Vaginismus is a condition involving a muscle spasm in the pelvic floor muscles. The term vaginismus is less commonly used alone. Instead, the DSM-5 classifies the condition under genito-pelvic pain/penetration disorder (GPPPD). This phrase describes a constellation of vulvovaginal problems, including vaginismus.

GPPPD is a complex condition that can make it painful, difficult, or impossible to have sexual intercourse, undergo a gynecological exam, or insert a tampon. When one tries to insert an object into the vagina, the muscles around the opening of the vagina or in the pelvic floor can spasm involuntarily.

Vaginismus is just one possible cause of painful intercourse, also known as dyspareunia. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM–5) classifies vaginismus under the wider category of genito-pelvic pain/penetration disorder (GPPPD).

According to the American College of Obstetricians and Gynecologists (ACOG), 3 out of 4 women experience pain during sex at some point during their lives.

The condition is underresearched, but it reportedly impacts roughly 1–7% of women worldwide. However, this estimate could be low. Due to existing stigmas around female sexuality, female health, and the female genitals, women may be underreporting sexual dysfunctions.

Without treatment, vaginismus can lead to frustration and distress, and it may get worse. However, treatment is possible.

Fast facts about vaginismus

  • There are different forms of vaginismus, and symptoms vary between individuals.
  • Pain can range from mild to severe, and it can cause different sensations.
  • Vaginismus can result from emotional factors, medical factors, or both.
  • Treatment, which involves physical and emotional exercises, is usually effective.

There are different types of genital or pelvic pain, and they can affect people of various ages. Vaginismus, as it was called before it fell under the umbrella of GPPPD, is grouped into four categories: primary, secondary, global, and situational.

Primary vaginismus

This is a lifelong condition in which the spasming begins the first time a person tries to have sexual intercourse or insert an object like a tampon into the vagina. It may be difficult for a person to undergo a gynecological exam.

During sex, a partner is unable to insert anything into the vagina. They may describe a sensation like “hitting a wall” at the vaginal opening. A person may experience pain, burning, or generalized muscle spasms. The symptoms stop when the attempt at vaginal entry stops.

Secondary vaginismus

This develops after a person has already experienced expected sexual function. Vaginismus has not always been present. It can occur at any stage of life, and it may not have happened before.

This usually stems from a specific event, such as an infection, menopause, a medical condition, surgery, or childbirth.

Even after a doctor successfully treats any underlying medical condition, the pain can continue if the body has become conditioned to respond in this way. Vaginismus can also have psychological roots, such as physical or emotional trauma or a combination of both.

Global vs. situational vaginismus

Global vaginismus and situational vaginismus can be either primary or secondary. Global vaginismus refers to cases when the symptoms occur in response to any type of penetration.

Alternatively, situational vaginismus means the symptoms occur in response to some types of penetration but not others. For example, a person may not be able to have sex, but they will be able to insert a tampon.

The symptoms vary between individuals.

They may include:

  • painful intercourse (dyspareunia), with tightness and pain that may be burning or stinging
  • penetration that is difficult or impossible
  • long-term sexual pain with or without a known cause
  • pain during tampon insertion
  • pain during gynecological examination
  • generalized muscle spasm during attempted intercourse

Pain can range from mild to severe in intensity, and the sensation may range from slight discomfort to a burning feeling.

Vaginismus does not prevent people from becoming sexually aroused, but it may lead to anxiety about sexual intercourse and cause people to avoid sex or vaginal penetration.

During sexual activity, a person with vaginismus can still experience an orgasm from clitoral stimulation. The condition does not prevent this ability and only affects penetrative sex. However, some people with vaginismus have other sexual dysfunctions, such as difficulty reaching orgasm.

Vaginismus is a condition that can occur due to physical stressors, emotional stressors, or both. It can become anticipatory, meaning it happens because the person expects it to happen.

Emotional triggers

These include:

  • fear, for example, of pain or pregnancy
  • anxiety about performance or because of guilt
  • relationship problems, for example, having an abusive partner or feeling vulnerable
  • traumatic life events, including sexual assault or a history of abuse
  • childhood experiences, such as exposure to sexual images or portrayals of sex while growing up

Physical triggers

These include:

  • infection, such as a urinary tract infection (UTI) or yeast infection
  • health conditions, such as cancer or lichen sclerosis
  • childbirth
  • menopause
  • pelvic surgery
  • inadequate foreplay
  • insufficient vaginal lubrication
  • medication side effects

Sexual problems can affect people of all genders. A person should not blame themselves or feel ashamed. In most cases, treatment can help.

