Vaginismus: what is it and how can you treat it?

Is it impossible for you to have sex? Or better said: is it impossible for you to get penetrated because it is painful or because your vagina doesn’t seem to be large enough? You might have vaginismus. You can read all about how to deal with it, whether there are treatments, and what can cause vaginismus in this blog post.

What is vaginismus?

If you have vaginismus then it is generally speaking impossible to insert a finger, tampon, or penis into your vagina. The muscles surrounding your vagina – your pelvic floor muscles – tighten so much that is becomes impossible to insert anything. Your muscles will tighten against your will, which can make it seem like your vagina is ‘locked’. Even the thought of inserting a tampon, finger, or penis can cause a vaginismus reaction.

Different kinds of vaginismus

There are various kinds of vaginismus:

Psychogenic or organic

Psychogenic vaginismus has no physical cause. Your subconscience creates an involuntary blockage by tensing the pelvic floor muscles. This is not the case with organic vaginismus: this does have a physical cause. However, this is very rare.

Primary en secondary

There is also a difference between primary and secondary vaginismus. Primary vaginismus means that you’ve had vaginismus since you were young and you’ve never been able to insert a tampon or finger into your vagina. Secondary vaginismus occurs later in life. You used to be able to insert a tampon or even experience painless penetration. This kind of vaginismus can develop during a change in your hormones for example, such as after a pregnancy or while you’re going through menopause. This causes the vagina to create less vaginal fluid, which means irritations of the skin can occur. A traumatic sexual experience can also lead to secondary vaginismus.

Complete and partial

Every woman with vaginismus is different, so what she can and can’t insert can vary per person. Some women can tolerate inserting a tampon for example, but not a penis. This is partial vaginismus. When nothing can be inserted into the vagina, it’s called complete vaginismus.

Situative vaginismus

If a woman has this kind of vaginismus, it depends on the circumstances if she can or can’t have sex. For example, it is possible that a woman can have sex with a certain partner, but not with another partner.

Dyspareunia

If you’re trying to have sex, it won’t work, but a gyneacologist inserting a speculum into your vagina during an examination is no problem at all. Inserting your own finger is also no problem. We call vaginismus dyspareunia if your vagina only ‘locks’ in situations where you’re trying to have sex.

Difference vaginismus and dyspareunia

Vaginismus and dyspareunia are similar: both conditions cause pain during penetration. They’re both a genito-pelvic pain/penetration disorder. Dyspareunia can have all kinds of causes, such as irritation of the vaginal wall or dry mucous membranes. Sometimes there are relatively simple solutions, like using lubricant. Dyspareunia can lead to vaginismus, because the fear of experiencing pain can cause extra tension. This will of course make sex more painful, thus creating a vicious circle.  The difference between dyspareunia and vaginismus is that the vagina can be penetrated in certain situations if you have dyspareunia, while this is not the case with vaginismus.

Causes of vaginismus

We wrote earlier that the causes of vaginismus are generally psychological. There is rarely a physical cause. And sometimes there isn’t even a psychological cause, but this is even more rare. Menopause or a difficult pregnancy/birth can be the cause of vaginismus. These are the most common causes of vaginismus:

Abuse in the past

If you have been abused in the past, you can develop vaginismus or have a vaginismus reaction when your partner approaches you. You might find yourself reliving the sexual trauma, even though you really do want to have sex with your partner.

Relationship problems

If you have relationship problems, your sex drive is often lower than usual. By giving in to your partner’s desires even though you don’t really want to, you cross your own boundaries. Your body can prevent this by tensing the pelvic floor muscles. This is how a vaginismus reaction occurs. If your partner shows a lack of understanding about this, you can end up in a vicious circle. You will feel insecure and might even experience some guilt. If your partner isn’t sympathetic and he or she still tries to have sex with you, then you might need to ask yourself if your partner is right for you.

Fears

You can be afraid of various things during sex. That fear can cause your pelvic floor muscles to tighten, even though you don’t want them to. Some examples:

• You’re afraid you will become pregnant or that your bed partner might give you an STD.
• You were raised with the idea that sex is dirty or that you shouldn’t have sex before marriage for religious reasons. This can make you fearful.
• Your first sexual experience was painful and you’re afraid it will hurt again. Stories from other people about painful experiences can cause extra tension as well.
• You have a fear of failure: you’re afraid you won’t be good in bed.
• Your partner’s penis is larger than average and you’re afraid it won’t fit in your vagina.

You’ve ended up in a vicious circle

Nothing is as difficult as breaking a vicious circle. You can end up in one if you’re unable to insert anything into your vagina. The next time you try, your muscles will inadvertently tighten from fear of pain or failure. And if it does indeed hurt again when you’re trying to insert a tampon or when you’re trying to have sex, you’ll end up in a vicious circle. This can make you unwilling to even try to insert a tampon or have sex. It can also cause negative thoughts or shame.

Are there treatments?

Fortunately, there are ways to treat vaginismus. However, that doesn’t mean that every woman wants to be treated. Also, the treatment won’t work for every woman. The eventual goal of the treatment is being able to have pleasurable sex without pain.

First step: talk to your GP

It’s important to talk to your GP first. GPs, sexologists, and gynaecologists have seen it all, so they definitely won’t think your condition is strange or something to be ashamed of. Your GP will ask you questions and might examine you physically. He or she can then refer you to a therapist.

Therapy

First you will discuss your problem with the therapist you were referred to. The goal is to find out what causes your vaginismus. For example, if you’ve been sexually abused in the past, it’s important to process this trauma with the help of therapy. EMDR therapy can be very effective for example. If you have problems like anxiety or depression, you can also be referred to a psychologist or sexologist.

Physical therapy for your pelvic floor

The treatment will not just focus on psychological issues. Your pelvic floor muscles also play an important part in the treatment. Physical therapy for your pelvic floor muscles will help your lean how to gain more control over these important muscles. You will get an explanation about how these muscles work and you will also learn how to tighten and, most importantly, how to relax them. Your therapist will most likely also teach you breathing and relaxation techniques.

During therapy, you will learn how to insert an increasingly large object into your vagina. It starts with something like cotton buds or your finger. The size of the object will increase over time. The goal is to eventually remove the fear of something being too large to fit into your vagina. You can practise at home in your own time. Your therapist is there to support you.

Vaginismus shame

It’s unclear how many women have or have had vaginismus, as many are too ashamed of their condition to seak help. We want to stress that there are people who can help you and that vaginismus is nothing to be ashamed of. The fact that your body doesn’t work the way you want to is never your own fault. So talk about it, and also discuss it with your lover or partner.

Giving birth vaginally when you suffer from vaginismus

Pelvic floor specialist Ellen Hawinkels says women do not have to worry about giving birth when they suffer from vaginismus. It’s a different process: from the inside to the outside. Contractions help with this process. Unfortunately, a vaginal birth doesn’t help treat vaginismus. Most women still suffer from vaginismus after giving birth.