What’s Vaginismus and How Do I Know if I Have It?

Are you experiencing pain during sex? While many like pain during sex when it's part of kinky, rough play, pain during vaginal intercourse is a different story. It can indicate a serious medical issue. There are many causes of pain with sex, and vaginismus is one of them. This reproductive health condition can cause not only painful intercourse but other problems related to vaginal penetration as well. 

Though vaginismus can have a major impact on your sex life, it is treatable, and many people who undergo treatment eventually have pain-free sex. Let's dig into all things vaginismus, including symptoms, causes, and treatment. 

What is vaginismus?

Vaginismus is a medical condition in which the muscles in your vagina involuntary spasm and tighten.

“Muscle spasms can make it painful, difficult, or even impossible to have sexual intercourse, insert a tampon, or have a gynecological exam,” says Lexi Burtman, a pelvic floor physical therapist and the founder of Elevated Pelvic. “When the muscles that surround the vaginal opening are in constant spasm, they can end up shortened and contracted, making it more difficult to relax.”

Vaginismus can affect women and people with vaginas of all ages, races, and sexual orientations, regardless of their sexual experience. 

Symptoms of Vaginismus

Vaginismus can present in various ways, but the most common include the following:

• Painful intercourse, also known as dyspareunia
• Difficulty or inability to insert tampons or have pelvic exams
• Burning or stinging sensation during attempted vaginal intercourse
• Fear or anxiety about vaginal penetration
• Tightening or clenching sensation in the pelvic floor muscles

Please note that the severity of these vaginismus symptoms can vary widely. Women and people assigned female at birth with mild vaginismus may still be able to have penetrative intercourse, though the muscle spasms will make it painful. People with severe vaginismus may not be able to insert anything in their vagina, even a finger.

Causes of Vaginismus

So, what causes vaginismus? There are several reasons — both emotional and physical — why you might experience vaginismus.

Some of the most common causes include:

• Pelvic and vaginal infections
• Injuries from surgery or childbirth
• Hormonal changes
• Certain medical conditions
• Trauma
• Relationship troubles
• Negative sexual experiences
• Fear of having sex
• Anxiety 

There’s also a link between vaginismus and other reproductive health conditions like vulvodynia and endometriosis. 

It’s important to note that, in some cases, there’s no direct cause for vaginismus.

Similar Conditions

While they both can cause pain during sex, vaginismus and dyspareunia are not the same. Vaginismus is characterized by the painful muscle spasms that make vaginal penetration difficult or impossible, while dyspareunia is an umbrella term for pain during sex. Dyspareunia is typically seen as a symptom of vaginismus.

Aside from vaginismus and dyspareunia, there are other conditions that can make sex quite painful, including:

• Endometriosis
• Infections
• Vulvodynia
• Pelvic floor dysfunction
• Pelvic congestion
• Vulvar vestibulitis
• Uterine fibroids
• Atrophic vaginitis
• Pelvic inflammatory disease (PID)

Burtman also adds that vestibulodynia, genitourinary syndrome of menopause, interstitial cystitis, pudendal neuralgia, constipation, and lichen sclerosis may contribute to painful sex.

To ensure you get an accurate diagnosis, please be sure to reach out to your healthcare provider if you regularly experience pain during vaginal intercourse. 

Diagnosis & Management of Vaginismus

If you believe you have vaginismus, know that you’re not alone and that there’s help available. It's important to talk to a healthcare professional so you can get a proper diagnosis.

The process for diagnosing this condition can include:

• A review of your medical history: Your healthcare provider will look at your medical history and symptoms.
• Questions about sexual trauma: Some of the questions they may ask could make you uncomfortable, such as history of sexual trauma, but understand that they have your best interest in mind. Vaginismus is a mental as well as physical condition, so your doctor needs to understand your sexual history to give you an accurate diagnosis.
• Pelvic exam: If you’re feeling comfortable, your healthcare provider may perform a pelvic exam by inserting one or two lubricated fingers into your vagina to feel for intense vaginal spasms. 
• Electromyography (EMG): A healthcare provider may use EMG to see if you’re experiencing heightened levels of muscle activity in your pelvic floor muscles.

We know it can be quite uncomfortable to be open with your healthcare provider about your sexual health. However, it’s crucial to be completely honest with them to ensure you get a proper diagnosis and can move forward with the proper treatment. 

Treatment Options for Vaginismus

Good news — vaginismus is curable with a combination of treatments, which may include dilation therapy, pelvic floor physical therapy, medications, and psychotherapy.

Here’s a look at the many treatment options for this reproductive health condition:

• Pelvic floor physical therapy: This vaginismus treatment involves exercises that can help strengthen and relax the muscles in your pelvic floor. You’ll work with a licensed therapist who can help lower your pain, improve muscle control, and address other symptoms like painful sex.
• Vaginal dilator therapy: These are devices that can slowly retrain your vaginal muscles to accommodate penetration without tensing the muscles. Vaginal dilators are often prescribed for conditions like vaginismus. Dilators come in a variety of sizes to increase your comfort and vaginal elasticity.
• Vaginal stretching exercise: These gentle stretching exercises can increase the flexibility of your vagina and relieve discomfort during penetration.
• Sex therapy or counseling: Doing individual or couples counseling may help you better navigate vaginismus and its effect on your sex life. Working with a licensed therapist can help you address concerns like pain during sex, intimacy issues, and any anxiety surrounding sexual activity.
• Mindfulness and relaxation techniques: Meditation, deep breathing, yoga, and progressive muscle relaxation are mindfulness techniques that can help you lower your anxiety and potentially reduce pelvic pain and tension. 
• Medications: In some cases, your healthcare provider may prescribe topical creams or oral medications to treat any underlying condition tied to vaginismus. 

The Bottom Line

If you seek treatment for vaginismus, you can see a significant change in your symptoms and have a pain-free sex life. Finding the treatment that works for you may take some trial and error, but don’t lose hope, and don’t hesitate to seek support when you need it.