What is vaginismus?
Vaginismus, also known as Genital-Pelvic Pain and Penetration Disorder, is a female sexual dysfunction characterized by involuntary vaginal contraction, which causes discomfort, burning, pain, problems with penetration or total inability to have sex .
It is a psychosomatic disease in which, during sex, women experience discomfort and pain in the vaginal region, often leading to involuntary spasms of the pelvic muscles and other parts of the body (buttocks, thighs, lower back, etc.) and even even temporary stop of breathing.
It is estimated that vaginismus affects about 2 in every 1000 women. However, this number may be higher, since obtaining statistical data on this condition is difficult due to factors such as the shame and embarrassment of many women who, intimidated by this taboo, do not seek treatment.
Its causes are varied, and may have physical origins, such as abortions, normal births, urinary and fungal infections, or psychological, such as childhood trauma, fear and anxiety .
The disease is curable and it usually involves psychological treatment, sexual therapies or exercises to contract and relax the pelvic floor muscles.
Remembering that vaginismus and dyspareunia should not be confused. Vaginismus is characterized by the impediment of sexual intercourse and penetration due to the involuntary contraction of the pelvic muscles, whereas dyspareunia is simply pain during sexual intercourse, and penetration is possible, with no contraction of the muscles.
If you suspect vaginismus, do not be afraid of the taboo and seek professional guidance. Your life only tends to improve after you accept the problem and look for a solution!
Vaginismus is classified in two different ways: by shape and by intensity.
Primary vaginismus occurs when vaginal penetration has never / never been achieved. In this case, contractions occur since the first attempt at sexual intercourse. The male partner is unable to insert the penis into the vagina as it is completely closed.
This form of vaginismus does not only affect sexual intercourse, it can make it difficult to place tampons and perform gynecological exams.
In addition, in addition to pain, a woman may experience generalized muscle spasms and even temporarily stop breathing. Fortunately, these symptoms stop happening when the attempt to penetrate is stopped.
Secondary vaginismus occurs when vaginal penetration has been possible without pain or spasms at some point in life, but it is no longer viable.
He can start showing his first signs at any time and with any woman, even those who have never experienced any symptom of vaginismus. Its causes are usually related to specific events, such as infections, menopause , traumatic events, problems in the marital relationship, surgeries or after childbirth.
Unfortunately, even after treating these specific events, the pain and contractions can continue due to the sensory conditioning of the woman’s body.
Global vaginismus occurs when pain and discomfort are present during any situation and with any object. For example, women who suffer from global vaginismus are unable to masturbate, put on OB or simply touch the vagina without feeling the contractions.
Situational vaginismus occurs when pain and discomfort are present only in certain specific situations, such as during sex, not interfering with routine activities such as gynecological exams, masturbation, placing and removing OB etc.
Vaginismus often comes as a surprise: unexplained contractions, discomfort, pain and penetration problems appear unexpectedly during sexual intercourse.
This pain is the result of involuntary contraction of the muscles around the vagina.
Usually, the origin of vaginismus is associated with a combination of physical and non-physical causes, making the woman anxious and beginning to anticipate the pain.
The involuntary reaction to this anxious anticipation is the contraction of the pelvic muscles, as if the body is protecting itself and closing itself against some imminent danger.
For example, when we anticipate some kind of impact, such as falling on the ground or hitting an object, the muscles of the arms, legs, lap and eyelids contract, trying to protect themselves.
The same occurs before sexual intercourse in women who suffer from vaginismus, making sex painful and penetration more difficult and even impossible.
These reactions can be triggered by physical events as simple as inadequate foreplay or lack of lubrication, as well as by other non-physical emotional factors, such as anxiety, which are responsible for most cases.
The emotional causes that cause the symptoms of vaginismus are often unconscious and require investigation. It is important that effective treatment processes include treating all emotional triggers so that a pleasurable and painless sexual relationship can be enjoyed.
However, the most important thing to note is that it is not the woman’s fault. It does not intentionally “cause” the contraction or cause your body to contract. She just can’t seem to stop this process.
In most cases, patients suffering from vaginismus do not have any physical problems inherently related to the disease, since their main cause is due to psychological problems.
However, there are cases in which the condition is caused by physical problems such as infection and obstruction of the vaginal canal, diseases such as cancer or sclerosis and other diverse causes. Check out.
- Malformed or poorly positioned vaginal canal;
- Very thick hymen;
- History of trauma in the pelvis;
- Urinary tract infections or urinary problems;
- Fungal infections;
- STD’s (Sexually Transmitted Diseases;
- Endometriosis (a disorder in which the lining of the uterus grows out of it);
- Genital or pelvic tumors;
- Vulvodynia / vestibulodynia (chronic pain at the opening of the vagina);
- Pelvic inflammatory diseases;
- Lichen planus (inflammation of the skin and mucous membranes);
- Lichen sclerosus (chronic disease that causes white and thin patches on the skin, usually in the genital region);
- Vaginal prolapse;
- Pain of normal childbirth;
- Cesarean sections;
- Menopause and hormonal changes;
- Vaginal dryness;
- Vaginal atrophy;
- Any type of pelvic surgery, difficult pelvic exams or other pelvic trauma;
- Physical aggression, rape or physical / sexual abuse.
