Vaginismus: How It Feels, Pain Triggers, Treatment

October 15th, 2024
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By Brandi Jones, MSN-ED RN-BC

Vaginismus is when vaginal muscles tighten involuntarily, causing painful or difficult vaginal penetration. It can affect your experience getting pelvic exams, menstruation, sex, and your mental health. Research estimates between 1% and 7% of women have vaginismus, but this is likely a low estimate due to underreporting; experts estimate that the prevalence is closer to 17%. Treatment options are advancing, and about 71% of people with vaginismus find relief with treatment.

What Vaginismus Means

Vaginismus means your vaginal muscles tighten without you wanting them to, making penetration—with a penis, finger, tampon, or speculum—painful or impossible. It can be something you’ve always had or begin suddenly.

Tightness and Anatomy

During vaginal penetration, you might feel sharp, burning pain or tight pressure. Some describe this as hitting a wall. It can occur at the entrance or deeper inside the vagina.

Effect on Pelvic Exams

Pelvic exams can be painful or impossible for those with vaginismus. Consider asking for a pediatric speculum, longer appointments, or a muscle relaxant prescription if this is the case.

smus: How It Feels, Pain Triggers, Treatment 

Vaginismus is when vaginal muscles tighten involuntarily, causing painful or difficult vaginal penetration. It can affect your experience getting pelvic exams, menstruation, sex, and your mental health. Research estimates between 1% and 7% of women have vaginismus, but this is likely a low estimate due to underreporting; experts estimate that the prevalence is closer to 17%. Treatment options are advancing, and about 71% of people with vaginismus find relief with treatment.

What Vaginismus Means

Vaginismus means your vaginal muscles tighten without you wanting them to, making penetration—with a penis, finger, tampon, or speculum—painful or impossible. It can be something you’ve always had or begin suddenly.

Tightness and Anatomy

During vaginal penetration, you might feel sharp, burning pain or tight pressure. Some describe this as hitting a wall. It can occur at the entrance or deeper inside the vagina.

Effect on Pelvic Exams

Pelvic exams can be painful or impossible for those with vaginismus. Consider asking for a pediatric speculum, longer appointments, or a muscle relaxant prescription if this is the case.

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Effect on Menstruation

Inserting tampons or menstrual cups can be painful or impossible. Many people think this is normal, but using a tampon shouldn’t hurt. Not being able to use tampons can be frustrating because using pads is tricky for activities like swimming or gymnastics.

Effect on Sex 

Vaginismus causes pain during attempted penetration, making sexual intercourse or masturbation impossible. Worrying about the pain can also cause panic attacks. The effect of vaginismus on sex can strain relationships because you might avoid sex, or your partner might be afraid of hurting you.

Mental Health Effects 

Struggling with vaginismus can make you feel like a failure, leading to feelings of inadequacy and shame. These feelings can create a cycle of isolation and guilt, which might lead to depression, panic attacks, or deep sadness, especially if it affects your hopes of having a family.

Vaginismus Causes and Triggers

The causes and triggers of vaginismus can be physical, emotional, or psychological. Symptoms can start at any age and may not always have a clear cause. Some people experience symptoms with any insertion, while others have issues only with certain partners or during medical exams. Risk factors include:

  • Abuse (sexual, physical, or emotional)
  • Cancer treatment
  • Difficult sexual experiences
  • Family history
  • Hormonal changes
  • Hysterectomy
  • Infections
  • Menopause
  • Mental health disorders
  • Negative feelings or misunderstandings about sex
  • Painful genital or urinary medical procedures as a child
  • Physical trauma (such as sexual assault or difficult childbirth)
  • Relationship conflicts
  • Stress

Steps to Diagnose Vaginismus

  • Providers typically diagnose vaginismus when you have the following symptoms lasting six months or more:
  • Anxiety about vaginal pain
  • Difficulty using or removing tampons
  • Involuntary tightening of vaginal muscles during penetration
  • Pain during intercourse
  • Trouble with gynecological exams

Conditions That Can Cause Painful Sex

Your provider may also perform a physical exam, imaging tests, or a urinalysis (peeing in a cup) to rule out the following conditions that could also cause painful sex.

Vaginismus Self-Care for Symptom Management

The following relaxation and breathing techniques can reduce muscle tension and improve vaginismus symptoms.

  • Relaxation: Use aromatherapy (like lavender), hot tea, calming music, or a warm bath.
  • 4-7-8 breathing: Breathe in for four seconds, hold for seven seconds, then breathe out for eight seconds.
  • Deep belly breathing: Lie on your back with your knees bent and place your hands on your rib cage. Breathe deeply, expanding your rib cage, then exhale slowly.

