Vaginismus

Vaginismus is a medical condition characterized by an automatic or involuntary muscle spasm that prevents vaginal penetration. One of the main results of this obstructive spasm is discomfort or pain during vaginally penetrative sex. However, vaginismus does not necessarily affect one’s capacity to become aroused and experience sexual pleasure by other means such as external stimulation and anal sex.

While vaginismus is often conflated with vaginal pain or the inability to have vaginally penetrative sex with a partner, this can also affect other common activities such as inserting a tampon, using a speculum during a medical exam, or any internal stimulation during masturbation with fingers or sex toys.

The cause of vaginismus is not yet known; risk factors include a history of vaginitis, endometriosis, sexual assault, and genophobia.

Types of Vaginismus

The most common symptom of vaginismus is pain during penetrative sex. The pain typically only happens during penetration and lets up when the activities have ceased. Because of the pain associated with sex and penetration, many people with vaginismus may experience, or go on to develop, a loss of sexual desire or a notable fear of sex.

Vaginismus is broken down into two main types: primary and secondary.

Primary vaginismus, also known as lifelong vaginismus, is when pain has been experienced consistently through one’s life any time vaginal insertion is attempted. 

Secondary vaginismus, also known as acquired vaginismus, is when vaginal pain during insertive activities is developed later on. While these activities were pain-free in the past, it has now become problematic or too painful to endure.

Cause of Vaginismus

The cause of vaginismus has not yet been confirmed. There is a strong correlational link between vaginismus and anxiety, generalized fear of sex, or genophobia. However, it is unclear if there is a causal connection between them.

Regardless, the psychological factor does seem to present strongly in some cases. For some people with vaginismus, their symptoms are universal while with others, they only experience discomfort in certain situations or certain objects. For example, one may be able to insert tampons with ease but be unable to endure penetrative sex with a partner or a speculum during a medical exam.

Vaginismus is not the only cause of pain during sex. Other conditions like vaginal dryness, menopause, vaginal infection, urinary tract infections, endometriosis, birth or injury trauma, and not using enough lube can also cause painful intercourse. If pain is frequently experienced during sex, a medical professional should be consulted.

Diagnosis and Treatment

To diagnose vaginismus, a medical professional performs an assessment of the symptoms, including a pelvic exam, and compares it with medical and sexual histories. 

Vaginismus treatments target the vaginal and pelvic floor muscles as well as the psychological factors that may be associated with the tension held in that area of the body.

Common treatments for vaginismus include:

- Topical lidocaine or creams to manage the pain

- Use of vaginal dilators to help gently and gradually train the vagina to be more comfortable with insertion and stretch

- Pelvic floor physical therapy

- Cognitive-behavioural therapy

- Sex therapy