What is vaginismus and why does it cause painful sex?

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Image for an article explaining what is vaginismus. Young upset black woman is sitting on the edge of the bed, her boyfriend is lying in bed. There is tension because of the impact vaginismus has on their relationship.

Vaginismus is an extremely common condition that can hugely impact women, their partners, and relationships. Yet many with it feel alone and without hope as it’s rarely discussed. | Photo ©F8studio / Adobe Stock

What is vaginismus and why does it cause painful sex?

Discover what vaginismus is and why it causes painful sex. Learn about the common but rarely discussed condition that affects women, their partners, and their relationships. Find out how vaginismus can be diagnosed and treated and its impact on self-esteem and mental health. 

The social and cultural messages we receive around sex give the impression everyone’s “doing it,” and it’s always fun and enjoyable. But for many people, having sexual intercourse is extremely painful or impossible. One of the leading causes of painful penetration is vaginismus. 

What is vaginismus? It is an extremely common condition that can have a huge impact on women, their partners, and their relationships. Yet many with it feel alone and without hope, as it’s rarely talked about.

But women don’t need to live with vaginismus — it’s easy to diagnose, and it’s treatable.

Painful sex and vaginismus

Australian research shows that about 20% of women and 2% of men experience painful sex.

Male sexual problems, such as erectile dysfunction, have been in public awareness since the advent of “the little blue pill” — Viagra. But sexual difficulties in women are missing from the story.

Without the push of pharmaceutical industries, awareness, and knowledge about sexual difficulties in women (or people with vaginas who don’t identify as women) have not advanced in the same way as it has for men.

A recent study, which is not yet published, found, in 2019 57% of female patients who attended the Sexual Medicine and Therapy clinic (Monash Health) attended because of painful sex. 60% of them had Vaginismus. Almost half of these women had experienced this for more than five years, and it had occurred in around one in five of these women for ten or more years.

What is vaginismus?

Vaginismus occurs when someone has persistent or recurrent difficulties in allowing vaginal entry of a penis, finger, or any object, despite her wish to do so.

Some women experience fear, difficulties, or pain from the first time they try to insert something into their vagina, and instead of getting better, it can get worse over time. This is called “primary vaginismus”.

Others can be fine for years and develop pain at some later date. This is “secondary vaginismus”.

Vaginismus can be mild, moderate, or severe. The pain is often described as burning, cramping, or a tight feeling. And for some, nothing can go into the vagina. Sufferers describe it as like hitting a brick wall.

The mental impact of vaginismus

There is a mental impact of vaginismus as well. Those with undiagnosed vaginismus can feel embarrassed or abnormal, which can deter them from seeking help. And undiagnosed vaginismus can significantly impact self-esteem and lead to anxiety or depression.

Those with vaginismus may avoid being sexual, as it can be a very painful experience. They also may avoid any intimacy for fear that it may lead to “sex”. This can significantly impact relationships, leading to distance and conflict.

It can also inhibit single people from forming relationships. They may avoid socializing, dating, and meeting new partners, feeling burdened with a “shameful secret”.

"Those with vaginismus ​may avoid being sexual, as it can be a very ​painful experience."

Image for an article explaining what is vaginismus. Young upset black woman is sitting on the edge of the bed, her boyfriend is lying in bed. There is tension because of the impact vaginismus has on their relationship.
Caption:Women with vaginismus may avoid any intimacy for fear it may lead to painful sex. This can significantly impact relationships leading to distance and conflict​​.  Credit:©F8studio / Adobe Stock 

What causes vaginismus?

When it comes to sex (and life), you can’t separate the mind and the body. Vaginismus is no exception. The causes of vaginismus are extremely variable and often influenced by multiple factors.

Sometimes there is no obvious cause, but common factors in the development of primary vaginismus include:

  • fear or anxiety: about pain, pregnancy, or sexually transmitted infections. Generalized anxiety or other anxiety disorders can also cause vaginismus
  • taboos: cultural or religious taboos around sex or inner conflict about whether to be sexual or not
  • unaroused sex: having sex when you don’t really want to
  • history of abuse: a history of physical, emotional, or sexual trauma or abuse
  • unrealistic expectations: of sex leading to fear of not being “good enough”.

Secondary vaginismus can occur due to any of the above or after anything that leads to painful sex, such as:

  • relationship problems: leading to a lack of libido or arousal
  • infections or skin problems: vaginal infections, such as thrush and vulval dermatological (skin) problems or Vulvodynia can cause vaginismus
  • gynecological problems: such as endometriosis, gynecological (or breast) cancer and its treatment or pelvic surgery
  • pregnancy: vaginismus can occur after pregnancy, delivery, or as a new parent.

A normal reaction to any anxiety and fear is a tightening of muscles, and vaginismus occurs when this happens in the pelvic floor muscles. A strong pelvic floor is important, but we also need to learn how to relax it when we want to.

How is vaginismus diagnosed?

How is vaginismus diagnosed? Vaginismus can usually be diagnosed by taking a careful history and looking at which factors may be causing it.

Medical professionals who are experienced in treating the condition will do an examination in a gentle, empowering way only when the woman is ready to, so she is not distressed or traumatized in any way.

What is the treatment for vaginismus?

When being treated for vaginismus, women should be reassured that tightness in the pelvic floor is an involuntary, protective response they can learn to overcome with help.

A multidisciplinary approach to management has been shown to be most effective. This includes:

  • education about vaginismus, the pelvic floor, and sex
  • medical management of any underlying physical conditions
  • psychological management of any underlying worries
  • pelvic floor therapy for vaginismus can help women learn how to relax, generally and on the pelvic floor
  • vaginismus physical therapy
  • learning about what is pleasurable, as unaroused sex is a common cause of painful sex.

Women should also be empowered to feel free to choose if, when, and how to be sexual. Many women are either coerced into sex or are compliant for the sake of their partner’s needs.

They need to be supported to recognize and express their own needs and wishes. Although women can continue to be sexual in any way they wish, it’s vital to stop doing anything that hurts, such as continuing to try to have painful penetrative sex while vaginismus is being treated.The Conversation

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"What is vaginismus and why does it cause painful sex?," was first published in The Conversation, a network of not-for-profit media outlets that publish news stories written by academics and researchers.