The following pelvic floor relaxation exercises can also help:

  • Child’s pose: Kneel, touch your toes, spread your knees wider than your hips, and stretch your arms forward. Hold for five to 10 breaths.
  • Cobra pose: Lie on your stomach, press your feet and pubic bone into the floor, lift your chest, and squeeze your shoulder blades together. Hold for five to 10 breaths.
  • Happy baby pose: Lie on your back, bring your knees to your belly, grip your feet with your hands, and open your knees toward your armpits. Hold for five to 10 breaths.
  • Piriformis stretch: Lie on your back with your knees bent. Place your left ankle on your right knee (like a figure four). Pull your right thigh toward your chest. Hold for 30 seconds, switch sides.

Kegels vs. Reverse Kegels 

Kegel exercises strengthen weak pelvic floor muscles. However, vaginismus involves tight muscles, so reverse Kegels may be a better choice. Here’s how to do them:

  • Relax the muscles you use to start and stop urine.
  • Imagine gently pushing out.
  • Breathe deeply into your belly while relaxing your pelvic floor.
  • Hold for a few seconds, then release.
  • Repeat several times.

Vaginismus Medical Treatment

Vaginismus is a treatable condition that often requires a treatment team, including gynecology providers, pelvic floor therapists, psychologists, and sex therapists.

Counseling and Sex Therapy

Psychological counseling addresses emotional and mental challenges. A sex therapist can teach you about:

  • More comfortable sexual positions
  • Non-penetrative activities, like outercourse
  • Progressing from partial to full penetration
  • Sensate touch
  • Tools like Ohnut to control penetration

Pelvic Floor Physical Therapy

A pelvic floor physical therapist can guide you through exercises and exposure therapy, gradually inserting your fingers or vaginal dilators into the vagina. Vaginal dilators are devices that help stretch the vaginal wall, making penetration more comfortable.

Medications and Procedures

The following medications and procedures can also help:

  • Diazepam or Baclofen for muscle relaxation (not a long term solution)
  • Estrogen for vaginal dryness
  • Osphena (ospemifene) for vaginal dryness
  • Botox (onabotulinumtoxinA) injections for muscle relaxation
  • Local anaesthetic injections for temporary relief
  • Vaginal dilators
  • Surgery (rare) to remove scar tissue

Coping With Chronic Vaginismus 

Living with vaginismus can be challenging. Consider connecting with others who understand through support groups or online forums. If you are beginning dilator treatment, be patient with yourself and go at your own pace. It can be more emotional than you might expect. Here are a few other vaginal dilator tips:

  • Create a relaxing environment
  • Start with the smallest size
  • Use a lot of lubricant
  • Insert at a slight downward angle
  • Relax vaginal muscles during insertion
  • If you face resistance, keep the dilator in place until your muscles relax

Summary 

Vaginismus is when the muscles around the vagina tighten, making penetration difficult. Symptoms include pain during sex, trouble inserting tampons, and difficult or impossible pelvic exams. Underlying causes can be physical and psychological. Living with vaginismus can be frustrating, but many people get relief with self-care or medical treatments.

References: 

Pithavadian R, Dune T, Chalmers J. Patients’ recommendations to improve help-seeking for vaginismus: a qualitative study. BMC Womens Health. 2024;24(1):203. doi:10.1186/s12905-024-03026-x

Pacik PT, Geletta S. Vaginismus treatment: clinical trials follow up 241 patients. Sex Med. 2017;5(2):e114-e123. doi:10.1016/j.esxm.2017.02.002

Hill DA, Taylor CA. Dyspareunia in women. Am Fam Physician. 2021;103(10):597-604. PMID:33983001.

Anğın AD, Gün İ, Sakin Ö, et al. Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assist Reprod. 2020;24(2):180-188. doi:10.5935/1518-0557.20200018

Toussaint L, Nguyen QA, Roettger C, et al. Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evid Based Complement Alternat Med. 2021;2021:5924040. doi:10.1155/2021/5924040

National Association for Continence. How to relax your pelvic floor.

National Association for Continence. Ask the doc: Can kegels really help my OAB symptoms?

American College of Obstetricians and Gynecologists. When sex is painful.

American College of Obstetricians and Gynecologists. Treatment of urogenital symptoms in individuals with a history of estrogen-dependent breast cancer.

Rapkin AJ, Satmary W. A deep dive into devices for sexual health. Contemporary OB/GYN Journal. 2024;69(2).