Vaginismus refers to tension in the vaginal muscles, which in turn causes painful intercourse. Women with vaginismus may have vaginal muscles that become so tight the vagina cannot be entered. They often experience pain in the genital, vaginal or pelvic area, and they fear penetration and intercourse.
Sometimes this tension occurs only during sexual encounters, resulting in the inability to have intercourse. Or it may be more global, preventing the woman from inserting a tampon or having a pelvic examination. Many women with vaginismus have a medical condition that causes pain in the vulva, vagina or pelvis. This pain may be constant, occasional, or only during sex. Vaginismus is an involuntary reaction of a woman’s body to protect from anticipated pain.
Some women have positive attitudes toward sex and enjoy many pleasurable sexual activities with their partners, including orgasms. Only intercourse is a problem. Other women have not had any specific negative sexual experience but have strong fears or negative feelings about sex. They may have been raised with little or no accurate information about sexual anatomy or functioning and may have many misconceptions. They may believe that sex is painful, sinful or dirty, their genitals are ugly or disgusting.
Some women with vaginismus have a history of sexual abuse, rape or other trauma and have an intense fear of further pain, penetration or violation. The tightening of the vaginal muscles may be an unconscious effort by these women to protect themselves.
Diagnosis and Treatment of Vaginismus
The diagnosis of vaginismus requires a detailed history and physical examination by a gynecologist familiar with the problem. Because vaginismus is often situation-dependent, it can be difficult to diagnose and its presence or absence during a gynecological exam is not a definitive diagnosis. For example, while involuntary contraction of the vaginal muscles may prevent insertion of the penis, a pelvic exam might not be as anxiety provoking, and even insertion of a speculum might be possible. (A speculum is the instrument used to hold the walls of the vagina apart so the interior can be examined). For some women, vaginismus may occur with one partner but not with another. For others, it might occur in all situations. For an accurate diagnosis, the combination of a physical exam, gynecological history and sexual history from both partners is often necessary.
Treatment for vaginismus is promising, with research studies reporting success rates of 80% or better. Typically, treatment includes relaxation, Kegel exercises (to relax the vaginal muscles) and individual and partner involvement in a series of at-home exercises, including repeated practice with insertion (dilation) training. Each woman moves at her own pace and decides when she is ready for the next step. Pain and discomfort are avoided throughout the treatment.