Picture this scenario: A young man and woman get married. They have waited for marriage to experience sexual intimacy, yet intercourse is not what they eagerly anticipated. While they may have expected the first few times to be a bit uncomfortable, this is something different: she is experiencing actual pain.
This isn’t a hypothetical scenario. Increasingly, women are opening up about sex being painful, and realizing that this is a symptom of an underlying issue called vaginismus.
In our previous article on why sex should not be painful, the author shared about her struggles with vaginismus. In this article, we will delve deeper into what vaginismus is, how it is diagnosed, and most importantly, how it can be healed.
What is vaginismus?
Vaginismus is a musculoskeletal disorder where the muscles inside a woman’s vagina spasm when something is inserted [1]. This may occur during sex, a pelvic exam, or while inserting a period product like a tampon. These spasms can cause mild to extreme боль for the woman, potentially making penetrative sex impossible.
Vaginismus isn’t always painful
In some cases, vaginismus spasms are not painful per se, but can be so strong and uncontrollable as to physically prevent anything from being inserted into the vagina. In these instances, pain may come from the forcing of something (whether a penis or a tampon) through the muscle spasm, rather than from the spasm itself.
In some cases, vaginismus spasms are not painful per se, but can be so strong and uncontrollable as to physically prevent anything from being inserted into the vagina.
Pelvic floor physical therapist Jenny Porter also helpfully notes, “Dyspareunia (pain with sex), vulvodynia (pain of the vulva), and vestibulodynia (pain of the vaginal vestibule) are the technical diagnoses of pelvic pain. So I would list both dyspareunia and vaginismus if there were both sexual pain plus muscle spasm with vulvar or vaginal stimulation.”
There are two classifications for vaginismus: primary and secondary [2]. Primary vaginismus occurs when a woman experiences this condition having never had anything inserted into the vagina before (i.e. the first time she tries to insert a tampon or have sex). Secondary vaginismus occurs when a woman who previously did не struggle with vaginismus develops it and is unable to have penetrative intercourse.
What causes vaginismus?
Medical professionals are not sure of the exact cause of vaginismus, but it is believed to be a multifactorial condition, meaning that multiple things probably contribute.
Some proposed causes of vaginismus include the following [3]:
- Infection or irritation
- Sexual trauma
- Injuries or scars in the vagina from childbirth, surgery, or sexual abuse
- Anxiety, fear, or other psychological problems
Vaginismus can also coexist with other conditions that cause pelvic pain, such as endometriosis [1]. In her book, Missing Pieces: Female Perspectives on Sex for Catholic Women, author Mary Bruno, who herself experienced both endometriosis and vaginismus, noted that vaginismus may also be connected to “purity culture” or religious beliefs that place the blame on women for men’s sexual sin, and/or that imply that a woman who is no longer a virgin has ‘nothing to offer,’ or that wives owe their husbands sex (whether they are interested in it or not) because that’s what makes men feel loved.
How do I know if I have vaginismus?
The primary symptom of vaginismus is uncontrollable contraction of the pelvic floor muscles at the level of the vagina, whether they are experienced during a pelvic exam or when trying to insert a period product, be it a tampon, cervical disk, or menstrual cup [3]. If you experience pain during any of these instances, this is not normal.
While it’s always a good idea to let your OB/GYN or midwife know about reproductive system symptoms, they will most likely encourage you to seek out a физиотерапевт тазового дна (learn how to find one здесь!) to assess you for vaginismus and then help you make a treatment plan.
What are the treatment options for vaginismus?
If you are diagnosed with vaginismus, that is the first step towards healing the condition. You do not have to suffer through these painful spasms for the rest of your life. Because there is not a singular known cause for vaginismus, and because it’s often multi-faceted, your doctor may recommend a combination of treatments to alleviate the condition [2][4]:
- Pelvic floor physical therapy–According to pelvic floor PT Dr. Jenny Porter, a pelvic floor physical therapist works to improve the natural function the pelvic floor muscles by first educating women on what’s causing the issues, teaching them to regulate the nervous system, help them improve muscle control (including how to relax the pelvic floor, which is easier said than done!), addressing the contributing factors, recommending relevant lifestyle modifications, and referring women to other healthcare professionals for collaborative treatment, if appropriate. As an example, one treatment pelvic floor PTs may utilize is inserting a dilator into the vagina to help teach the muscles to relax. This treatment usually involves a series of dilators that increase in diameter to gradually teach the vaginal muscles to handle insertion.
- Sex therapy– A sex therapist licensed by AASECT, the American Association of Sexuality Educators, Counselors, and Therapists, will guide individual women or couples through counseling related to her/their particular needs.
- Topical numbing creams–These creams will help with the pain as you heal.
- Cognitive behavioral therapy—The therapist will help you work through any psychological causes of the condition as well as the emotional distress of not being able to participate in or experience satisfaction from sex.
- Хирургия–This is only for rare, extreme cases of vaginismus where there is a physical problem with the vaginal muscles that cannot be cured through other means.
The bottom line on vaginismus
Vaginismus is a sexual disorder wherein the woman experiences uncontrollable spasms in her vaginal muscles. These spasms may cause mild to severe pain during intercourse, pelvic exams, or when using a menstrual product like a tampon, particularly if insertion is forced. In severe cases of vaginismus, the woman may not be able to have penetrative sex at all, which would also prevent her from getting pregnant.
Women need to understand that vaginal pain is не нормальный in these circumstances, and they should reach out to their healthcare professional for a vaginismus diagnosis. Once diagnosed, vaginismus can be healed through hard work and persistence. However, the patient should be aware that they may have to pursue multiple avenues for healing, as vaginismus is often not caused by a singular issue.
