Vaginismus is an embarrassing problem for many women. Symptoms, treatment and prevention

Vaginismus is the involuntary contraction of the vaginal muscles. Women may experience this at the beginning of sex, while inserting a tampon, or during a gynecological exam. Vaginismus can make intercourse painful (dyspareunia). Kegels, vaginal dilators, and cognitive behavioral therapy (CBT) can help your muscles relax and stop contractions.

What is vaginismus?

Vaginismus is vaginal pressure resulting from involuntary tension of the pelvic floor muscles, causing discomfort, burning, pain, penetration problems, and even complete inability to have sexual intercourse and prevent the insertion of tampons or a gynecological examination. Vaginal muscle contractions during vaginismus are an unconscious reaction to the fear of impending vaginal penetration.

Since vaginismus causes painful sex, it is a type of dyspareunia – the medical term for persistent pain before, during, or after sexual intercourse. Three out of four women experience pain during sex at some point in their lives, according to researchers at the American College of Obstetricians and Gynecologists.

Women with vaginismus can still experience orgasms as a result of clitoral stimulation, and treatment can restore their ability to enjoy penetrative sex.

Also check: Why do some women feel pain during intercourse?

Vaginismus – types

There are two main types of vaginismus.

Primitive vaginismus

Primary vaginismus is life-long, and contractions begin the first time a woman tries to have sexual intercourse or insert an object such as a tampon into the vagina. Of course, the problem may also arise during the gynecological examination. Symptoms may include pain, burning, or generalized muscle spasms. The symptoms cease when the attempt to enter the vagina ceases.

Secondary vaginismus

Secondary vaginismus develops after a woman has had sexual intercourse. It is not always painful and may appear at any stage of life. It is usually caused by an infection, menopause, medical condition, surgery or childbirth. Even after healing, the body may react in this way, which is to tighten the muscles of the vagina. According to experts, vaginismus can be psychological and may be a response to physical or emotional trauma, or both.

According to the DSM-5 classification of genito-pelvic pain / penatration disorders (GPPPD; vulvar pelvic pain / penetration disorders) there are two more types of vaginismus, namely global vaginismus (from English. global vaginismus) and situational vaginismus (from ang. situational vaginismus). Both can be primary or secondary. Global vaginismus is one in which symptoms occur in response to any type of penetration. On the other hand, situational vaginismus symptoms appear in response to some types of penetration but not to others (e.g. a woman may not be able to have sex but will be able to insert a tampon).

What causes vaginismus?

Vaginismus can be physical and emotional, or both. Vaginismus can become anticipatory, which means it happens because a woman expects it.

Physical factors include:

1. clenching your muscles too much – the pelvic floor muscles have been ‘tied’ tight for a long time, ie gymnastics, dancing, pilates. Constantly pulling in your abdominal muscles can also contribute to your pelvic floor muscles becoming overactive. Being a generally muscular person (lack of flexibility, especially around the hips) can lead to vaginismus.
2. Ailments – urinary tract infections or problems with urination, yeast infections, sexually transmitted diseases, endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammation, lichen planus, vulvar lichen, eczema, psoriasis, vaginal prolapse e.t.c.
3. Birth – pain after normal or difficult vaginal deliveries and complications, caesarean section, miscarriages etc.
4. Age-related changes – menopause and hormonal changes, vaginal dryness / insufficient lubrication, vaginal atrophy.
5. Temporary discomfort – temporary pain or discomfort resulting from insufficient foreplay or insufficient vaginal lubrication.
6. Pelvic injury – any type of pelvic surgery, difficult pelvic examinations or other pelvic injuries.
7. Exploitation -physical assault, rape, sexual / physical abuse or assault.
8. Leki – the side effects of some medications can cause pelvic pain.

Emotional factors include:

1. Bow – fear or expectation of pain during intercourse, fear of incomplete physical healing after a pelvic injury, fear of tissue damage such as “tearing”, fear of becoming pregnant, fear of recurrence of pelvic health problems.
2. Stres – general anxiety, pressure related to the quality of sexual intercourse, previous unpleasant sexual experiences, negative attitudes towards sex, guilt, emotional trauma or other unhealthy sexual emotions.
3. Problems with partners – use, emotional distance, fear of commitment, distrust, fear of being vulnerable, loss of control.
4. Traumatic events – past emotional / sexual abuse, witnessing violence or abuse, repressed memories.
5. Childhood experiences – strict upbringing, bad teaching, eg “Sex is WRONG”, exposure to shocking sexual scenes, inadequate sexual education.
6. No reason – sometimes there is no identifiable cause (physical or non-physical).

Sexual problems can affect people of any gender. Man should not blame himself or be ashamed. In most cases, treatment may be helpful.

Vaginismus – risk factors

Physical risk factors include:

1. birth;
2. poor health;
3. having a family member with a similar health condition;
4. a history of urinary tract infections or yeast infections;
5. chronic pain syndromes;
6. endometriosis;
7. mental disorders;
8. stress or anxiety.

Psychological and social factors may include:

1. trauma due to sexual assault or sexual abuse in childhood;
2. trauma following a gynecological examination or other medical procedure involving insertion of something into the vagina;
3. a different type of trauma resulting from various economic or social factors;
4. negative perception of sex or belief in myths about sexuality;
5. sexual or physical harassment, including by a partner or family member;
6. other relationship problems;
7. emotional problems.

See also: How to fight harassment at work?

Vaginismus – symptoms

Symptoms of vaginismus can vary and include:

1. painful intercourse (dyspareunia), with pressure and pain which may be stinging or stinging;
2. difficult or impossible penetration;
3. prolonged sexual pain with or without a known cause;
4. pain when inserting a tampon;
5. pain during a gynecological examination;
6. generalized muscle contraction when attempting intercourse.

