The Ultimate Guide to Understanding Vaginismus

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. 

 

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. 

What are the Types of Vaginismus?

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. 

How to Spot if You Have Vaginismus?

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. 

What are the Factors that Contribute to Vaginismus?

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.

For those with vaginismus, it is often a combination of multiple aforementioned factors that contributes to their condition and in maintaining vaginismus. Oftentimes, these excessive fears or negative beliefs originate from a lack of information or misinformation about the body, genitals and acts of sex. Beliefs around sex, sexuality, sexual organs, relationships etc. are often shaped by the socio-cultural contexts one is raised in, and are often at loggerheads with one’s natural, biological sexual needs. With a trained professional and through targeted interventions and education, one can learn to identify which of these causes are contributing to their experience of vaginismus and gain insight into changing them and/or healing from traumatic past experiences. 

What are the Common Signs and Symptoms of Vaginismus?

Painful sex is the first and leading sign of vaginismus as it is often discovered at the time of one’s initial sexual penetration experience. This pain is also experienced as a pressure, cramp, burning, or the penis “hitting a wall”. Some women also experience bleeding at this time. This pain or discomfort typically goes away after the attempted penetration is over, but it may not always be the case. This discomfort is also experienced at the time of inserting a tampon or getting a pelvic examination. Additional common signs and symptoms to be aware of include the following: 

• Fear or pain associated with sexual activity 
• Loss of sexual desire or performance anxiety 
• Inability to insert a tampon or a menstrual cup 
• Inability to insert a sex toy 
• Random muscles spasms of the pelvic area or wall 
• Triggered spasms from massage, foreplay, or oral stimulation
• Long sustained contractions that are uncomfortable 
• Tension in hips, hamstrings, lower back, and abdominal muscles 

These symptoms can be experienced across a spectrum from mild to severe, are involuntary, and generally do not improve without any intervention or treatment.

Ultimately, vaginismus can lead to significant difficulty in many important aspects and relationships in a woman’s life, including with herself, her body, and her significant others. 

How can Vaginismus be Treated?

Vaginismus is still shrouded in taboo, shame, embarrassment or pure ignorance wherein women often do not have a name for what they are experiencing and are forced to live with their fate. The good news is that vaginismus is 100% curable with a multidisciplinary and disciplined approach to the treatment plan. 

Just as the experience and underlying causes of vaginismus are unique to each individual, the treatment also has to be custom-tailored in order to achieve the desired outcome. However, some components of the treatment are essential across all individuals. They ensure a holistic and well-rounded approach to healing vaginismus. 

• Psycho-sexual therapy 

Vaginismus is a ‘psychosomatic’ condition, which means that it is a physical condition caused or aggravated by mental or emotional causes. Hence, it is important to address the underlying causes of it. 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. 

Additionally, ignorance stemming from a lack of pleasure-centric sex education can also contribute to vaginismus. Education around sex, relationships, and pleasure can help one in understanding their body, patterns and preferences better, and enable them to cultivate a healthy, safe, respectful, and enjoyable sex life. 

• Mind and Body Relaxation

Relaxation techniques such as mindfulness, breathing, and targeted yoga exercises can help in relaxing the mind and body and provide the grounded foundation needed for the interventions in the treatment plan. 

• Pelvic Floor Exercises

Pelvic floor muscles can be tight and with tension points for those with vaginismus. Consulting with a physiotherapist for an accurate assessment and exercise plan would be helpful to target the pelvic floor muscles to gain better control of them and general movement to improve blood flow and oxygen to the area. 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

Vaginal training using 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 physiotherapist or professional to guide you as you get started with dilation. 

• Partner Relationship and Intimacy

Emotional and physical intimacy in relationships can often get strained in vaginismus cases. While healing vaginismus, it is also imperative to build a communication system with the partners involved to help them understand the condition better, provide a space for them to vent and feel supported, along with initiating partnered exercises aimed at improving emotional and physical connection. 

Conclusion

This post is meant to leave the reader better informed about vaginismus and the way forward with its healing. If you suspect someone you know might be dealing with vaginismus, reach out to us at Proactive For Her to schedule an initial consultation and gain more information about our award winning Vaginismus Healing Program that is designed to be holistic and supportive, including for the partner of someone with vaginismus. 

References

https://www.tandfonline.com/doi/full/10.1080/14681994.2021.2007233

https://www.nhs.uk/conditions/vaginismus/

https://proactiveforher.com/blogs/vaginismus/how-to-spot-if-you-have-vaginismus/

https://proactiveforher.com/blogs/vaginismus/can-vaginismus-be-cured-yes-it-is-treatable-here-s-how/

https://www.plannedparenthood.org/blog/whats-vaginismus-and-how-do-i-know-if-i-have-it