Vaginismus: Meaning, Symptoms and Treatment

Contents

In this article we will look at:

• What is vaginismus?
• Causes of vaginismus
• Types of vaginismus
• Symptoms of vaginismus 
• Diagnosis of vaginismus
• Treatment for vaginismus
• Exercising (Kegel Exercises) for vaginismus
  • Syncing the Kegel Exercises with Breathing Exercises

You can click on any of the links above to navigate to the section of your interest. 

What is vaginismus?

Vaginismus is a form of sexual dysfunction in women when unexplained tightness, discomfort, and pain occurs in the vagina: 

• during penetration, while having sex
• while inserting tampons
• while being touched in the vaginal area even for a gynecological exam

It is an involuntary pelvic response to fear when the muscles of the vagina contract at any hint of penetration into the vaginal area. Women suffering from vaginismus, in fact, are not even aware that their pelvic muscles have suddenly contracted. 

Vaginismus can affect women at any stage of life and at any age. 

This condition is also known as pelvic floor myalgia/genito-pelvic pain/penetration disorder (DSM-V). It is the main cause of unconsummated relationships. In fact, the first symptom of vaginismus in a woman is painful sex. 

Very often, when women who suffer from vaginismus try to have sex they experience a tearing pain in their vagina or feel that their male partner has “hit a brick wall” during penetration. 

What are the causes of vaginismus?

There is no direct single reason that causes vaginismus. This condition can be caused both by emotional and various physical factors:

What are the types of vaginismus? 

There are various types of vaginismus that can affect women at any age. The types include:

• Primary Vaginismus: This is a condition in which the pain has always been present lifelong at any hint of vaginal penetration i.e. while inserting tampons, penetration during sex etc. Women suffering from this condition experience pain during their first attempt at sexual intercourse and very often their relationship remains unconsummated.
  Their male partners often get the feeling of hitting against a wall when attempting to insert the penis into the vagina.
  These women also experience pain while attempting to insert a tampon. The pain disappears as soon as the attempts to penetrate the vagina stops.
• Secondary Vaginismus: This is a condition which occurs when vaginal penetration is extremely painful due to a specific event such as gynecological surgery, menopause, yeast infection, childbirth, any traumatic event or some sudden relationship issues. Women suffering from secondary vaginismus usually have already experienced normal sex life. Some women develop vaginismus after menopause which occurs when there is a decrease in estrogen levels in the body and the vagina becomes dry and loses its elasticity. Adequate lubrication in the vagina does not happen which makes sexual intercourse painful.
• Situational Vaginismus: Situational vaginismus as the name itself suggests occurs in certain situations. In this form of vaginismus, pain may occur while having a sexual intercourse but not while inserting a tampon. Or it may occur only during pelvic exams. The pain may also occur while having sex with one partner but not with others.
• Global Vaginismus: This type of vaginismus can be triggered by any object in all situations, for example, pelvic exam, tampon insertion, and sexual intercourse.

What are the symptoms of vaginismus? How is vaginismus diagnosed?

They may include:

• Involuntary tightening of vaginal muscles when penetration is attempted during sexual intercourse
• Experiencing painful sexual intercourse also known as dyspareunia
• Painful burning stinging and tearing sensation in the vagina when penetration is attempted
• Penetration during intercourse is extremely difficult or painful with the male partner feeling that he ‘has hit a wall’
• Experiencing pain while attempting to insert a tampon
• Experiencing pain during gynecological/pelvic examination by a doctor
• Halted breathing during attempts at intercourse
• Muscle spasms in the lower part of the body such as legs, lower back, during sexual intercourse
• Avoiding sex due to fear of pain

Diagnosis

Diagnosis of vaginismus firsts begins with the gynecologist asking you about your symptoms including:

• when did you first notice the problem
• what makes you feel uncomfortable
• how often does the problem occur
• instances when it occurs
• have you experienced any form of sexual abuse or trauma
• your medical history, if you have had any form of gynecological surgeries

Once the doctor learns about your symptoms, emotional life, and medical history, the next step will be to perform a physical exam, involving a pelvic exam. Women with vaginismus often fear the pelvic exam. The doctors are very gentle during the pelvic exam with patients who suffer from vaginismus, besides the patient undergoing the pelvic exam can tell the doctor without hesitation how the process can be made comfortable for her and what physical positions she is comfortable in. The patient can herself guide the doctor’s hand or the medical instruments during the exam. 

