What is Vaginismus?

Vaginismus is the involuntary spasming of the pelvic floor muscles surrounding the vagina. The vaginal entrance becomes so narrow that it is impossible or painful to penetrate the vagina, for example, when trying to insert a tampon, or during penetrative sex with the penis or sex toys. Even gynecological examinations can be painful or impossible.

Here we need to make an important distinction between primary and secondary vaginismus. Primary vaginismus develops during or before puberty, preventing a woman from inserting anything painlessly into her vagina. Secondary vaginismus occurs after an event, for example, the birth of a child or rape.

Vaginismus Symptoms

Typical symptoms include the following: 

• Painful intercourse (dyspareunia), with tightness and pain that may feel like burning or stinging 
• Vaginal penetration is difficult or impossible
• Long-term sexual pain with or without a known cause
• Pain during tampon insertion
• Generalized muscle spasm or breathing cessation during attempted intercourse

In addition to physical pain, vaginismus often results in psychological problems and anxiety triggered by hopelessness and a feeling of desperation when therapies don’t have the desired effect or no medical cause for the discomfort can be found.

Course & Diagnosis of Vaginismus

If left untreated, vaginismus can sometimes affect women for many years. We therefore advise therapy as early as possible.    

After discussing your symptoms and sexual history with you, doctors can diagnose vaginismus quickly through a pelvic exam, which includes a muscle evaluation. Since pelvic exams can cause painful muscle spasms in vaginismus patients, usually gynecologists can make this process less painful by applying topical numbing cream outside the vagina, or they may help you with relaxation exercises.

Doctors will use your medical history and a complete physical exam to rule out other conditions that cause painful sexual intercourse.

Causes & Difficulties of Vaginismus

Vaginismus is a condition that can be caused by any of the following physical stressors: infection, such as a urinary tract infection (UTI) or yeast infection; health conditions such as cancer or lichen sclerosis; childbirth; menopause; pelvic surgery; inadequate foreplay; insufficient vaginal lubrication; or medication side effects. Vaginismus can also be triggered by the following emotional stressors: fear (for example, fear of pain or pregnancy); anxiety about performance; guilt or relationship problems (for example, having an abusive partner or feelings of vulnerability).       

Vaginismus manifests itself physically in the form of vaginal cramps, but it is not often linked to a physical illness. Remember, the onset of vaginismus is not something for which you are responsible. Please don’t blame yourself. Most often, vaginal cramps occur during sex.

Vaginismus Treatment

The main difficulty with vaginismus is that treatment must be administered in an interdisciplinary manner by different specialists at the same time. Individual physicians often lack the time or capabilities for such a holistic approach.

In recent years, the prognosis has improved greatly, with promising chances of healing using a multimodal treatment.

Today, science supports a combination of physical therapy for pelvic floor such as stretches and techniques to release overtensed muscles in the pelvic, bladder, or anal area (trigger points); psychological therapy such as paradoxical and progressive relaxation techniques to reduce causative stress; and neuropathic irritation, which can help to cure or reduce causes and symptoms.