Overcoming Vaginismus: Exploring Causes, Symptoms, and Advanced Treatment Options

June 23rd, 2023
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Vaginismus is a distressing condition that affects many women around the world, causing involuntary muscle contractions in the pelvic floor muscles, particularly those around the vagina. These contractions can make vaginal penetration difficult or impossible, leading to pain, discomfort, and emotional distress. In this blog, we will explore the causes, symptoms, and management options for vaginismus, with a focus on the importance of psychological factors. We will also delve into various treatment approaches, including psychology, physical therapy/pelvic floor exercises, dilators, and medication management. Additionally, we will discuss the potential benefits of injection treatments, such as pudendal nerve blocks and botox injections, highlighting their role in addressing vaginismus.

Causes of Vaginismus:

Vaginismus can have various underlying causes, and it is often a complex interplay of physical, psychological, and relational factors. Psychological causes, in particular, play a crucial role in the development and perpetuation of vaginismus. Past traumatic experiences, such as sexual abuse or negative attitudes towards sex, can contribute to the development of anxiety and fear associated with vaginal penetration. These psychological factors can trigger a protective response in the body, leading to involuntary muscle contractions and making penetration challenging.

Non-psychological factors can also contribute to the development of vaginismus. These include physical issues such as infections, hormonal imbalances, endometriosis, childbirth trauma, surgical procedures, or certain medical conditions affecting the pelvic region. Infections, such as Candida or urinary tract infections, can lead to inflammation and increased sensitivity in the vaginal area, triggering involuntary muscle contractions. Hormonal imbalances, such as low estrogen levels during menopause, can result in vaginal dryness and discomfort, making penetration painful. Additionally, trauma during childbirth or pelvic surgeries can cause muscle damage or scarring, leading to heightened muscle tension and difficulties with penetration. It’s important to consider these non-psychological factors alongside psychological aspects when assessing and treating vaginismus.

Symptoms and Impact:

The primary symptom of vaginismus is the inability to engage in vaginal intercourse or other forms of vaginal penetration due to the involuntary tightening of the pelvic floor muscles. This can result in pain, burning, and a sense of “hitting a wall” during attempted penetration. The experience of vaginismus can cause significant distress, negatively impacting a woman’s self-esteem, body image, and overall quality of life. The fear and anxiety associated with attempted penetration can lead to avoidance of sexual activities, strain relationships, and hinder intimacy.

Management Options:

  1. Psychological Interventions: Addressing the psychological aspects of vaginismus is crucial for successful management. Psychotherapy, including cognitive-behavioral therapy (CBT), can help individuals identify and address underlying fears, anxieties, and negative beliefs surrounding sex. This therapy aims to reframe thoughts, reduce anxiety, and promote relaxation techniques, ultimately alleviating muscle tension and facilitating healthy sexual experiences.
  2. Physical Therapy/Pelvic Floor Exercises: Working with a trained pelvic floor physical therapist can be highly beneficial for individuals with vaginismus. These therapists employ techniques such as biofeedback, vaginal dilation, and progressive muscle relaxation to gradually desensitize the pelvic floor muscles, improve muscle control, and reduce pain.
  3. Dilators: Vaginal dilators are an integral part of vaginismus treatment. Gradually increasing in size, these smooth, tapered devices are used to gently stretch the vaginal muscles, helping to reduce muscle spasms and enhance comfort during penetration. Dilators are typically used in conjunction with therapy and guidance from a healthcare professional.
  4. Medication Management: In some cases, medication may be prescribed to help manage symptoms of vaginismus. Topical treatments, such as lidocaine creams or gels, can provide temporary relief by numbing the vaginal area and reducing pain during attempted penetration.

Injection Treatments:

For individuals who have not responded to other treatment approaches, injection treatments can offer promising results. Pudendal nerve blocks involve injecting a local anaesthetic around the pudendal nerve, which can help temporarily relax the pelvic floor muscles. Botox injections, on the other hand, work by blocking nerve signals and reducing muscle spasms. Botox injections into the pelvic floor muscles have shown promise in relieving vaginismus symptoms, allowing for successful penetration and improved sexual experiences.

Botox trigger point Injections:

Botox trigger point injections have shown promise as a treatment option for vaginismus when other interventions have been ineffective. Botox, or botulinum toxin, is a neurotoxin that temporarily blocks the release of acetylcholine, a neurotransmitter responsible for muscle contractions.

When injected into specific trigger points in the pelvic floor muscles, botox helps to relax and reduce the excessive muscle tension associated with vaginismus. The main muscles targeted with botox injections for vaginismus are the pubococcygeus and the levator ani muscles. These muscles form the pelvic floor and play a significant role in vaginal muscle contractions during penetration. By injecting Botox directly into these trigger points, muscle spasms and hyperactivity can be alleviated, allowing for easier vaginal penetration and reduced pain.

Research on the success rate of botox injections for vaginismus is limited but promising. Studies have reported success rates ranging from 60% to 90% in achieving improved vaginal penetration and reduction in pain levels. However, it’s important to note that individual responses may vary, and additional supportive therapies such as pelvic floor physical therapy and psychological interventions may be recommended alongside botox injections for optimal outcomes.

As with any medical intervention, botox injections for vaginismus do carry potential side effects. These can include temporary muscle weakness, localized pain or discomfort at the injection site, and rare instances of urinary retention.

How Dr Krishna Can Help:

As an experienced specialist in the field, Dr Krishna is dedicated to providing comprehensive care for individuals with vaginismus. Dr Krishna offers evidence-based advice and treatment options tailored to each patient’s unique needs. With expertise in injection treatments, including pudendal nerve blocks and botox injections, Dr Krishna can provide safe and effective interventions to alleviate vaginismus symptoms and improve overall well-being.


Vaginismus is a complex condition that requires a holistic approach for effective management. Recognizing the psychological factors that contribute to vaginismus and integrating psychological interventions with physical therapy, dilators, and medication management can significantly improve outcomes. For individuals who have not responded to other treatments, injection therapies like pudendal nerve blocks and botox injections can offer hope and relief. Dr Krishna’s expertise and patient-centred approach make him a valuable resource in the journey towards overcoming vaginismus and reclaiming a fulfilling and satisfying life.


  • National Health Service UK. (2021). Vaginismus. Retrieved from https://www.nhs.uk/conditions/vaginismus/
  • Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., Amsel, R., & Khalifé, S. (2003). Vaginal spasm, pain, and behavior: An empirical investigation of the diagnosis of vaginismus. Archives of Sexual Behavior, 32(3), 265-277.
  • Pacik, P. T. (2011). Botox treatment for vaginismus. Plastic and Reconstructive Surgery, 128(2), 509-510.
  • Pukall, C. F., Binik, Y. M., Khalifé, S., & Amsel, R. (2004). Vaginal spasm, pain, and psycho-physiological response to fear of penetration: A pilot study. Sexual and Relationship Therapy, 19(1), 13-22.
  • As-Sanie, S., Harris, R. E., & Harte, S. E. (2014). Vaginismus: A Diagnosis in Search of a Syndrome. Journal of Sexual Medicine, 11(1), 1-5.