How it feels, pain triggers, treatment

Vaginismus Vaginismus is a condition in which the vaginal muscles tighten involuntarily, causing painful or difficult vaginal penetration. It can affect your experience with pelvic exams, your periods, sex, and your mental health. Research estimates that between 1% and 7% of women experience vaginismus, but this is likely a low estimate due to underreporting; experts estimate the prevalence is closer to 17%. Treatment options are advancing, and approximately 71% of people with vaginismus find relief with treatment.

What does vaginismus mean?

Vaginismus is characterized by an involuntary tightening of the vaginal muscles, making penetration (with a penis, finger, tampon, or speculum) painful or impossible. This phenomenon can occur all along or come on suddenly.

Waterproofing and anatomy

During vaginal penetration, you may feel a sharp, burning pain or intense pressure. Some describe this as hitting a wall. This can happen at the entrance or deeper inside the vagina.

Effect on pelvic exams

Pelvic exams may be painful or impossible for people with vaginismus. Consider requesting a pediatric speculum, longer appointments, or a prescription for a muscle relaxant if this is the case.

Effect on menstruation

Inserting tampons or menstrual cups can be painful or even impossible. Many people think this is normal, but using a tampon shouldn’t hurt. Not being able to use tampons can be frustrating, as using pads is difficult for activities like swimming or gymnastics.

Effect on sex

Vaginismus causes pain during penetration attempts, making intercourse or masturbation impossible. Worrying about the pain can also cause panic attacks. The effects of vaginismus on sex can put a strain on relationships, as you may avoid sex or your partner may be afraid of hurting you.

Effects on mental health

Struggling with vaginismus can make you feel like a failure, which can lead to feelings of inadequacy and shame. These feelings can create a cycle of isolation and guilt, which can lead to depression, panic attacks, or deep sadness, especially if it affects your hopes of starting a family.

Causes and Triggers of Vaginismus

The causes and triggers of vaginismus can be physical, emotional, or psychological. Symptoms can appear at any age and may not always have a clear cause. Some people experience symptoms with every insertion, while others only have problems with certain partners or during medical examinations. Risk factors include:

• Violence (sexual, physical or emotional)
• Cancer treatment
• Difficult sexual experiences
• Family History
• Hormonal changes
• Hysterectomy
• Infections
• Menopause
• Mental health disorders
• Negative feelings or misunderstandings about sex
• Painful genital or urinary medical procedures during childhood
• Physical trauma (such as sexual assault or difficult childbirth)
• Relationship conflicts
• Stress

Steps to Diagnose Vaginismus

Providers usually diagnose vaginismus when you have the following symptoms that last six months or longer:

• Anxiety related to vaginal pain
• Difficulty using or removing tampons
• Involuntary contraction of vaginal muscles during penetration
• Pain during intercourse
• Problems with gynecological examinations

Self-care for managing vaginismus symptoms

The following relaxation and breathing techniques can reduce muscle tension and improve symptoms of vaginismus.

• Relaxation:Use aromatherapy (like lavender), hot tea, soothing music, or a warm bath.
• Breathing 4-7-8:Inhale for four seconds, hold for seven seconds, then exhale for eight seconds.
• Deep abdominal breathing: Lie on your back with your knees bent and place your hands on your rib cage. Take a deep breath, expanding your rib cage, then exhale slowly.

The following pelvic floor relaxation exercises may also help:

• Child’s Pose: Kneel down, touch your toes, spread your knees wider than your hips and stretch your arms forward. Hold this position for five to ten breaths.
• Cobra Pose: Lie on your stomach, press your feet and pubis into the floor, lift your chest and squeeze your shoulder blades together. Hold this position for five to ten breaths.
• Happy Baby Pose: Lie on your back, bring your knees towards your stomach, grab your feet with your hands and open your knees towards your armpits. Hold this position for five to ten breaths.
• Piriformis muscle stretch: Lie on your back with your knees bent. Place your left ankle on your right knee (like a figure four). Pull your right thigh toward your chest. Hold this position for 30 seconds, then switch sides.

Medical treatment of vaginismus

Vaginismus is a treatable condition that often requires a treatment team, including gynecologists, pelvic floor therapists, psychologists, and sexologists.

Sex counseling and therapy

Psychological counseling addresses emotional and mental issues. A sexologist can advise you on:

• More comfortable sex positions
• Non-penetrative activities, such as intercourse with a partner
• Moving from partial penetration to full penetration
• Sensual touch
• Tools like Ohnut to control penetration

Pelvic floor physiotherapy

A pelvic floor physiotherapist can guide you through exercises and exposure therapy, gradually inserting your fingers or vaginal dilators into the vagina. Vaginal dilators are devices that help stretch the vaginal wall, making penetration more comfortable.

Medications and procedures

The following medications and procedures may also help:

• Valium (diazepam) for muscle relaxation
• Premarin, Estrace (estrogen) for vaginal dryness
• Osphena (ospemifene) for vaginal dryness
• Botox (onabotulinumtoxinA) injections for muscle relaxation
• Marcaine (bupivacaine) injections for temporary numbness
• Insertion of vaginal dilators under sedation
• Surgery (rare) to remove scar tissue

How to Deal with Chronic Vaginismus

Living with vaginismus can be difficult. Consider connecting with others who understand your situation through support groups or online forums. If you start vaginal dilator treatment, be patient with yourself and go at your own pace. This can be more emotional than you think. Here are some other tips for vaginal dilators:

• Create a relaxing environment
• Start with the smallest size
• Use plenty of lubricant
• Insert at a slight downward angle
• Relax the vaginal muscles during insertion
• If you encounter resistance, hold the dilator in place until your muscles relax

Summary

Vaginismus occurs when the muscles around the vagina tighten, making penetration difficult. Symptoms include pain during intercourse, difficulty inserting tampons, and difficult or impossible pelvic exams. Underlying causes can be physical and psychological. Living with vaginismus can be frustrating, but many people find relief through self-care or medical treatments.