Difference Between Primary And Secondary Vaginismus
Sneha Annmary Chandy

Sneha Annmary Chandy

Mar 01Vaginismus

Difference Between Primary And Secondary Vaginismus

Vaginismus is a condition characterised by involuntary muscle spasms in the pelvic floor muscles, specifically the muscles surrounding the vagina. These spasms can make vaginal penetration painful or near impossible, impacting sexual intercourse, inserting a tampon, menstrual cup or finger or even going through a gynaecological exam. It's often linked to psychological factors like fear or anxiety related to sex or penetration and even trauma experiences. 


There are two types of vaginismus- primary and secondary.

Primary vaginismus is when a person has never been able to have pain-free vaginal penetration (the key word here being ‘never’), like during sex or using tampons, because their muscles tighten up involuntarily. Fear, anxiety, trauma, or even physical issues can be the reason for it. Treatment typically involves a combination of physical and psychological therapy.

Therapy for primary vaginismus typically involves a combination of physical and psychological approaches:

  • Pelvic Floor Physiotherapy: A pelvic health physiotherapist will help the individual learn to relax and control their pelvic floor muscles through exercises and techniques.

  • Education and Counseling: Therapists/coaches provide education about the condition, helping individuals understand their bodies and the reasons behind their symptoms. Therapy will also address any psychological factors contributing to vaginismus, such as anxiety or trauma.

  • Gradual Exposure: Physiotherapists guide individuals through a gradual process of exposure to vaginal penetration using vaginal trainers or other techniques. This helps reduce fear and anxiety while gradually stretching the vaginal muscles, at the pace of the individual.

  • Relaxation Techniques: Learning relaxation techniques, such as deep breathing and mindfulness, can help individuals manage anxiety and muscle tension during penetrative activities.

  • Partner Support: Involving a supportive partner in therapy can be beneficial, helping to create a safe and understanding environment for the individual to work through their challenges.


Secondary vaginismus on the other hand, is when a person who was able to have pain-free vaginal penetration in the past suddenly experiences difficulties with it. This can happen due to various reasons like physical trauma such as childbirth (vaginal or caesarean), radiation, or injury. It can also happen due to hormonal changes that cause changes to the skin, or new infections in and around the pelvic floor and its organs. Chronic constipation can be a potential cause for secondary vaginismus as well! Secondary Vaginismus can also happen due to sexual trauma, stress and anxiety, or even relationship challenges. 

The treatment for secondary vaginismus is similar to that for primary vaginismus which includes counselling, pelvic floor training, relaxation techniques and vaginal training. Identifying exactly when the difficulty began and what the triggers are is crucial to healing, and the coach/therapist will be able to do this in therapy sessions. Pelvic health physiotherapists help to retrain the muscles to allow penetration and decrease sensitive areas. Another important aspect in terms of healing of secondary vaginismus is couple dynamics. Couple therapy can help in identifying if there are any issues between the couple which have resorted to difficulties in smooth penetration, and thereby resolve them.

The specially curated online Vaginismus Healing Program at Proactive For Her is designed to provide comprehensive support and treatment for individuals experiencing vaginismus. Our program incorporates a holistic approach that addresses both the physical and psychological aspects of the condition, in the most non-judgemental, empathetic and gradual way. The program includes pelvic floor training, psychotherapy & counselling, support group sessions, partner involvement, ongoing support and monitoring. All this will be covered along with one on one coaching by a professional. If you feel like you need offline support, we have pelvic health physiotherapists who are trained in treating vaginismus and dilator support, who can help guide you through your healing process.