Vaginismus is a mental health concern - Here's why
Nandini Bhatia

Nandini Bhatia

Mar 21Vaginismus

Vaginismus is a mental health concern - Here's why

What is Vaginismus?

Vaginismus involves recurrent or persistent involuntary spasms of the vagina’s outer muscles, preventing the penetration of any object (penis, finger, tampon, menstrual cup, gynaecologist’s speculum etc.), despite the person's definite desire to do so. It is understood as the body’s protective response that causes an involuntary contraction of the pelvic floor muscles, causing the entrance of the vagina to close. It is an uncontrollable response generally rooted in fear. It does not necessarily affect one’s ability to get aroused or enjoy other types of sexual contact. 

Vaginismus is classified as primary or secondary. It is primary vaginismus if it’s a lifelong condition i.e. if the individual has never been able to have penetration of any kind, despite desiring so. This is often discovered during one’s first attempt at penetrative sex, inserting a tampon, or the first time a pelvic examination is attempted by a doctor. It is secondary vaginismus if painless intercourse has been experienced in the past but the individual is no longer able to have it. This can be triggered by particularly stressful life events, emotional distance created by marital conflicts, childbirth trauma and injuries, or health conditions such as pelvic inflammatory diseases, infections, endometriosis etc.

It has been associated with high levels of disturbance for those affected and can have a profound impact on how a woman feels about herself, on her partner, and on their relationship. 


Why is Vaginismus a Mental Health or Psychological Concern? 

Vaginismus is a psychosomatic condition, which means that it is borne out of an interaction between the mind and the body. Traditionally, vaginismus was understood as a physical concern characterised by the vaginal spasm. However, a multi diagnostic framework was needed to understand it beyond the physical diagnostic markers to focus on deeper cognitive and emotional meanings behind the physical symptoms. The factors that contribute to vaginismus are understood to lie on a spectrum and are understood as a combination of physical to psychological, influenced by relationships and one’s cultural context. Different blends of these factors will contribute to it in unique ways to each set of partners experiencing vaginismus. Some of these factors include: 

  • Beliefs around penetrative sex being painful or underlying fears about tissue damage or the hymen being torn, due to misinformation about the body and acts of sex
  • Beliefs around sex and masturbation being shameful or wrong including overly restrictive upbringing (in which sexuality was considered a taboo subject), repressive religious teaching resulting in unhealthy or sex negative messages, and inadequate sex education,
  • Negative beliefs around sexual organs including the vagina being too small or having a penis aversion
  • Excessive fears around negative consequences of sex including painful childbirth, unwanted pregnancy, sexually transmitted diseases etc. 
  • Experiences of pain around genitals including painful periods, vaginal injuries or surgeries 
  • Painful first sexual experiences 
  • Traumatic events including past emotional, physical and sexual abuse or being a witness of violence or abuse, or exposure to unsafe touch experiences, or excessive exposure to stories of sexual assault 
  • Having a general anxiety disorder that is characterised by hyper-vigilance, catastrophic thinking and an excessive need for control as well as development of perfectionism
  • Relationship dynamics, particularly a lack of emotional safety with one’s partner (due to mistrust, lack of commitment or emotional detachment) which could create anxiety about being vulnerable.

As the aforementioned factors underlying vaginismus are primarily psychological, emotional, relational, and cultural in nature, it makes vaginismus a mental health or psychological concern as well. 


How to Spot if You Have Vaginismus and How is it Diagnosed?

Paying attention to one’s body and symptoms during penetration of any kind can help to know whether it is vaginismus. Given below are some of the signs that point towards vaginismus: 

  • Feeling like there is a “wall” down there, blocking anything from penetrating. 
  • Painful vaginal penetration, including during sexual intersource, tampon insertion or a medical examination. 
  • Fear or anxiety around penetration, which can make one avoid penetration, sexual activity, or push the partner away in anticipation of sexual activity and/or pain. 
  • Feeling like the vaginal opening is too small for anything to penetrate. 

The condition can be extremely difficult to talk about as there can be shame and taboo surrounding matters of sexual health. However, vaginismus is more common than one thinks and it is curable, when approached with a multi-faceted, well-rounded treatment plan. It is advised to consult with a non-judgemental and trauma-informed medical expert to accurately examine the symptoms, diagnose, and suggest evidence-based treatment options. 


Can a Gynaecologist Provide the Ideal Treatment for Vaginismus?

Often, a gynaecologist is a woman’s first point of contact when challenges related to sex or the genital region may appear. It is advised to consult with a non-judgemental and trauma-informed gynaecologist to accurately examine the symptoms and diagnose vaginismus. However, since vaginismus is a combination of a physical, psychological, mental health, and relational symptoms and factors, the ideal treatment for vaginismus must also be holistic and address these multiple components. These include: 

  • Psycho-sexual therapy to address the underlying psychological and mental health factors of vaginismus. In the presence of a trauma-informed mental health expert, one must gain insight into the negative beliefs and stressors that may be contributing to vaginismus as well as heal their related past trauma. 
  • Mind and body relaxation done through mindfulness, breathing, and exercises as advised by a trained yoga professional. 
  • Pelvic floor exercises as advised by a trained pelvic health physiotherapist to target the pelvic floor muscles to gain better control of them and general movement. This also aids with vaginal training or dilation wherein the movement and stretching would decrease the pain and allow the muscles to relax. 
  • Vaginal training using vaginal dilators can be extremely helpful for the mental, visual, and physical adaptation to penetration and to refute negative beliefs around penetration being painful. Dilators are cylindrical shaped devices which come in various sizes. They are used to help open and stretch the tissues in the vaginal canal and release pain points, along with building the mental and emotional threshold to accept penetration. Oftentimes, women are just given a set of dilators to practise with on their own and it can be an overwhelming experience to go through alone. It’s important for a trained pelvic health physiotherapist or professional to guide you as you get started with dilation. 
  • Partner relationship and intimacy to build better communication and understanding between partners, provide a space for them to vent and feel supported, along with initiating partnered physical exercises aimed at improving emotional and physical connection. In some cases, couples counselling may be needed to address some deeper running issues. 
  • Support network with other women with vaginismus to address feelings of isolation that come with the condition, experience empathy and support. 


There is a need for widening of the perspective on vaginismus as from beyond a physical condition to a multi-faceted condition with psychological roots. Proactive For Her’s award winning, multi-faceted 

Vaginismus Healing Program has a multidisciplinary team to treat vaginismus holistically and supportively. If you suspect someone you know might be dealing with vaginismus, reach out to us to schedule an initial screening call and gain more information.