Vaginismus is a condition involving a muscle spasm in the pelvic floor muscles. It can make intercourse painful. Psychological therapy, vaginal dilators, and pelvic exercises can help someone overcome vaginismus.

Healthcare professionals do not often use the term “vaginismus” on its own. Instead, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies the condition under “genito-pelvic pain/penetration disorder (GPPPD).” This phrase describes a group of vulvovaginal problems, including vaginismus.

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

Keep reading to learn more about vaginismus.

Vaginismus is just one possible cause of painful intercourse, which is also known as dyspareunia. The DSM-5 classifies vaginismus under the wider category of GPPPD.

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

The condition is underresearched, but it reportedly affects roughly 1% to 7% of females worldwide. However, this estimate could be low. Due to existing stigmas around female sexuality, female health, and the female genitals, females may be underreporting difficulties with sexual function.

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

Fast facts about vaginismus

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

There are multiple types of genital or pelvic pain, and they can affect people of various ages. Healthcare professionals divide vaginismus into two categories: primary and secondary.

Primary vaginismus

This is a lifelong condition. Vaginisumus is primary when a person has never experienced vaginal penetration without pain. The condition may also make it difficult for a person to undergo a gynecological exam.

During sex, a partner is unable to insert anything into the vagina. A person may experience pain, burning, or generalized muscle spasms. The symptoms stop when the attempt at vaginal entry stops.

Secondary vaginismus

A person with this type of vaginismus has previously experienced vaginal penetration without pain but begins to experience pain. 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 the two.

The symptoms vary from person to person but may include:

  • painful intercourse (dyspareunia), which features tightness and possibly a burning or stinging sensation
  • difficulty inserting anything into the vagina, or an inability to do so
  • 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 — it affects only penetrative sex. However, some people with vaginismus have other difficulties with sexual function, such as difficulty reaching orgasm.

What does vaginismus feel like?

Some women describe the feeling as a “block,” and pain may accompany this feeling. The condition can also take a toll emotionally.

Vaginismus can occur as a result of physical stressors, emotional stressors, or both. It can become anticipatory, meaning it happens because the person expects it to happen.

Emotional triggers

Possible emotional triggers for the condition include:

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

Physical triggers

Possible physical triggers include:

  • an 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

Difficulties with sexual function 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
  • the presence of a similar condition in family members
  • a history of UTIs or yeast infections
  • chronic pain syndromes
  • endometriosis
  • mental health conditions
  • stress or anxiety

Psychological and social risk factors can include:

  • trauma from sexual assault or childhood sexual abuse
  • trauma from a gynecological examination or another medical procedure involving vaginal insertion
  • 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 difficulties

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 receive 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 and experiences may lead to symptoms similar to those of vaginismus, but they are distinct from it. These include:

  • atrophic vaginitis, which is a thinning and drying of the vaginal walls after menopause due to the reduction in estrogen
  • vulvar vestibulitis, which causes intense pain, usually in the vulva, during intercourse or when inserting an object such as a tampon
  • a vaginal infection, such as a yeast infection or a sexually transmitted infection
  • lichen sclerosis or another condition that can create vaginal scar tissue
  • physical trauma to the vaginal area
  • long periods of time 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 relate to the condition.

Progressive desensitization

The core treatment for vaginismus is progressive desensitization. This therapy involves slowly and gradually exposing a person to penetration. This can begin with encouraging the 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 move on to touching and opening 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 to 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 condition has a psychological cause, such as anxiety.

Other treatments for vaginismus

Additional ways to treat vaginismus include:

  • Pelvic floor control exercises: A person can practice muscle contraction and relaxation activities, or Kegel exercises, to improve their control of the pelvic floor muscles.
  • Education and counseling: Providing information about the sexual anatomy and sexual response cycle can help people understand their pain and the processes their body is going through.
  • Botox: A 2019 research review suggests that Botox may improve vaginismus symptoms. However, more research is necessary to verify this conclusion.
  • Pulsed radiofrequency: This is a relatively new treatment that is typically used for nerve pain. Limited research has shown potential for improvement as a result of this therapy.
  • Surgery: This is very rare and is typically necessary only if there is a problem with the vagina that mimics the symptoms of vaginismus.

Because the causes of vaginismus can be so multifaceted, 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 mental health conditions.

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

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

In a small 2021 study, researchers found that 85 out of 91 participants with primary vaginismus were able to have pain-free intercourse after treatment. The researchers divided the participants into 4 groups according to the severity of their condition, and the success rate was 92% or greater for all groups.

The results of a small 2020 study suggest that people with vaginismus might be more resistant to treatment if they blame themselves for the condition and that treatment may be more difficult if vaginismus runs in a person’s family.

Vaginismus is a painful condition in which tightening of the pelvic floor muscles makes it difficult or impossible for a person to tolerate vaginal penetration.

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

Typically, treatment involves diagnosing and managing any underlying health conditions, participating in psychological therapy, performing pelvic exercises, and using vaginal dilators to gradually improve tolerance of penetration.

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