Pain may be mild to severe, and the sensation may range from mild discomfort to a burning sensation.

It should be added that vaginismus does not prevent sexual arousal, but it can lead to fear of sexual intercourse and cause avoidance of sex or vaginal penetration. During sexual activity, a woman suffering from vaginismus may experience orgasm as a result of clitoral stimulation. Vaginismus affects only penetration. It’s worth pointing out, however, that women with vaginismus may have other sexual dysfunctions, such as difficulty reaching orgasm.

Also read: 63 percent of women have orgasm problems

Vaginismus – diagnosis

In the case of vaginosis diagnosis, the doctor conducts a medical interview and a gynecological examination. Causes such as infection may need to be ruled out before treatment for vaginismus is started.

For the diagnosis of vaginismus, it is also recommended to:

1. Pap smear of the cervix;
2. colposcopic examination;
3. Ultrasound of the small pelvis;
4. laparoscopy.

Conditions and diseases resembling vaginismus

Some conditions may look similar to vaginismus, but they are other disorders. These include:

1. atrophic vaginitis – consists in thinning and drying out of the vaginal walls after menopause due to the reduction of estrogen levels;
2. inflammation within the vulva – causes intense pain during intercourse or inserting a tampon into the vagina (pain usually occurs in the vulva);
3. vaginal infections, e.g. yeast infection or sexually transmitted disease (STI);
4. lichen sclerosus of the vulva or any other disorder that can form scarring in the vagina;
5. physical trauma to the vaginal area;
6. going through long periods without penetrative sexual intercourse, which may lead to temporary difficulties during penetration.

See also: Do you have such marks on your underwear? It could be a venereal disease

Vaginismus – treatment

When treating vaginismus, the goals are to reduce automatic muscle tension, remove the fear of pain, and resolve any other fears that may be related to vaginismus.

The treatments used to treat vaginosis focus on dealing with any negative emotions associated with vaginal penetration. Women can learn to do home exercises to control and relax the muscles around the vagina. Physiotherapists who help women relax while exercising by using vaginal dilators and other methods to help ease penetration anxiety can be very helpful.

The methods of treating vaginismus include:

1. desensitization (progressive desensitization) – involves the use of fingers or special vaginal dilators to gradually and slowly get a woman used to touching the vagina and finally penetrating it.
2. sexual therapy – this form of psychotherapy aims to inform patients about their anatomy and improve their feelings about the body and sex life. This method is helpful for women who have vaginismus due to anxiety psychology.
3. cognitive behavioral therapy (CBT) – helps to understand how thoughts affect our emotions and behavior. It is an effective treatment for anxiety, depression and post-traumatic stress disorder (PTSD).
4. pelvic floor exercises – are designed to help women regain control of the vaginal muscles. Common exercises include Kegel exercises, mindfulness meditation and deep breathing.

These treatments differ from each other, but all focus on stopping painful, involuntary muscle contractions. It should be emphasized that the treatment of the vagina takes time and patience, but the treatment success rate is over 90%.

Other treatments for vaginismus

Additional ways vaginismus may be treated include:

1. botox Interestingly, research published in the International Journal of Sexual Health in 2019 shows that botox can improve vaginismus symptoms. However, more research is needed to verify this conclusion.
2. impulsowa radiofrekwencja (Pulsed radiofrequency; PRF) – This is a relatively new treatment usually used for nerve pain. A study published in Revista Brasileira de Anestesiologia in 2017 showed the potential for improvement with this therapy.
3. operation – a rare method usually used when there is a problem of imitation vaginismus.

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

See also: Who should decide to consult a sexologist?

Vaginismus and self-care

A woman can fight vaginismus at home alone. At first, she should relax and get used to the new feeling around and inside her vagina. When the patient is satisfied that she is ready, she should try to gently insert her fingers into the vagina. It may take days or weeks to get to the point where you are comfortable enough to do this. The woman may also try to insert a moistened tampon.

If a woman has a sexual partner, she may ask him to gently touch her genitals to try to get used to the fact that he is around her vagina. Each of these steps takes time and patience to make you feel comfortable.

Over time, a woman may feel well enough that she will want to try sexual intercourse.

If these methods do not help, the woman should see a doctor who may refer her to a sexual health specialist.

Vaginismus – complications

Vaginismus can be a source of relationship problems and can adversely affect your quality of life. It can be associated with low self-esteem, depression and anxiety. Infertility may be a problem.

Due to vaginismus, a woman may not be able to participate in the cervical screening program, although without penetrating intercourse she would still be at a lower risk of cervical cancer.

See also: Self-esteem – how to understand this term and what to do to raise it?

Vaginismus – prevention and prognosis

In addition to the fact that it is not entirely clear why a woman develops vaginismus, it is also not known how to prevent it.

On the prognosis, a 2020 study published in JBRA Assisted Reproduction found that female patients may have a worse prognosis if vaginismus has occurred among their family members, or if one couple either takes full responsibility for the problem or blames the other partner.

Women with advanced vaginismus should be aware that treatment will require more time and patience, and that it will be more complicated. The willingness of a woman to come to the patient and participate in treatment is also extremely important in the prognosis.

How to live with vaginismus?

Sexual dysfunction can have a negative impact on relationships. Being proactive and getting treated can be crucial to saving a marriage or relationship. A woman with vaginismus should know there is nothing to be ashamed of. Instead, she should openly and honestly talk to her partner about her feelings and concerns about the relationship.

For help, she should see a doctor and start treatment. Many women with vaginismus recover and have a happy sex life.

It may be a good idea to see a therapist. The use of lubrication or certain sexual positions can make intercourse more comfortable.

See also: How to talk while having sex?