Women with vaginismus may experience significant pelvic pain and discomfort during sexual activity. The causes of vaginismus can be both physical and psychological. As we delve deeper into the topic, we will explore the various causes, symptoms, and potential treatments, including pelvic floor physical therapy, to help women overcome vaginismus and engage in sexual intercourse without pain.
What is Vaginismus?
Vaginismus is a condition, not a structural problem because the vagina is typically ‘just fine’ as many women were told upon examination.
Vaginismus is a reflexive, instantaneous clenching of the vaginal opening in anticipation or upon vaginal penetration. The cause is always an underlying anxiety or fear about ‘what will happen when it goes in’ and thus this ‘bracing for impact’ involuntary reaction. To say it differently, vaginismus is a panic attack in the vagina.
Historically speaking, vaginismus was considered a sexual disorder without considering the ‘other’ vaginal penetrations that the condition affects: finger, menstrual inserts (tampons, disc, cup), gynecologic examination, vaginal applicator, vaginal ultrasound). After much effort and education, the condition is now classified as a genito-pelvic pain/penetration disorder.
What are the types of vaginismus?
Vaginismus has two types, primary and secondary. Primary means the woman has always had it, while secondary means the vaginismus developed following an adverse life event like surgery, vaginal trauma, infections, menopause, endometriosis, cancer treatment, etc.
What is Dyspareunia?
Dyspareunia, or painful intercourse, is a condition of pain with penetrative sex due to many different causes including medical, environmental, hormonal, sexual, and more. Watch this video for more details.
Vaginismus is often confused with dyspareunia because of the associated pain with sexual intercourse. However, while vaginismus is always an anxiety-based condition, dyspareunia is not.
How does it feel to have Vaginismus?
Vaginismus and symptoms of vaginismus affect women across the board regardless of age, education, socioeconomic status, religion, relationship status, or sexual identity. Vaginismus feels awful, body and mind.
Physically speaking, it brings vaginal pain, discomfort, burning, and pressure.
But worse than the physical symptoms are the emotional and sexual implications. While vaginismus will ‘kill’ the woman, it will ‘kill’ every aspect of her life such as
- Feeling inadequate and shameful;
- Believing she is the ‘only one’ who has vaginismus;
- Feeling like a failure, as if not like ‘a real woman;’
- Feeling stuck forever with this ‘problem;’
- Believing she does not deserve a sexual relationship;
- Feeling she will sexually fail the partner;
- Losing hope of a ‘normal’ relationship, of having children naturally;
- Pretending to be ‘normal’ but knowing that she is not;
- Compromising relationships and sexual intimacy choices.
What are the causes of Vaginismus?
Based on our thousands of vaginismus cases and keeping tight data, it is clear as day to us that vaginismus is categorically a symptom of underlying either panic, anxiety, OCD (obsessive compulsive) disorders, or a combination of them. From our understanding, it has little to do with vaginal muscles or pelvic floor muscles, meaning it’s not something we would characterize as a a problem in a woman’s anatomy.
A woman may or may not be aware she has any of these underlying disorders, yet it is quite common during treatment for her to express, “I cannot believe how much my mind affects and manipulates my vagina!”
Read What Causes Vaginismus for an in-depth discussion of this topic.
How does having Vaginismus affect your sex life?
Vaginsimus greatly affects all aspects of the woman’s sex life, including
- Penetrative sex not being available;
- Penetrative sex is possible albeit with pain and duress;
- Afraid to even try penetrative sex;
- Avoids sex altogether;
- Mental strain when you criticize yourself for having “sexual dysfunction”
- Reluctant to enter intimate relationships;
- Chooses partners who are not ‘into sex;’
- Feeling inadequate, broken, ashamed, a failure, not a ‘real woman,’ not worthy of a relationship, a ‘fake;’
- Poor self esteem;
- Has a list of ‘why I don’t want to have sex;’
- Relationship breakdowns;
- Living is secrecy as to why ‘we don’t yet get pregnant.’
However, let us note that many women will manage to be positive enough to engage in active non-penetrative sexual intimacy while maintaining the vagina as ‘off limits.’
How do you get a diagnosis of Vaginismus?
Diagnosing vaginismus is rather simple and has to do with assessing the ability to have all vaginal penetrations and the associated level of distress (panic, anxiety, OCD):
- Finger in vagina?
- Use of menstrual inserts, such as tampons, disc, cup?
- Use of a vaginal applicator to insert medication (when applicable)?
- Undergoing a pelvic (speculum) exam?
- Undergoing vaginal ultrasound (when applicable)?
- Having sexual intercourse?
Vaginismus can come in different combinations of the above list: can do none, can have all penetrations comfortably except for intercourse, can have all/most but always under duress.
Note that most women will self-diagnose although they would not necessarily know why they have vaginismus. It is the role of the clinician to do a proper assessment and enlighten the woman so proper intervention will be implemented.
How do I get treatment for Vaginismus?
First let’s put down a fact: vaginismus is curable, and there is no reason to live with the condition.
- Speak with a gynecologist or a pelvic floor physiotherapist and have them evaluate your needs and provide resources/referrals;
- Search the Internet for vaginismus experts in your locale and be sure to vet them about their experience and expertise by asking questions such as how many vaginismus do they see per week/month, how many they treated to-date, how do they define a cure, how many sessions will be needed, do they have references/publications/are they known in the medical community, do they have vaginismus statistics for review?
- Do not hesitate to expand your search for vaginismus experts who may be located far away – the distance should not stop you from seeking a cure!
- Consider online/virtual vaginismus treatment programs as another viable option;
- Join vaginismus support groups;
- Once you identify a specialist and begin treatment, follow their guidance and be sure to ask any questions that you may have. If you feel your goals are not being met, move on to other resource/s;
- Will vaginismus treatment hurt?
- Be mindful of vaginismus treatment misconceptions!
- Watch: A Partner’s Guide to Vaginismus.