Read more: What are the symptoms of Vulvodynia?
Psychic origin is one of the main causes of vaginismus. This results in anxiety due to fear of pain. More difficult to treat and to observe, psychic causes have numerous variants. For this reason, we have drawn up a list of non-physical causes. Check out:
- Fear or anticipation of sexual pain;
- Fear of not being completely healed physically after a pelvic trauma;
- Fear of tissue damage (ie, “being torn”);
- Fear of becoming pregnant;
- Concern that a pelvic medical problem may reoccur;
- Anxiety in general;
- Pressures to perform well;
- Previous unpleasant sexual experiences;
- Negativity in relation to sex;
- Emotional trauma or other unhealthy sexual emotions;
- Emotional detachment;
- Fear of commitment;
- Anxiety about being vulnerable, losing control;
- Previous sexual / emotional abuse;
- Witnessing violence or abuse;
- Suppressed memories;
- Overly strict education during childhood;
- Unbalanced religious education (that is, the idea that “sex is bad”);
- Exposure to shocking sexual images;
- Inadequate sex education.
Feeling pain during sexual intercourse is usually one of the first signs of vaginismus. This pain occurs, in most cases, only with penetration. It usually fades after withdrawal of the penis, but not always.
Women who suffer from this dysfunction describe the pain as a sensation of tearing or else the feeling that the penis is “hitting against a wall”.
Many women also experience discomfort when they insert tampons or during an internal examination.
Below is a list of the main symptoms of vaginismus:
- Burning or throbbing with narrowing of the vaginal opening during sex.
- Penetration difficult or impossible.
- Pain at the vaginal entrance.
- Uncomfortable insertion of the penis.
- Frequent sexual discomfort or pain after delivery.
- Involuntary spasms in other muscle groups (legs, lower back, etc.).
- Hold your breath involuntarily during penetration.
- Avoid sexual intercourse due to pain and / or failure.
If you suspect you have vaginismus, see your gynecologist and get an exam. Many women are ashamed to seek help, but vaginismus is a common problem that can improve with the right treatment.
It is very important that you seek help from a professional. He is the most qualified person to guide you in the treatment of your condition.
There is no medical examination to confirm the condition of vaginismus. It is diagnosed through the patient’s medical history, description of the problem or pain on a gynecological exam.
As the dysfunction has no apparent physical cause, its diagnosis is more complicated than normal. Women may need to advocate strongly for themselves, insisting on a thorough diagnosis by an experienced professional to rule out any other health problems.
The main problem is that many doctors are not familiar with vaginismus. Therefore, an essential part of the process is to find a doctor who is knowledgeable about the condition.
In addition, sexual pain disorders such as vaginismus are commonly misdiagnosed or left unattended. Women need to be very courageous and to demand concerns to receive the necessary attention.
Talking to doctors about sexual problems can be difficult. Embarrassment, shame and anxiety are often present, making communication and obtaining the appropriate treatment difficult.
To let you know which doctors to consult, we have made a short list with the types of professionals indicated.
- Gynecologists: not every gynecologist has experience in diagnosing and treating vaginismus. However, they are extremely experienced and will be able to help you rule out other health problems, clarify doubts and arrive at an accurate diagnosis.
- Physiotherapists: there is an increasing number of physiotherapists specializing in pelvic floor disorders and sexual pain such as vaginismus. Many physical therapists work with their patients to develop home programs, allowing women to do the programs at their own pace.
- Sex therapists and psychologists: they can identify psychological causes and help you diagnose vaginismus.
It is worth mentioning that the most accurate method to diagnose vaginismus is through a pelvic exam with a gynecologist. Therefore, before starting any treatment on your own, seek the opinion of a professional in that field.
What should I tell the doctor?
As it is an extremely taboo topic, Hickey solution made a list with tips on what to say to the doctor during a consultation to help you both face this topic and to improve the doctor’s understanding. Check out.
Enter the problem
First of all, tell the doctor what the problem is. Say you suffer from pain during sex and ask for help.
Describe the pain and be specific
Don’t be afraid to go into details. Tell everything thoroughly. Describe how the pain happens and where it affects you. Go into details about the duration, intensity and tell what tactics you have tried to use to lessen the pain.
The doctor is a professional used to hearing all kinds of reports and must, by law, keep his patients’ personal information confidential. So, don’t be shy.
