Treatment of vaginismus depends on whether the cause can be identified. If there is an obvious physical cause, such as an injury or infection, this can be treated with appropriate medication.
Read more about the causes of vaginismus.
If the cause is less obvious, you may be taught some self-help techniques to try to resolve the problem.
Your GP will refer you to a health professional who specialises in sexual health, such as a psychosexual doctor or sex therapist. They will teach you some techniques to retrain your vagina to respond normally to penetration (see below).
As well as advising you on self-help techniques, your specialist may offer you:
- counselling to address any underlying psychological issues (such as fear or anxiety)
- cognitive behavioural therapy to change any irrational or incorrect beliefs about sex and, if necessary, to educate you about sex
Your treatment plan will be based on your needs. You will be encouraged to take full control of your self-help treatment and go at your own pace. If you have a partner, they can also be involved in your treatment.
A technique to relax the muscles in the vagina involves using a set of vaginal trainers. These are four smooth, penis-shaped cones of gradually increasing size and length, which can be used in the privacy of your own home.
The smallest one is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on.
It is important to go at your own pace and it does not matter how long it takes, whether it is days or months.
When you can tolerate the larger cones without feeling anxious or any pain, you and your partner may want to try having sexual intercourse.
It is important to note that in cases of vaginismus the vaginal cones are not "stretching" a vagina that is "too narrow". Women who experience vaginismus have a perfectly normal-sized vagina. The cones are simply teaching the vagina to accept penetration without automatically contracting the pelvic floor muscles.
Relaxation and touching
If the cone method is not right for you, relaxation and exploration exercises may help.
A bath, massage and breathing exercises are good ways to relax while you get to know your body.
Your therapist may also teach you a technique called progressive relaxation. This involves tensing and relaxing different muscles in your body in a particular order. You can then practise tensing and relaxing your pelvic floor muscles before trying to insert your finger or a cone.
If you reach the stage where you can put your finger inside your vagina, you can try to insert a tampon, using lubricant if needed.
It is important to take things slowly and gently and, when you are ready for intercourse, make sure you are fully aroused before attempting penetration.
Pelvic floor exercises
A physiotherapist may be able to teach you some pelvic floor exercises that will help your vaginismus, such as squeezing and releasing your pelvic floor muscles.
Biofeedback may help with the exercises, as you can monitor how well you are doing the pelvic floor exercises by receiving feedback as you do them. A small probe is inserted into your vagina. This senses when the muscles are squeezed and feeds the information to a computer screen.
If you are in a relationship, you could try sensate focus. This is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman's breasts).
Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. Explore your bodies, knowing that you will not have sex.
After the agreed period of time has passed, you can begin touching each other's genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing them. This can build up to include penetrative sex.
In some cases, surgery may be a treatment option for vaginismus. For example, if a condition is causing you physical pain during sex, and this is contributing to your vaginismus, it may be possible to treat the underlying cause of the pain.
Endometriosis is a possible reason for surgery. The condition causes small pieces of the womb lining to grow outside the womb. Surgery can remove or destroy these areas of tissue.
Enlarging the vagina
Surgery can be carried out to enlarge your vagina. This may be necessary if, for example, previous surgery to this area has meant that scar tissue has formed and is either blocking or restricting your vagina. This can occur if it was necessary for doctors to make a cut in your perineum during childbirth (episiotomy).
A small operation called a Fenton's procedure can be done to remove the scar tissue. The operation involves neatly cutting out the scar tissue and sewing together the clean-cut edges with small stitches. These should dissolve on their own after a few weeks. The operation will be carried out under either local anaesthetic or general anaesthetic.
You may experience some pain after the operation, which you can treat with painkillers such as paracetamol. You may also have some bleeding. Use sanitary towels rather than tampons.