Vaginismus

Amanda Olson - DPT
Medically Reviewed By Dr. Amanda Olson, DPT, PRPC

What is Vaginismus?

Vaginismus is a medical condition in which involuntary muscle spasms in the pelvic floor muscles make any kind of vaginal penetration—whether during sexual intercourse, insertion of a tampon, or during a gynecological examination—difficult or impossible. This can cause pain, discomfort, and emotional distress.

Vaginismus

Vaginismus Types

There are two main types of vaginismus and each can be classified based on its triggers, symptoms, and duration. Understanding the type of vaginismus is important for effective treatment. 

Primary Vaginismus

This type of vaginismus occurs when a woman has never been able to have penetrative sex or insert tampons without pain. It is often discovered at a young age, such as during the first attempts at using tampons or during sexual activity. Causes may include psychological factors like fear, anxiety, or past trauma, although it can sometimes be linked to physical conditions.

Secondary Vaginismus

Secondary vaginismus occurs in women who have had pain-free penetrative sex before but start experiencing pain later in life. This may happen due to a variety of factors, such as hormonal changes, medical conditions, surgeries, or psychological factors like relationship stress or trauma.

Learn more about primary vs secondary vaginismus.

Common Symptoms of Vaginismus

  • Sexual pain with no known cause
  • Inability to tolerate vaginal penetration for sex, pelvic exam, or tampon use
  • Vaginal burning or stinging with sex
  • Muscle spasms around the vagina with attempted sex
  • Unconsummated marriage
  • Protective behaviors

These protective behaviors may include muscular guarding or clenching of the muscles in the pelvic floor, buttocks, hips, thighs, neck, chest, and shoulders.

Vaginismus Causes

The causes of vaginismus can be complex and multifactorial, often involving both physical and psychological elements. Understanding the underlying causes can be crucial for effective diagnosis and treatment. Below are some of the common causes:

What are the Physical Causes of Vaginismus?

  • Medical Conditions: Conditions like urinary tract infections, yeast infections, or sexually transmitted infections can cause pain and may trigger vaginismus.
  • Hormonal Changes: Changes in hormone levels, often related to menopause, childbirth, or hormonal contraceptives, can lead to vaginal dryness and discomfort, which may trigger vaginismus.
  • Surgery or Injury: Any kind of surgery or injury to the genital area or pelvic region can cause physical discomfort and potential psychological trauma, leading to vaginismus.
  • Childbirth: For some women, the experience of childbirth, particularly if it was traumatic or involved complications, can result in vaginismus.
  • Pelvic Inflammatory Disease (PID): This condition can cause pain during intercourse and may lead to vaginismus in some women.

What Are the Psychological Causes of Vaginismus?

  • Sexual Trauma or Abuse: Any history of sexual assault or abuse can lead to vaginismus. The involuntary spasms can be a protective reaction.
  • Emotional Factors: Anxiety, stress, and depression can play a role in the onset of vaginismus.
  • Relationship Issues: Emotional distance, trust issues, or other relationship-related stressors can sometimes be underlying causes.
  • Cultural or Religious Beliefs: In some cases, strict cultural or religious teachings about sex and virginity can create anxiety and contribute to vaginismus.
  • Fear or Anticipation of Pain: Sometimes, the mere anticipation or fear of pain, even in the absence of any physical issue, can trigger vaginismus.

Mixed Causes

Often, it is not a single factor but a combination of physical and psychological factors that cause vaginismus. For example, a woman might experience pain due to a urinary tract infection and then develop anxiety around sexual intercourse, resulting in a cycle of pain and anxiety that perpetuates the condition.

Idiopathic

In some cases, there is no identifiable cause for vaginismus. This can make diagnosis and treatment more challenging, requiring a more holistic approach to care.

Diagnosing Vaginismus

While health care providers may do certain tests and procedures such as ultrasounds or lab testing to rule out disease, these tests will come back negative in women with vaginismus.

Once it has been determined that vaginismus, either primary or secondary, is the diagnosis, there are gentle and non-invasive treatment methods that are helpful prior to or during the use of vaginal dilator kits. This includes pelvic physical therapy, a specialized form of physical therapy, referred to as dilator therapy, done with a highly trained pelvic physical therapist.

Counseling and other forms of therapy are also beneficial depending on the woman’s goals and individual needs.

Why Does Vaginismus Make Sex Painful?

Vaginismus creates difficulty with vaginal penetration due to an involuntary contraction of the pelvic floor muscles. The pelvic floor muscles support the pelvic organs including the bladder, uterus, and bowel.

These muscles surround the vaginal opening, and women who experience vaginal pain during penetration often experience severe tightness of these muscles.

This Tightening is Involuntary 

Women with vaginismus don’t intentionally tighten or restrict the muscles, rather it is a reflexive response. This makes penetration difficult or impossible. When intercourse is attempted, it can feel like a partner is crashing into a brick wall causing extreme pain, frustration, and sadness for both partners.

Friction within the relationship is commonly experienced in couples with this issue. Counseling and therapy (marital, couples, or sex) are highly recommended. By participating in both the physical and mental aspects of training, while simultaneously receiving support from a counselor or therapist, couples learn new skills to support each other.

Often, a male partner simply does not know how to best support his female partner when vaginismus is involved, which can lead to further distress for both partners.

The good news is that this condition is fixable. Retraining the muscles to relax takes time. Many women who experience vaginismus experienced abuse, rape, surgery, radiation, or a traumatic experience that preceded vaginal pain with penetration.