The pelvic exam is performed to rule out any other possible causes for the pain such as infection, or scarring. If no other possible causes for the pain is found then the patient most likely suffers from vaginismus. 

What are the complications of vaginismus?

The complications of vaginismus include: 

• Psychological distress and strain
• Dyspareunia
• Stress
• Depression
• Relationship issues
• Poor self-esteem
• Infertility

What is the treatment for vaginismus?

Medical Treatment for Vaginismus

The treatment for vaginismus is usually threefold:

1. Sex therapy and counseling which includes teaching the patient about her anatomy and what occurs when there is sexual arousal and during sexual intercourse, how the muscles contract when vaginal penetration is attempted. This talk based therapy will help the patient to resolve any disturbing feelings that she may have about sex and will make her feel comfortable about her own body, her sexuality, and expressing the sexuality.
2. Learning to relax and overcome the fear of penetration while managing the anxious feelings around penetration. This part can involve mindfulness techniques, breathing exercises and gentle touch therapy to make the patient comfortable and relax.
3. Exercises to gradually gain control of vaginal muscles and be able to relax during penetration. This third part of the treatment can also involve the use of vaginal dilators under the supervision of a medical professional. You will be given a cone-shaped dilator and be guided to gently insert it into your vagina. It will start with a small sized dilator.
   The dilators get progressively bigger which helps the vaginal muscles stretch and become more elastic and flexible.

Exercising for Managing Vaginismus

Doing The Kegel Exercises

Vaginismus can be treated by doing Kegel exercises. Kegel exercises were named after Dr. Arnold Kegel, who has popularized them in the ‘50s.These exercises initially were meant to cure patients suffering from urinary incontinence (often after childbirth).

Gradually the efficacy of Kegel’s exercise was discovered for patients who suffer from vaginismus. 

You can easily identify the muscles which cause vaginismus with this simple exercise. 

Go to the bathroom and urinate a little, then stop the flow of your urine. Then start urinating again, retain the flow of urine, and stop again and then start again. Do so until you have emptied your bladder. 

The muscles which just acted according to your wishes are the same ones involved in your vaginismus. They contract as a reflex, preventing any form of penetration in the vagina.

Once you identify these muscles it is important to exercise them in order to be able to contract and relax these muscles at will. 

The exercise of alternatively stopping and letting the urine flow is only for test purposes to identify the muscles which need to be exercised while performing the Kegel's exercises.

Warning: Please do not do the Kegel exercise while urinating. 

This is known as Kegel’s exercise. 

When you are still at the stage of practicing the Kegel exercise do not attempt a sexual intercourse with penetration.

The Kegel Exercise

Practice the Kegel exercise for a week or two. 

Find a quiet suitable place to do the exercise. You can do it after waking up in the morning and just before bedtime while lying on your bed. 

Follow the steps given below:

1. Contract your pelvic muscles. Squeeze and hold for 3 seconds
2.  Then relax for another 3 seconds.
3. Repeat the exercise for as many as 10 times each session, until you can do around 15 repetitions.

Initially, a certain effort of concentration will be needed to contract the pelvic muscles only, without contracting the abdominal and gluteal muscles. When you get used to it, it will become automatic.

Once you become comfortable doing these sessions quietly in bed, you can do the Kegel exercises anytime while doing some other activities, for example, watching TV, working on your computer, in your car, etc. 

Syncing the Kegel Exercises with Breathing Exercises

Once you are comfortable doing the Kegel’s exercise anywhere sync them with breathing exercises. 

1. Focus on your breathing for a few minutes. Breathe in and out deeply a couple of times to relax yourself.
2. Then inhale deeply and hold your breath for a few seconds while strongly contracting your pelvic floor muscles.
3. Then exhale deeply and relax these muscles.

Repeat several series of this exercise. You can do these exercises in front of a mirror in order to visualize your vaginal muscles at work. This can immensely help to improve your mental awareness of this part of your body and help boost your performance when you resume your sex life.