What is vaginismus?
Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible due to pain (dyspareunia). Vaginismus is not common. It can cause severe physical and psychological pain.
Vaginismus can be classified as either primary or secondary. Primary vaginismus occurs when the woman has never been able to have penetrative intercourse because of the involuntary contraction of her vaginal muscles. Secondary vaginismus occurs when a woman has previously been able to have intercourse but is no longer able to be penetrated, because of the involuntary muscle spasms.
Symptoms of vaginismus
Make a point of seeing your doctor if you experience any of the following symptoms:
- Finding it hard to insert a tampon into your vagina
- Struggling with vaginal penetration during sex
- Feeling burning or stinging pain during sex
Due to similar symptoms, sometimes vaginismus is confused with these conditions:
- Vulvar vestibulitis (provoked vestibulodynia): This condition causes painful sex (dyspareunia). People may have pain from initial penetration throughout the entire experience.
- Vaginal atrophy: Lack of estrogen after menopause makes the lining of the vagina thinner and drier, which can cause sex to be painful or challenging.
Causes of vaginismus
In general, involuntary tightening of vaginal muscles is due to an overreaction of the limbic system, which regulates body reactions and behaviors. Vaginismus is usually attributed to non-physical or emotional reasons, such as fear or anxiety toward penetration, previous sexual trauma, fear of pregnancy, or a negative view of sex.
In some cases there is no obvious, identifiable cause.
Who gets vaginismus?
Vaginismus symptoms may appear during the late teen years or early adulthood when a person has sex for the first time. The condition can also happen the first time a person tries to insert a tampon or has a pelvic exam at a healthcare provider’s office.
Some women develop vaginismus later in life. It can happen after years without any problems. Spasms or discomfort may occur anytime there’s vaginal penetration. Or you may have them only at certain times, such as during sex or pelvic exams.
You may be more at risk for developing vaginismus if you have experienced sexual trauma or abuse, have anxiety about penetration, or have had medical pelvic issues in the past (such as childbirth injuries).
Diagnosis for vaginismus
It is important to see your doctor about your vaginismus symptoms. They will ask you about your symptoms and may ask to examine your vagina. The examination is usually brief. Your doctor will take a quick look to rule out other conditions, like an infection. It's unlikely they'll need to perform an internal examination of your vagina.
If your doctor thinks you have vaginismus, you may be referred to a specialist, such as a sex therapist.
Treatments for vaginismus
Vaginismus is both a physical and psychological condition, making treatment complex. Treatment often involves a combination of counseling, education, muscle exercises, and sometimes medication. Commitment to these interventions can reduce or cure your vaginismus symptoms.
Your doctor may prescribe antidepressants (tricyclics or venlafaxine) or anticonvulsants (usually carbamazepine or gabapentin). Anxiolytic medication, such as diazepam, in combination with psychological therapy, has been the most commonly used medication for this condition. In other cases, local anesthetics, such as lidocaine gel, have been proposed as a form of treatment.
It is possible to treat vaginismus using the following alternative methods:
- Sex Therapy: This approach may involve relaxation techniques and gradually inserting a dilator or finger into the vagina. It is sometimes called systematic desensitization.
- Kegel Exercises: These exercises involve the repeated contraction and relaxation of the pelvic muscles. The exercises can help improve control over the vaginal muscles.
- Cognitive Behavioral Therapy (CBT): CBT helps you understand how your thoughts affect your emotions and behaviors. It’s an effective treatment for anxiety, depression, and post-traumatic stress disorder (PTSD).
- Relaxation Techniques: Mindfulness, breathing, and gentle touching exercises can help you learn to relax the vaginal muscles.
Complications and side effects of vaginismus
Vaginismus can affect your sex life and relationships with your partner. It can affect your mental health, leading to increased anxiety and self-image issues. If you’re trying to become pregnant, vaginismus may make it more challenging to conceive.
While the alternative therapies for vaginismus are considered safe, antidepressants can have side effects. If your doctor prescribes antidepressants as part of your vaginismus treatment, be wary of side effects ranging from rash to insomnia to increased anxiety. Also ask your doctor how antidepressants may interact with your other medications.
Women's Conditions Resources
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Cleveland Clinic: "Vaginismus."
The Cochrane Database of Systematic Reviews: "Interventions for vaginismus."
Harvard Health Publishing: "What are the real risks of antidepressants?"
Harvard Health Publishing: "When sex gives more pain than pleasure."
Indian Journal of Psychiatry: "Successful management of vaginismus: An eclectic approach."
National Health Service: "Vaginismus."
Vaginismus: Hope & Her: "Vaginismus: Typical Causes."
Winchester Health: "Vaginismus."