Vaginismus is a condition involving a muscle spasm in the pelvic floor muscles. It can make it painful, difficult, or impossible to have sexual intercourse, to undergo a gynecological exam, and to insert a tampon.

When you try to insert an object such as a tampon, penis or speculum into the vagina, it tightens up because of an involuntary contraction of the pelvic floor muscles.

This leads to generalized muscle spasm, pain and temporary cessation of breathing.

The most common muscle group affected is the pubococcygeus (PC) muscle group. These muscles are responsible for urination, intercourse, orgasm, bowel movements and childbirth.

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

There are different types of vaginismus that can affect women at different ages.

Primary vaginismus

Vaginismus can lead to stress in a relationship.
Vaginismus can lead to stress in a relationship.

This is a lifetime condition in which the pain has always been present. It will be difficult to use a tampon and to undergo a gynecological exam.

It is often experienced by women during their first attempt at intercourse. The male partner is unable to insert his penis into the vagina. He may describe a sensation like “hitting a wall” at the vaginal opening.

There may be pain, generalized muscle spasms, and the woman may temporarily stop breathing. The symptoms are reversed when the attempt at vaginal entry is stopped.

Secondary vaginismus

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

It usually stems from a specific event, such as an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery, or childbirth.

Even after any underlying medical condition is corrected, pain can continue if the body has become conditioned to respond in this way.

Global vaginismus

Vaginismus is always present, and any object will trigger it.

Situational vaginismus

This occurs only in certain situations. It may happen during sex but not during gynecological exams or tampon insertion.

The symptoms vary between individuals.

They may include:

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

Pain can range from mild to severe in nature and from discomfort to burning in sensation.

Vaginismus does not prevent people from becoming sexually aroused, but they may become anxious about sexual intercourse, so that they try to avoid sex or vaginal penetration.

Vaginismus is a condition which can be caused by physical stressors, emotional stressors, or both. It can become anticipatory, so that 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 feelings of vulnerability
  • traumatic life events, including rape or a history of abuse
  • childhood experiences, such as the portrayal of sex while growing up or exposure to sexual images

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 both men and women. They are not anyone’s fault, and they are nothing to be ashamed of.

In most cases, treatment can help.

To diagnose vaginismus, a doctor will take a medical history and carry out a pelvic examination. Treatment may involve different specialists, depending on the cause.

Any possible underlying causes, such as an infection, may need to be ruled out or treated first, before focusing on the vaginismus.

The aim of treatment will be to reduce the automatic tightening of the muscles and the fear of pain, and to deal with any other type of fear that may be related to the problem.

Treatment usually includes a combination of the following:

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 the individual understand their pain and the processes their body is going through.

Emotional exercises: This can help the person identify, express, and resolve any emotional factors that may be contributing to their vaginismus.

Reducing sensitivity to insertion: A woman will be encouraged to touch the area as close as possible to the vaginal opening every day without causing pain, moving closer each day. When she is able to touch the area around the vagina, she will be encouraged to touch and open the vaginal lips, or labia. The next step will be to insert a finger.

Insertion or dilation training: Once a woman can do this without pain, she will learn to use a plastic dilator, or a cone-shaped insert. If she 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, she can use a larger insert, and then she can teach her partner how to apply the insert.

When the woman feels comfortable with this, she can allow her partner to put his penis near the vagina, but not inside. When she is completely comfortable with this, the couple can try intercourse again. They may wish to build up gradually to this, as with the insert.

The time it takes for vaginismus to be successfully treated will depend on the individual.

It is very rare that vaginismus needs surgery.

Anyone who is concerned about symptoms relating to vaginismus should speak with their health provider for evaluation.

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