Whilst you might be used to calling it a vagina, the external part of the female reproductive system is actually called a vulva. The vulva is connected via a muscular canal to the neck of the uterus, and this canal is called the vagina. It’s like a tunnel that connects these two parts of your anatomy.
Vaginismus refers to an uncontrollable, automatic reaction when something – maybe a penis, a tampon, a medical device or all of the above – attempts to penetrate the vagina. It’s not a conscious thing that you’re willing yourself to do – it’s an automatic response that is outside of your control.
“Vaginismus is a condition that causes involuntary muscle spasms or contractions in the pelvic floor surrounding the vaginal opening, which can cause sexual intercourse to be painful or even impossible,” says Dr. Dayananda, OBGYN*. “Along with intercourse, the use of tampons or undergoing a pelvic exam can also be painful or impossible due to vaginismus. This condition is complex in that its root causes can be both physical and psychological depending on the person.”
What are the symptoms of vaginismus?
Dr. Martha Tara Lee*, D.H.S., M.A., M.A., B.A. (she/ her), Relationship Counselor & Clinical Sexologist, describes the typical symptoms of vaginismus:
- Pain or discomfort during attempted penetration.
- Inability to insert a tampon, finger, or penis into the vagina.
- Fear or anxiety related to penetration.
- Tensing or tightening of the pelvic floor muscles during attempted penetration.
There are two main types of vaginismus. “Primary vaginismus occurs when a person has never been able to have penetrative sex due to the involuntary muscle spasms. It can often be present from the first attempt at penetration. Secondary vaginismus occurs when a person develops vaginismus after a period of pain-free penetrative sex. It may be triggered by factors such as trauma, infection, childbirth, or menopause,” says Dr. Martha Tara Lee.
How common is vaginismus?
Around one in ten women in the U.K experience some kind of pain whenever they have sex, and around 75% of women will experience painful sex during their lifetime. It’s hard to tell exactly how many people have vaginismus, as some may feel too embarrassed to come forward for treatment.
Many people with vaginismus have a positive response to treatment, although it’s important to remember that it can take time.
What causes vaginismus?
It’s unclear what the exact cause of vaginismus is, and it may be different for different people – especially as some may have experienced vaginismus since their first attempt at penetration and others may have developed it later on.
“The causes of vaginismus can vary and may include physical, psychological, or emotional factors,” says Dr. Dayananda. “Some common causes include past traumatic experiences, anxiety related to sex or penetration, cultural or religious beliefs surrounding sex, and certain medical conditions such as infections or endometriosis.”
Vaginismus is usually linked to fear around having sex, but it can be hard to tell whether the fear or the vaginismus came first – if the vaginismus came first then a fear of penetrative sex makes perfect sense if the only types of penetrative sex you’ve had have been painful. Some people experience vaginismus with all penetration, whilst others may experience it in specific cases – i.e. with one partner but not another, or only with penises but not with tampons or medical devices.
How can vaginismus affect your sex life?
As vaginismus can make it uncomfortable, difficult or impossible to engage in vaginal penetration, this can affect some of the types of sex you may want to engage in. Whilst some types of sex involve penetration, not all of them do and you can enjoy a fulfilling sex life without including it. Vaginismus doesn’t usually affect someone’s ability to enjoy clitorial stimulation, and it doesn’t mean the person experiencing it does not enjoy sex or has a low sex drive.
Before trying to ‘fix’ vaginismus, we encourage you to spend some time thinking about what types of sex you want to have, why you want to have them and what is and isn’t important to you. It’s your body and your choice.
How do you treat vaginismus?
“To get diagnosed with vaginismus, it is important to consult with a healthcare professional specialising in sexual health, such as a gynaecologist or a sex therapist,” says Dr. Martha Tara Lee. “They will conduct a thorough assessment that may include a physical examination, discussion of symptoms and medical history, and ruling out any underlying medical conditions. It is important to remember that every individual’s experience with vaginismus is unique, and treatment approaches may vary. Working with a healthcare professional who specialises in sexual health can provide personalised guidance and support throughout the treatment process”
When being treated for vaginismus, your doctor will first try to rule out other causes for pain around penetration, which could be caused by vaginal atrophy, where a lack of oestrogen makes the lining of the vagina thinner and dryer, or vulvar vestibulitis, a condition which causes painful sex. The doctor may conduct a pelvic exam to confirm that your vaginal muscles are spasming. Remember that you deserve to feel comfortable and safe, so if you’d prefer, check in advance if you can request a female doctor, and let the healthcare professional know if you have any concerns or if they can do anything to help make you feel more comfortable.
It is important to remember that every individual’s experience with vaginismus is unique, and treatment approaches may vary.
Treatment could involve working with a physical therapist to do things like pelvic floor exercises to gain more control over your muscle spasms, and/or therapy like CBT, sex therapy or longer forms of self exploration where you can explore and address any underlying fears, shame, beliefs and so on which may be contributing to the physical reactions. Treatment options may include:
- Pelvic floor muscle exercises: A physical therapist can give you exercises (which you can do at home) with the aim of slowly helping you learn how to control and relax the muscles around your vagina. The exercise regime usually involves kegels (where you squeeze the same muscles you would use to stop peeing) to help you explore and get more used to controlling that part of your body.
- Gradual desensitisation: This is where you slowly start inserting things (perhaps a finger or a vaginal dilator) to get to know what happens when you attempt penetration and learn ways to potentially have a different response.
- Therapy: Working with a therapist or sex coach can help you identify and work out any underlying psychological or emotional factors that may be contributing to your vaginismus, such as anxiety or past trauma.
- Education and communication: Learning about sexual anatomy, arousal, pleasure, and effective communication can help you be seen, heard and feel safer with your sexual partner(s).
Many people with vaginismus have a positive response to treatment, although it’s important to remember that it can take time. Remember that you don’t need to have vaginal penetration in order to enjoy a fulfilling sex life, and just because treatment options are available doesn’t mean you necessarily have to try them. Make sure that you’re doing it only because you want to, and know that you can stop at any time. There are many ways to enjoy sex, and the right people will work with you to find what is good for everyone involved.
*The healthcare professionals cited in this article do not endorse any products or brands.
Hana® 75µg film-coated tablets contains desogestrel and is an oral contraception for women of child bearing age to prevent pregnancy. Always read the instructions on the package leaflet carefully.