Physical risk factors for the broad category of GPPPD include:

  • childbirth
  • poor health
  • family members of a similar condition
  • history of urinary tract infections (UTIs) or yeast infections
  • chronic pain syndromes
  • endometriosis
  • psychiatric illness
  • stress or anxiety

Psychological and social symptoms can include:

  • trauma from sexual assault or childhood sexual abuse
  • trauma from a gynecological examination or other medical procedure involving vaginal insertion
  • another type of trauma resulting from different economic or social factors
  • negative perceptions of sex or belief in myths about sexuality
  • sexual or physical abuse, including by a romantic partner or family member
  • other problems in one’s romantic relationship
  • emotional problems

To diagnose vaginismus, a doctor will take a medical history and carry out a pelvic examination. The doctor may need to rule out possible underlying causes, such as an infection, before focusing on treating the vaginismus.

According to the DSM-5’s criteria for diagnosing GPPPD (including vaginismus), to get a diagnosis, a person needs to have one or more of the following symptoms for at least 6 months and experience significant distress:

  • vaginal difficulties during sexual intercourse
  • vaginal or pelvic pain during penetrative sexual intercourse or attempts at penetration
  • tightening or tensing of the pelvic floor muscles during penetrative sexual intercourse or attempts at penetration
  • feelings of fear or anxiety about experiencing vulvovaginal or pelvic pain from vaginal penetration

Conditions that may mimic vaginismus

Some conditions may present similarly to vaginismus but are different disorders. They include:

  • atrophic vaginitis, which refers to a thinning and drying of the vaginal walls after menopause due to the reduction in estrogen
  • vulvar vestibulitis, which causes intense pain during intercourse or insertion of an object like a tampon (pain usually occurs in the vulva — the external part of the female genitals)
  • vaginal infection, such as a yeast infection or a sexually transmitted illness (STI)
  • lichen sclerosis or another disorder that can create vaginal scar tissue
  • physical trauma to the vaginal area
  • going long periods without penetrative sexual intercourse, which may lead to temporary difficulties during penetration

Depending on the cause, treatment may involve different specialists. Generally, vaginismus treatment aims to reduce the automatic tightening of the muscles, remove the fear of pain, and resolve any other fears that may be related to the problem.

Progressive desensitization

This core treatment for vaginismus is progressive desensitization. This therapy involves slowly and gradually exposing a person to penetration. It can begin with encouraging a person to touch an area as close to the vaginal opening as possible without causing pain. Each day, they will move their touch closer to the vaginal opening.

When they are able to touch the area around the vagina, they will be encouraged to touch and open the vaginal lips, or labia. The next step will be to insert a finger.

Once a person can do this without pain, they will learn to use a plastic dilator or a cone-shaped insert. If they can insert this without pain, the next step will be to leave it in for 10–15 minutes to let the muscles get used to the pressure. Next, they can use a larger insert, and then they can teach their partner how to apply the insert.

When the person feels used to this, they can allow their partner to put their penis near — but not inside — the vagina. When they are completely comfortable with this, the couple can try intercourse again. They may wish to build up gradually to this, as with the insert.

This type of therapy can include learning relaxation techniques, which may be especially helpful if the cause is psychological, such as anxiety.

Other treatments for vaginismus

Additional ways a doctor may treat vaginismus include:

  • Pelvic floor control exercises: These include muscle contraction and relaxation activities, or Kegel exercises, to improve control of the pelvic floor muscles.
  • Education and counseling: Providing information about the sexual anatomy and sexual response cycle can help individuals understand their pain and the processes their body is going through.
  • Botox: Research shows that Botox may improve vaginismus symptoms. However, more research is necessary to verify this conclusion.
  • Pulsed radiofrequency (PRF): This is a relatively new treatment typically used for nerve pain. Limited research has shown potential for improvement using this therapy.
  • Surgery: This is very rare and usually only necessary when there is a problem with the vagina that mimics the symptoms of vaginismus.

Since the causes of vaginismus can be so multifaceted, a person’s treatment should focus on both physical and psychological factors. A person may need to work with a therapist or psychiatrist, who may recommend medications that can treat underlying psychological issues.

Anyone concerned about symptoms relating to vaginismus should speak with a healthcare professional for evaluation.

The more severe the vaginismus is, the harder it may be to treat. However, the condition is treatable.

In a 2021 study, researchers found that 85% of subjects with primary vaginismus were able to have pain-free intercourse after treatment. The success rate was only slightly lower for those whose condition was more severe.

A 2020 study showed that people with vaginismus might be more resistant to treatment if they blame themselves for the condition. Treatment may also be more difficult if vaginismus runs in a person’s family.

Vaginismus is a painful condition in which a person is unable to tolerate penetration of the vagina. It occurs due to a tightening of the muscles of the pelvic floor.

It is possible to treat and even cure vaginismus. However, treatment will depend on the underlying cause, which may be physical, psychological, or a combination of both. The more complex the cause or severe the symptoms, the longer treatment may take.

Typically, treatment involves diagnosing and managing any underlying physical problems, undergoing psychological therapy, performing pelvic exercises, and using vaginal dilators to gradually improve tolerance of penetration.

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