Vaginismus

Not all women enjoy sex. While psychological issues have been identified that can affect some women’s sexual enjoyment, for other women it’s a physical issue. If vaginal penetration is painful or impossible, they may be suffering from vaginismus.

A protective tensing of the musculature surrounding the vaginal opening, vaginismus prevents anything from penetrating. A woman with vaginismus doesn’t directly control the tensing, allowing it to occur—it is an involuntary pelvic response. Vaginismus is a misunderstood problem and therefore sometimes missed by health care professionals. Consequently, actual numbers of vaginismus sufferers are difficult to calculate.

Two types

There are two types of vaginismus—primary and secondary. Primary vaginismus occurs when a woman struggles with vaginal penetration from her first attempt at intercourse. Secondary vaginismus occurs suddenly in a woman who has had no previous problems with penetration.

“The majority of cases are primary,” says Dr. Bianca Rucker, registered nurse and sex therapist. “A woman discovers this is how her body responds and she has vaginismus.”

Dr. Rucker dispels the often-misunderstood belief that this condition is strictly psychological in nature, for instance caused by past sexual trauma or abuse, painful sex, or a difficult birth experience. Gynecological examinations and insertion of tampons may also cause a woman pain.

There certainly are some instances where a woman’s past experiences influence her feelings around sex and these need to be acknowledged. Yet for the majority of cases the woman wants penetration, but her body doesn’t respond in kind—it closes off. “There isn’t any negative event that particularly precedes it or contributes to it,” says Dr. Rucker. “It just is that way.” 

Other factors

Even though vaginismus is a stand-alone diagnosis, medical professionals are beginning to look at other factors influencing their patients’ condition. Vaginismus may be a symptom that accompanies something else. Vulvar vestibulitis syndrome (VVS), a neuropathic pain condition wherein vulvar touch is perceived as painful, may cause or contribute to problems related to vaginismus. An experienced gynecologist can properly diagnose VVS.

Treatment of vaginismus begins by speaking to a health care professional. “I need to find out what is going on inside the woman’s mind as well as in her body by talking to her,” says Dr. Rucker.

A woman with vaginismus does not need to feel isolated or that her situation is hopeless. Successful treatment is available.

Help is at hand

The goal

• To retrain the body to be more comfortable with, and receptive to, vaginal penetration by learning how to relax specific muscles

The helpers

• Get a referral to someone who has experience in this area—either a sex therapist and/or a pelvic physiotherapist

A sex therapist

• Encourages communication
• Helps couples enjoy non-intercourse sex
• Helps retrain the body to relax (may include hypnotherapy or instruction on the use of vaginal inserts)

A pelvic physiotherapist 

• Teaches specific pelvic floor muscle relaxation exercises
• Provides instruction in the use of graduated vaginal inserts or vaginal accommodators so women can slowly become comfortable with them

Helpful websites

• vaginismus.com
• nva.org