Mention any type of previous problem
If you have had any previous problems in the pelvic and vaginal area like STDs, yeast infections, bladder problems etc., don’t forget to mention them. This will help the doctor to rule out or include any possible cause.
Mention any previous sexual abuse
As difficult as it may be for you to talk about this subject, if you have suffered any type of sexual abuse, tell the doctor. He will understand and can refer you to a mental health professional to help you better deal with the trauma caused by this event, which can be one of the causes of your condition.
Speak what you think is the problem
Tell the doctor what your suspicions are. He is an expert and can reassure you, whether or not you have vaginismus.
Yes, vaginismus is curable and treatment will depend on what is causing the disease.
Although there is no surgical or drug treatment for the disease, it is considered a sexual dysfunction whose treatment has good results. High success rates are very common, within reasonable time frames.
If there is an obvious physical cause, such as infections or ultra-sensitive nerves at the opening of the vagina, vaginismus can be treated with drugs intended for those same physical causes.
However, the physical causes mentioned above are not directly responsible for veganism, as it is a psychosomatic disease, not a physical one. Often, no matter how much the physical causes are treated and they disappear completely, vaginismus itself can continue to occur.
Therefore, if physical causes are not found in medical tests and examinations, self-help techniques such as sex education, professional counseling and vaginal exercises can be employed to try to solve the problem.
Check out some of the types of treatment below.
Sexual therapies and psychotherapeutic accompaniment
One of the most common treatments is sexual therapies. They involve educating yourself and learning about your anatomy and what happens during arousal and intercourse.
Doctors and specialists will help you understand which muscles are involved, which are contracted, how they contract and why they hurt. This can help you to face the dysfunction more easily, so that you will know how your body works and how it responds, and may have more control over itself.
Later, you will take this advice into your private life and be able to start relaxation techniques , either alone or with your partner.
Because it is a psychosomatic condition, psychotherapeutic follow-up is also indicated in conjunction with sexual therapies.
As its causes can stem from trauma, anxiety and other psychological conditions, a psychotherapist and a psychiatrist are essential pieces to help you understand and accept your own history, calm down and take control over your body.
Seeking advice from sexologists, psychologists and gynecologists is very important for the treatment of the disease. They will teach you relaxation techniques, body control and may even apply hypnosis methods. These therapeutic tactics promote relaxation and can help you feel more comfortable during sex.
Your gynecologist or sex therapist can recommend the use of vaginal dilators with the supervision of a professional.
This treatment consists of inserting dilators that are gradually getting larger in the vagina to stretch the muscles of the pelvic region and make them more flexible.
One of the ways to make this treatment less hassle is to do it with the help of your partner. After finishing treatment with a series of dilators, you and your partner can try to have sex again.
There are physical therapies for vaginismus. They include developing a range of skills and re-educating the pelvic muscles to establish greater control over the region so that they respond to sexual stimuli in a positive and controlled manner.
Kegel exercises are a simple technique of contraction and relaxation of the pelvic floor that make the muscles in this region stronger and more elastic.
Your pelvic floor is a series of muscles and tissues that make up your entire pelvic region.
You can locate these muscles when you urinate. After you start peeing, try to stop the chain on purpose. Those muscles that you contract to stop urinating are the pelvic muscles. Pay attention to how you manage to squeeze them and make them move. They move in groups, then contract and relax simultaneously.
Practicing these contraction and relaxation exercises helps you to have more control over your body. Follow these steps:
- Empty your bladder;
- Contract the pelvic floor muscles and count to 10;
- Relax your pelvic floor muscles and count to 10 again;
- Repeat these movements 10 times, 3 times a day.
To effectively strengthen your pelvic musculature, try your best to use only your pelvic musculature, avoiding contracting the muscles of the abdomen, buttocks or thighs during exercises.
Masters and Johnson therapy
During the 60s, the sexologists Masters and Johnson were pioneers in creating therapy of “sensate focus” ( sensitive focus – free translation).
The treatment consists of isolating the couple in a residential clinic where the two are instructed not to attempt any kind of sexual intercourse. Instead, the two should participate in daily sessions where they should relax and exchange affection as much as possible, stimulating their bodies.
Over time, the couple reaches a point where the man can gently penetrate the woman with a small dilator and, later, with wider ones while she concentrates on relaxing.
Then, finally, the woman, “mounted” on top of the man, must, little by little, insert her partner’s penis, gradually going deeper.
Sexual dysfunctions can have a major negative impact on relationships. Being proactive and seeking treatment is essential to saving the marriage or the relationship.
It is important to note that there is nothing to be ashamed of. Talking to your partner about your condition can be difficult, but it can also make you more peaceful and relaxed. Your doctor or therapist can also provide you with ways to deal with the disease.
Face the problem positively, always taking the necessary actions and without fear of being judged for that, after all, the problem is not your fault.