For this reason, counseling may be beneficial while working on training the body. Anxiety, stress, pain, and fear of pain often reinforce the symptoms of vaginismus.

The process of curing vaginismus involves learning to sense when the muscles spasm, and training the brain to relax them prior to the contraction starting via vaginismus exercises.
 

Sexual Frustration

 

Vaginismus Treatment

The best form of treatment for vaginismus can vary from person to person, depending on the underlying causes, symptoms, and personal preferences. Treatment often involves a multi-disciplinary approach that may include medical, physical, and psychological interventions. Vaginismus surgery is another option and involves a quick procedure. 

Breathing Exercises for Vaginismus Pain

Learning to breathe properly is an important part of healing pelvic and vaginal pain. Many women with pelvic pain breathe shallowly and into their chests. By learning to breathe through the diaphragm, it is possible to improve overall circulation, reduce strain on the pelvic floor muscles, and reduce tension in the neck, head, and shoulders.

In order to breathe properly, practice the following exercises. It is often best to couple this training with vaginal training. Perform this breathing method prior to using the vaginal trainers daily. To start, find a comfortable position lying down. Often, it is helpful to put pillows or a bolster under the knees to reduce tension in the lower back.

Place one hand on the chest bone and the other on the stomach. The goal during this breathing exercise is to keep the chest still but allow the stomach to rise and fall with the breath.

Breathe in slowly and deeply through the nose, allowing your stomach to gently rise, keeping the chest still. Exhale gently through the mouth, allowing the stomach to gently fall. Pay close attention to your stomach rising and falling as you breathe in through the nose and out through the mouth.

Continue to take nice, slow breaths as you allow all thoughts and disruptions to fade away. Visualize the tension in your body being released as your body relaxes.

Practice releasing tension in your body, specifically in the pelvic floor muscles and the muscles around the vagina. To do this, begin by focusing attention on your feet. The feet share common nerves with the pelvic floor, so it is helpful to practice noticing the muscles in your feet clenching and unclenching.

Maintain your breathing pattern and clench your toes on both feet as hard as you can, making a “fist” with your feet for about 5 seconds. Then let them completely relax. Next, clench them only halfway – give a 50% effort to clenching your feet – again for 5 seconds. Then allow the muscles to completely relax. Notice how different they feel relaxed compared to clenched.

Next, do the same thing with your gluteal muscles, or buttocks. Maintain your breathing (do not hold your breath) and clench your buttocks together as hard as you can for 5 seconds, and then relax. Do it again at 50% effort for 5 seconds, and then relax.

Take note of the difference in sensation in clenched versus relaxed. Next, do this with the pelvic floor muscles. Contract them as hard as you can as if you were shutting off the flow of urine, and then relax. Really note the sensation of relaxation in your muscles after they have clenched and then relaxed. Now perform a 50% effort contraction.

Take note of the difference in effort between clenching and relaxing.

Bring your attention to your abdominal muscles. Keep breathing and contract these muscles as hard as you can by pulling your belly button in toward your spine. Hold for 5 seconds and then relax. Repeat this contraction at 50% effort, pulling the belly downward, and hold for 5 seconds, and then relax. As you relax, notice how it feels to allow the muscles to be still compared with how they felt when they were clenched.

Finally, notice the tension around the shoulders, neck, and jaw. Maintain your breathing and press your head slowly back and lift your shoulders toward your ears. Hold this for 5 seconds, and then relax.

Contract those muscles again, only this time at 50% of your strongest effort, and hold for 5 seconds and then relax. Notice the sensation of the muscles when they are fully relaxed. Continue breathing deeply into your belly for a few more minutes to conclude your practice.

This exercise of clenching, unclenching, and noticing the sensation of relaxation is important because it gives your brain information. This information allows you to be more aware of clenching patterns that may arise throughout your day during times of stress, anxiety, or pain.

Having the ability to unclench the muscles and breathe allows you to, little by little, decrease the clenching pattern over time. The goal is this: if the muscles begin to clench, your brain will notice immediately because it has learned to monitor this pattern, and it will then relax the muscles.

 

Dilators for Vaginismus

Use this training program with a vaginal dilation trainer. For vaginal or pelvic dilation to address vaginal pain, vaginitis treatment, or pelvic exercise following gender affirming surgery, buy your silicone dilators online at Intimate Rose. 

An Overview From Amanda & Aaron

FAQs

How do my patients give their script to Intimate Rose?

We've added the ability to upload a script as part of the purchase process. Visitors on www.intimaterose.com can choose the Prescription Upload link directly below the Add To Cart button on dilator product pages. Visitors can upload their script via mobile or desktop. Any file version will do. Alternatively, visitors can also email a copy of their script to support@intimaterose.com.

What is the longer term plan?

We are actively working on a better experience for customers and clinicians to make the vaginal dilator purchase process as seamless as possible. We will share updates as this solution becomes available.

What can I do as a healthcare provider?

Healthcare providers can help their patients with this process in a few ways. If you can write a script, you can provide one to support@intimaterose.com referencing your patient or have your patients upload / email it to us. State laws vary on who can or can't write a prescription. If you can not write a script, you can call your patient's PCP and ask them if they'd help.

Where can I find official FDA documentation?

Here is a link to the FDA document on Vaginal Dilators: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=HDX.

This link shows that Vaginal Dilators are considered a class 2 medical device that require 510(k) documentation to be compliant with the FDA.

Does this have something to do with Insurance or FSA?

No, this is completely independent of any insurance or FSA compliance, and that isn't a cause or effect of this.