismus, they will perform the examination as gently as possible.

During the physical examination, the doctor will look to rule out any physical disorders, while confirming the presence of muscle spasms. If there is no physical reason for the vaginal muscles to contract then your doctor won’t find another cause for the symptoms.

Vaginismus can be treated. With a suitable treatment programme, the symptoms can be fully overcome, resulting in no pain or discomfort.

A vaginismus cure does not involve drugs or surgery. An effective treatment programme will often combine counselling, education and exercises, including:

  • Counselling: You will have the option of attending the counselling sessions alone or with your partner.
  • Physiotherapy: A physiotherapist can show you how to do pelvic floor exercises and specific vaginismus exercises. These can help you to control the spasms and manage the pain.
  • Insertion or dilation training: This is a technique that helps relax the vaginal muscles. It involves gradually widening the vagina using a set of silicone vaginal trainers, also called vaginismus dilators. These are a set of smooth cones, which gradually increases in size and length.
  • Pain elimination techniques: These involve relaxation techniques and breathing exercises. For the treatment programme to work, it is important that you go at your own pace. It may take days or weeks before you start to feel an improvement in your symptoms. These treatments are easily done in the privacy of your own home.

The condition can take a toll on your relationships, so it is important that you talk with your partner about your feelings. If you have vaginismus, it doesn’t necessarily mean that you will have to stop all sexual activities. Many women who have the condition can still get sexual pleasure. Using water-based lubrication or certain sexual positions can help make sexual intercourse more comfortable. You can also have orgasms by doing sexual activities that don’t involve penetration. These include:
  • Oral sex
  • Masturbation
  • Sexual massage

Most women, who have followed a treatment programme, go on to have a normal sex life.

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem.

They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation.

An appointment with an experienced Consultant at your nearest BMI hospital can be helpful. They will assess and diagnose the cause of your symptoms and then discuss any suitable treatment options for your specific situation. To schedule your visit, book a specialist appointment online today.

We partnered with pioneering research charity Wellbeing of Women to produce our Women's Health Matters 2021 report. Wellbeing of Women help improve pregnancy care, IVF outcomes and the risk of childbirth complications for women through their ground-breaking research.

Women's Health Matters 2021 provides a comprehensive analysis of ten of the most common gynaecological conditions misdiagnosed or misunderstood for years at a time. Infertility, debilitating chronic pain, the onset of associated conditions and severe depression are common effects of living with a gynaecological condition without access to the right care. Yet despite this, education and awareness around women’s health is lacking.

Millions of women in the UK continue to suffer in silence while waiting for a diagnosis, unsure of how best to manage their pain or seek help. The aim of this Women's Health Matters is to tackle taboos in women's health by sharing the hard-hitting stories of other women living with these conditions, as well as:

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