The main complication of vaginismus is to lead women to sexual disinterest. Because of the pain, many women start to avoid having sex, because they get frustrated and get anxious.
The anxiety suffered by women can lead them to anticipate pain, causing them to enter the so-called “pain cycle”, which happens as follows:
- The body anticipates pain and the woman feels fear and anxiety;
- As a reaction to anticipation, the body automatically tightens the vaginal muscles;
- This tightening makes sex painful, and may make penetration an impossible task;
- The pain intensifies;
- At the end of the act, the body is conditioned to react in the same way when it goes through the same situation;
- Traumatized, the woman starts to avoid intimate relationships and the lack of desire can develop.
These complications can lead to compromised relationships in which the woman is inserted. Many marriages are not consummated because of the dysfunction and its consequences can be extremely emotionally damaging.
Problems with pregnancy
Untreated and unresolved vaginismus can cause problems to get pregnant and pose some challenges during pregnancy.
Problems to get pregnant
For a woman to conceive naturally, it is necessary for full penetration and ejaculation to occur within the vaginal canal. In severe vaginismus, this is impossible to happen.
Such a problem can be solved through artificial insemination, however, this will not change the fact that the pelvic floor muscles contract.
Problems during pregnancy
Despite contractions, vaginismus does not cause any complications during childbirth. This is because hormones are activated and cause the cervix and the vaginal canal to expand involuntarily and automatically, ignoring the urges of vaginismus and allowing the baby to leave without major complications.
However, vaginismus can cause difficulties during pregnancy. The disease can make the performance of pelvic exams and other prenatal and postnatal procedures more complicated, in addition to hindering medical interventions due to complications in childbirth, making it necessary to choose cesarean sections instead of normal birth.
So it is very important that women try to resolve the issue of vaginismus before giving birth.
Can vaginismus go away without treatment?
As it is an involuntary and self-perpetuating condition, it is not possible to solve the problem spontaneously. It is necessary to seek help from a health professional to resolve it.
Sexual intercourse is not necessary to achieve orgasm. What is important for most female orgasms is stimulation of the clitoris.
However, for some women with vaginismus, the arousal process is interrupted when attempted intercourse becomes painful or uncomfortable. If a woman’s body reacts to stimulation by triggering the response of vaginismus, the contracted pelvic floor can end the process of arousal.
This abrupt contraction ends up interrupting intercourse with penetration, causing the vagina to block the insertion of the penis, causing pain during sexual intercourse. The ability to reach orgasm manually can also be interrupted because of the pain from this involuntary contraction.
In addition, any emotional problems that contribute to the response of vaginismus can impair a woman’s ability to relax and allow the arousal cycle to continue until orgasm.
It is worth remembering that one of the characteristics of orgasm is the involuntary contraction of the muscles. The difference is that in vaginismus, this contraction is painful and uncomfortable, while in orgasm, the contractions are pleasant, with the muscles contracting and relaxing in a pleasant way.
Can normal delivery help to reduce vaginismus by widening the vaginal opening?
The vaginismus untreated and generally resolved remains after birth .
Although the birth process widens the vaginal opening, it usually does not significantly cure or relieve vaginismus. On the contrary, the situation can often get worse as a result of the additional trauma or pain of recovery.
It is important to understand that vaginismus is not cured or treated by simply widening the vaginal opening. The problem is not with the size of the vaginal opening, but with the involuntary contractions caused by the muscles around the vagina.
The true and most effective treatment process includes exercises designed to develop control over the pelvic floor muscles and psychological treatment.
Are vaginismus and dyspareunia the same thing?
Vaginismus and dyspareunia are not the same thing. Dyspareunia is characterized by pain during sexual intercourse, while vaginismus is the impediment of sexual intercourse due to involuntary contractions.
In the case of dyspareunia, sexual relations are not prevented or impossible to happen. On the contrary, penetration is possible and is accompanied by pain. It can be caused by physical causes like lack of lubrication, infections and allergic reactions, or psychological causes like depression and anxiety.
Although the causes are similar, the two conditions differ from each other by the way they occur. In dyspareunia, penetration is possible and it happens. In vaginismus, it is difficult or, as in most cases, prevented.
Can I have sex during treatment?
It is suggested by professionals and specialists that couples continue to have exchanges of pleasure without penetration until they complete the treatment. During the initial stages, mainly, the attempt of penetration is not recommended.
When attempting sexual intercourse is premature, it can result in pain and discomfort, worsening the situation of vaginismus. In addition, there may be anxiety, fear of more pain, feelings of disappointment, physical complications and other relapses.
Apart from penetration, every form of sexual pleasure is still valid and even recommended.
Vaginismus is a treatable psychosomatic disease. Its complications are not so much physical, but social and emotional. However, with proper treatment, any woman can overcome this problem.
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