What is Vaginismus?

This blog comes after seeing quite an increase of women coming through the clinic having been diagnosed (or undiagnosed) with Vaginismus. Vaginismus is a condition that often goes undiscussed, and yet despite its prevalence affecting many women worldwide, it also remains under-researched. Characterised by involuntary contractions of the pelvic floor muscles, vaginismus can make vaginal penetration—whether during sex, tampon use, or medical examinations—extremely painful or even impossible. It’s important to recognise that this condition is not just a physical issue; it intertwines deeply with emotional and psychological well-being.

Understanding Vaginismus

Vaginismus is a musculoskeletal disorder where the muscles inside a woman’s vagina spasm when something is inserted or in some cases even mildly touches the opening of the vagina. This may occur during sex, a pelvic exam, or while inserting a period product like a tampon. These spasms can cause mild to extreme pain for the woman, potentially making penetrative sex impossible or at the very least, very uncomfortable. 

There are two classifications for vaginismus:

• Primary Vaginismus: Occurs when a woman has never been able to have penetrative sex without pain.

• Secondary Vaginismus: Develops after a period of pain-free intercourse, often triggered by factors like childbirth, surgery, or trauma.

Causes and Contributing Factors

The exact cause of vaginismus isn't always clear, but it's often linked to a combination of physical and psychological factors:

• Psychological Factors: Anxiety, fear of pain, past sexual trauma, or negative beliefs about sex can contribute to the development of vaginismus.

• Physical Factors: Infections, hormonal changes, or medical conditions like endometriosis can play a role.

  
  

It’s difficult to establish the prevalence of vaginismus for a number of reasons. Firstly, the rates reported are only based on the number of visits to medical clinics when women are seeking help and/or a diagnosis for their condition. It’s also shrouded in shame and stigma like many aspects of the female body are, as well as it being associated with sexual activity unfortunately making it a secret or hidden problem. Guilt is often very nicely wrapped up in this shame package, again feeding into the low reporting rates by women. There is also a strong association between sexual abuse / trauma and vaginismus – another reason why some women may be reluctant to seek support in anticipation of what might be discovered as a result.

Diagnosis and Seeking Help

Diagnosing vaginismus typically involves a comprehensive medical and sexual history, along with a pelvic examination. However, many women face challenges in getting a proper diagnosis due to lack of awareness among healthcare providers. A study highlighted that women often feel dismissed or misunderstood when seeking help, emphasising the need for better education and sensitivity among medical professionals.

A multidisciplinary approach, involving general practitioners, pelvic floor physiotherapists, and counsellors/psychologists, are recommended to address both the physical and emotional aspects of the condition.

Treatment Options

Treating vaginismus often requires a combination of therapies tailored to the individual's needs:

• Pelvic Floor Physical Therapy: Working with a pelvic floor physiotherapist to learn exercises that help relax, improve and restore the natural function of the pelvic floor muscles. This is not a quick fix and involves attention, focus and connection with this area of your body. This may also involve looking at contributing factors and adjusting lifestyle

  
  

• Counselling Therapies: Addressing underlying psychological factors, such as anxiety, how she perceives herself as a woman or past trauma through the process of talking and/or somatic therapies. This supports the woman to release any stored tension/trauma that may be contributing to her condition.

  
  

• Gradual Desensitisation: Using vaginal dilators of increasing sizes to gently acclimate the body to penetration. This is not something to force and works best when also delicately addressing the psycho/social/emotional factors.

  
  

• Education and Counselling: Understanding the condition and learning coping strategies can empower women and reduce fear.

  
  

So all those Kegel exercises, which strengthen pelvic muscles, may not be beneficial for vaginismus and could potentially exacerbate the condition. Instead, focus on connection, relaxation and surrendering away from the held tension.

The emotional toll on women with this condition can weigh heavily and be multifaceted. It is a delicate topic and one that requires great care and support. It is a complex condition, yet with the right support, it is possible for many women to re-establish connection and healthy function of this part of the body. From my clinical experience, it is evident for many of the women experiencing this condition, that their relationship with themselves as women comes into question and therefore the quality of their relationships with others. What standards do they hold for themselves; what is their level of self-worth and how is this expressed; are they confident in saying no; and do they hold their body as deeply precious and sacred?

None of these questions are to incite criticism but rather to simply reflect on the quality of their foundation with life, relationships, intimacy and indeed with themselves. It is an opportunity to set forth a path of much more substance than was perhaps there previously.

Note: This blog post is for informational purposes only and does not substitute professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment options.

References:

Chalmers, K. J. (2024). Clinical assessment and management of Vaginismus. Australian Journal of General Practice, 53(1–2), 37–41. https://doi.org/10.31128/ajgp/06-23-6870 

Graziottin, A. (2008). Dyspareunia and vaginismus: Review of the literature and treatment. Current Sexual Health Reports, 5(1), 43–50. https://doi.org/10.1007/s11930-008-0008-7 

McEvoy, M., McElvaney, R., & Glover, R. (2021). Understanding vaginismus: A Biopsychosocial Perspective. Sexual and Relationship Therapy, 39(3), 680–701. https://doi.org/10.1080/14681994.2021.2007233 

McGuire, H., & Hawton, K. K. (2001). Interventions for vaginismus. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd001760 

Pacik, P. T. (2014). Understanding and treating vaginismus: A multimodal approach. International Urogynecology Journal, 25(12), 1613–1620. https://doi.org/10.1007/s00192-014-2421-y 

Pithavadian, R., Dune, T., & Chalmers, J. (2024). Patients’ recommendations to improve help-seeking for vaginismus: A qualitative study. BMC Women’s Health, 24(1). https://doi.org/10.1186/s12905-024-03026-x