Vaginismus; Definition, Causes And Treatments

Vaginismus is a condition involving a muscle spasm in the pelvic floor muscles. This makes it painful, difficult to have sexual intercourse, to undergo a gynaecological exam, and to insert a tampon. The vagina tightens up because of an involuntary contraction of the pelvic floor muscles. This leads to a generalised muscle spasm, pain and temporary breathlessness. Eventually, this spasm can occur even when the woman is touched near the vaginal area.

The most common pelvic floor muscle group affected is the Pubococcygeus (PC) muscle group. These muscles are also responsible for urination, intercourse, orgasm, bowel movements and childbirth. These are situations in which these muscles should contract and tighten properly. So, remember that the pelvic floor muscles are never fully relaxed.

Vaginismus doesn’t interfere with sexual arousal, but it can prevent penetration. A gentle pelvic exam typically shows no cause of the contractions. Vaginismus can have additional symptoms, including fear of vaginal penetration and decreased sexual desire related to penetration. Women with vaginismus often report a burning or stinging pain when anything is inserted into the vagina.

It is important to note that in vaginismus, vaginal muscles tighten up despite the woman’s desire for sexual intercourse. If you have vaginismus, it doesn’t mean that you’ll stop enjoying sexual activities altogether. Women who have the condition can still feel and crave sexual pleasure and have orgasms. For a clinical diagnosis of vaginismus, all of these symptoms must be present at least 50% of the time while having intercourse.

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Although the population prevalence remains unknown, the prevalence rates in clinical settings have been reported to range between 5–17% of women. The wide range of reported prevalence rates most likely has a sociocultural cause, since the highest reports come from conservative countries where women’s rights and freedoms are often curtailed.


Primary Vaginismus

This is a lifelong condition in which the pain has always been present. It is experienced by women during their first attempt at intercourse. The male partner is unable to insert his penis into the vagina. He may describe a sensation like “hitting a wall” at the vaginal opening. The symptoms are reversed when the attempt at vaginal entry is stopped.

Secondary Vaginismus

This develops after a woman has already experienced normal sexual functioning. It can occur at any stage of life, and it may not have happened before. It usually stems from a specific event, such as an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery, or childbirth. Even after any underlying medical condition is corrected, pain can continue if the body has become conditioned to responding in this way.

Global Vaginismus

Vaginismus is always present, and any object will trigger it.

Situational Vaginismus

This occurs only in certain situations, or with certain partners.

The symptoms of vaginismus vary in severity with different women. For example:

  • Some women are unable to insert anything into their vagina.

  • Some women can insert a tampon and undergo a complete a gynaecological exam, but intercourse isn't possible.

  • Other women can try to have intercourse, but it is very painful.

  • Some women are able to have intercourse, but tightness and pain prevent orgasm.

  • Some women experience years of occasional difficulty with sex and have to be constantly ready to control and relax their vagina when the symptoms occur.


Vaginismus is a condition which can be caused by physical stressors, emotional stressors, or both. It can become anticipatory, so that it happens because the person expects it to happen.

Emotional Triggers

Let’s discuss the fear-avoidance model of vaginismus. Vaginismus usually begins when women first attempt to have sexual intercourse. However, it sometimes develops later, for example, when another factor makes intercourse painful for the first time or when women attempt intercourse while they are emotionally distressed.

Because intercourse may be painful physically, emotionally, or both, women begin to fear it. This fear makes muscles even tighter and causes or increases pain when sexual intercourse is attempted. A reflex reaction develops so that when the vagina is pressed or sometimes even just touched, the vaginal muscles automatically (reflexively) tighten. However, most women with vaginismus enjoy sexual activity that does not involve penetration.

Emotional Triggers Include:

  • fear of pregnancy

  • anxiety, about performance or because of guilt

  • relationship problems, for example, having an abusive partner or feelings of vulnerability

  • traumatic life events, including rape or a history of abuse

  • childhood experiences, such as the portrayal of sex while growing up or early exposure to sexual images and videos

Having difficulty understanding sex, or having feelings of shame or guilt around sex could make you feel uncomfortable if:

  • You've had a very strict upbringing where it was never discussed.

  • You have been told that sexual desire is wrong or sex is painful.

  • You are affected by cultural or religious taboos around sex.

Physical Triggers

In a lot of physical conditions, a lack of vaginal lubrication and elasticity makes intercourse painful, stressful, or impossible. In others, pelvic floor muscle dysfunction, i.e., some physical problem in the normal functioning of the pelvic floor muscles, leads to hypertonicity (increased tone) and reduced muscle control.

These include:

  • infection, such as a urinary tract infection (UTI), yeast infection or trichomoniasis, which is a parasitic infection

  • health conditions, such as cancer or lichen sclerosis

  • childbirth

  • menopause

  • inadequate foreplay

  • medication side effects

  • previous surgery to the genital area

  • radiotherapy to the pelvic area

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The aim of treatment will be to reduce the automatic tightening of the vaginal muscles and the fear of pain, and to deal with any other type of fear that may be related to the problem.


Education typically involves learning about your anatomy and what happens during sexual arousal and intercourse. you'll get information about the muscles involved in vaginismus, and understand why you're having pain.This can help you understand how the parts of body work and how your body is responding.

Sex Therapy and Counselling

Counselling may involve you alone or with your partner. Working with a counsellor who specialises in sexual disorders is the key. Sex therapy can help the person identify, express, and resolve any emotional factors (including past sexual trauma) that may be contributing to vaginismus.

As well as advising you on self-help techniques, your therapist may offer you:

  • Counselling to address