Vaginismus: Getting Vaginal Pain Validated and Seeking Treatment
Medically reviewed by Peter Weiss, MDMedically reviewed by Peter Weiss, MDVaginismus is when vaginal muscles tighten involuntarily, causing painful or difficult vaginal penetration. It can affect your experience getting pelvic exams, menstruation, sex, and your mental health. Research estimates between 1% and 7% of women have vaginismus, but this is likely a low estimate due to underreporting; experts estimate that the prevalence is closer to 17%. Treatment options are advancing, and about 71% of people with vaginismus find relief with treatment.
Illustration by Mira Norian for Verywell Health
What Vaginismus MeansVaginismus means your vaginal muscles tighten without you wanting them to, making penetration—with a penis, finger, tampon, or speculum—painful or impossible. It can be something you’ve always had or begin suddenly.Tightness and AnatomyDuring vaginal penetration, you might feel sharp, burning pain or tight pressure. Some describe this as hitting a wall. It can occur at the entrance or deeper inside the vagina. Effect on Pelvic ExamsPelvic exams can be painful or impossible for those with vaginismus. Consider asking for a pediatric speculum, longer appointments, or a muscle relaxant prescription if this is the case.Effect on MenstruationInserting tampons or menstrual cups can be painful or impossible. Many people think this is normal, but using a tampon shouldn’t hurt. Not being able to use tampons can be frustrating because using pads is tricky for activities like swimming or gymnastics.Effect on Sex Vaginismus causes pain during attempted penetration, making sexual intercourse or masturbation impossible. Worrying about the pain can also cause panic attacks. The effect of vaginismus on sex can strain relationships because you might avoid sex, or your partner might be afraid of hurting you.Mental Health Effects Struggling with vaginismus can make you feel like a failure, leading to feelings of inadequacy and shame. These feelings can create a cycle of isolation and guilt, which might lead to depression, panic attacks, or deep sadness, especially if it affects your hopes of having a family.Vaginismus Causes and TriggersThe causes and triggers of vaginismus can be physical, emotional, or psychological. Symptoms can start at any age and may not always have a clear cause. Some people experience symptoms with any insertion, while others have issues only with certain partners or during medical exams. Risk factors include:Abuse (sexual, physical, or emotional) Cancer treatmentDifficult sexual experiencesFamily historyHormonal changesHysterectomyInfections Menopause Mental health disordersNegative feelings or misunderstandings about sexPainful genital or urinary medical procedures as a childPhysical trauma (such as sexual assault or difficult childbirth)Relationship conflictsStressSteps to Diagnose VaginismusProviders typically diagnose vaginismus when you have the following symptoms lasting six months or more: Anxiety about vaginal painDifficulty using or removing tamponsInvoluntary tightening of vaginal muscles during penetrationPain during intercourseTrouble with gynecological exams
Conditions That Can Cause Painful SexYour provider may also perform a physical exam, imaging tests, or a urinalysis (peeing in a cup) to rule out the following conditions that could also cause painful sex.Endometriosis Ovarian cysts Painful bladder syndromePelvic adhesions (scarring)Pelvic floor dysfunctionPelvic inflammatory disease (PID)Skin problems like lichen sclerosus or lichen planusTipped uterusUnderdeveloped vaginaUterine fibroids Vaginal atrophy or drynessVaginitis (vaginal inflammation)Vulvodynia (chronic vulva pain)
Vaginismus Self-Care for Symptom ManagementThe following relaxation and breathing techniques can reduce muscle tension and improve vaginismus symptoms.Relaxation: Use aromatherapy (like lavender), hot tea, calming music, or a warm bath.4-7-8 breathing: Breathe in for four seconds, hold for seven seconds, then breathe out for eight seconds.Deep belly breathing: Lie on your back with your knees bent and place your hands on your rib cage. Breathe deeply, expanding your rib cage, then exhale slowly.The following pelvic floor relaxation exercises can also help:Child’s pose: Kneel, touch your toes, spread your knees wider than your hips, and stretch your arms forward. Hold for five to 10 breaths.Cobra pose: Lie on your stomach, press your feet and pubic bone into the floor, lift your chest, and squeeze your shoulder blades together. Hold for five to 10 breaths.Happy baby pose: Lie on your back, bring your knees to your belly, grip your feet with your hands, and open your knees toward your armpits. Hold for five to 10 breaths.Piriformis stretch: Lie on your back with your knees bent. Place your left ankle on your right knee (like a figure four). Pull your right thigh toward your chest. Hold for 30 seconds, switch sides.
Kegels vs. Reverse Kegels Kegel exercises strengthen weak pelvic floor muscles. However, vaginismus involves tight muscles, so reverse Kegels may be a better choice. Here’s how to do them:Relax the muscles you use to start and stop urine.Imagine gently pushing out.Breathe deeply into your belly while relaxing your pelvic floor.Hold for a few seconds, then release.Repeat several times.
Vaginismus Medical TreatmentVaginismus is a treatable condition that often requires a treatment team, including gynecology providers, pelvic floor therapists, psychologists, and sex therapists.Counseling and Sex TherapyPsychological counseling addresses emotional and mental challenges. A sex therapist can teach you about: More comfortable sexual positions Non-penetrative activities, like outercourseProgressing from partial to full penetrationSensate touchTools like Ohnut to control penetrationPelvic Floor Physical TherapyA pelvic floor physical therapist can guide you through exercises and exposure therapy, gradually inserting your fingers or vaginal dilators into the vagina. Vaginal dilators are devices that help stretch the vaginal wall, making penetration more comfortable.Medications and ProceduresThe following medications and procedures can also help:Valium (diazepam) for muscle relaxationPremarin, Estrace (estrogen) for vaginal dryness Osphena (ospemifene) for vaginal drynessBotox (onabotulinumtoxinA) injections for muscle relaxationMarcaine (bupivacaine) injections for temporary numbingInsertion of vaginal dilators under sedationSurgery (rare) to remove scar tissue Coping With Chronic Vaginismus Living with vaginismus can be challenging. Consider connecting with others who understand through support groups or online forums. If you are beginning dilator treatment, be patient with yourself and go at your own pace. It can be more emotional than you might expect. Here are a few other vaginal dilator tips:Create a relaxing environment Start with the smallest size Use a lot of lubricant Insert at a slight downward angleRelax vaginal muscles during insertion If you face resistance, keep the dilator in place until your muscles relaxSummary Vaginismus is when the muscles around the vagina tighten, making penetration difficult. Symptoms include pain during sex, trouble inserting tampons, and difficult or impossible pelvic exams. Underlying causes can be physical and psychological. Living with vaginismus can be frustrating, but many people get relief with self-care or medical treatments. Read the original article on Verywell Health.
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