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Vaginismus

 

Vaginismus is when the muscles around your vagina tighten involuntarily whenever there is an attempt to penetrate it with something. This could be your partner's penis, your finger or a tampon.

Vaginismus makes sexual intercourse difficult or impossible (the vagina can completely close up) and it can be painful. The symptoms can vary from one women to the next. Read more about the symptoms of vaginismus.

Because it disrupts or completely stops your sex life, vaginismus can cause distress and relationship problems and may prevent you from starting a family. It can also make gynaecological and pelvic examinations difficult or impossible. In some cases, a woman may need an anaesthetic before a doctor can examine her.

How is vaginismus treated?

Vaginismus is very treatable. If the cause is psychological, it may be treated using sex therapy, where you are helped to gradually overcome it using vaginal trainers and relaxation techniques. You will be given counselling or cognitive behavioural therapy (CBT) if necessary. Read more about treating vaginismus.

Why does vaginismus happen?

Many factors can cause vaginismus, but it is not always fully understood why the condition happens.

For some women, it may be caused by a traumatic past experience, such as a difficult childbirth or sexual abuse. They may associate sexual activity with pain and learn to avoid intercourse as a way of avoiding further pain. Read more about the causes of vaginismus.

There are two types of vaginismus:

  • Primary vaginismus is when you have never been able to have sex because of the condition.
  • Secondary vaginismus is when you have previously been able to have sex but now find it difficult or impossible. 

How common is vaginismus?

The condition is fairly common, especially in teenage girls and women in their twenties and thirties. It is likely that many women will experience it at some point, even if they have had a history of enjoyable and painless sex.

Symptoms of vaginismus include the following:

  • difficult or impossible penetration of the vagina, because the muscles in the vagina have tightened
  • burning or stinging pain and tightness of the vagina if penetrated by a tampon, finger or penis
  • fear of pain
  • intense fear of penetration and avoidance of sex
  • loss of sexual desire if penetration is attempted

Symptoms of vaginismus vary in severity:

  • Some women are unable to insert anything into their vagina. 
  • Some women can insert a tampon and 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.

Involuntary symptoms

These symptoms are completely involuntary and you cannot do anything to stop them. The body has learned to associate penetration with pain. Whenever the body expects penetration, the vaginal muscles tighten as a protective reaction.

It is not true that women who have vaginismus do not like or do not want to have sex. Many women with vaginismus enjoy closeness and share sexual pleasure with their partner. They can achieve orgasm during mutual masturbation, foreplay and oral sex. It is only when sexual intercourse is suggested or attempted that the vagina tightens to prevent penetration.

There are many reasons why the vaginal muscles can contract against a woman's will. But it isn't always clear each time why this might happen.

Sexual issues

There are various different sexual experiences or issues to do with sex which may contribute to vaginismus.

An unpleasant sexual experience at a young age, such as a clumsy, painful sexual encounter or examination, can make the body respond in a protective way to stop further pain.

Sexual abuse, assault or rape could also cause vaginismus. For information about help for victims of sexual abuse, assault or rape go to www.womensaid.ie or www.rcni.ie.

Having difficulty understanding sex, or having feelings of shame or guilt around sex, could also contribute to vaginismus. For example, you might feel uncomfortable with sex 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. 

Other causes

Other possible causes include:

  • fear that the vagina is too small for sexual intercourse
  • fear of getting pregnant 
  • the after-effects of childbirth
  • relationship problems
  • tiredness or depression

Causes of pain during sex

Anything that causes pain during sexual intercourse (known as dyspareunia) may lead to a woman developing a fear of painful sex. Research suggests that the fear of painful sex may be an important contributing factor to vaginismus.

The following may all cause painful sexual intercourse:  

  • previous surgery to the genital area
  • an infection of the genital area, such as trichomoniasis (a sexually transmitted infection caused by a parasite)
  • radiotherapy to the pelvic area
  • vaginal dryness, which can occur after the menopause 
  • lack of sexual arousal 
  • side effects of some medicines

Endometriosis and pelvic inflammatory disease are both conditions that can cause pain deeper within the pelvis, including pain during sexual intercourse.

What is the role of the vaginal muscles?

The pelvic floor muscles are involved in vaginismus. These muscles normally enable a woman to:

  • go to the toilet
  • have sexual intercourse
  • have an orgasm
  • give birth

Although these muscles should not tighten against a women's will when she has sex, it is important that they tighten on other occasions, for example when you need to hold on before going to the toilet. Therefore, the pelvic floor muscles are never fully relaxed.

If you have symptoms of vaginismus, see your GP.

Your GP will talk to you about the problem and base a diagnosis of vaginismus on your medical history, your symptoms and a physical examination, if possible. Your GP may need to ask some personal questions to find out more about your condition.

These might include: 

  • Can you tolerate anything penetrating your vagina, such as your finger or a tampon, and is this painful?
  • Qre you worried at the thought of anything penetrating your vagina?
  • Have you ever had a traumatic sexual experience?
  • Are you in a relationship and are you sexually active with your partner?

An examination of your genital area is necessary to rule out a physical cause of vaginismus, such as injury or infection. You can request a female GP if you prefer and they should explain to you exactly what they will do.

Referral

If the cause is psychological, your GP may refer you to another health professional, such as a sex therapist or gynaecologist. A gynaecologist is a specialist in treating conditions of the female reproductive system.

You may also need to be referred for some counselling, and you could suggest it to your partner too.

Read more about treating vaginismus.

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.

Sex therapy

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.

Vaginal trainers

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.

Sensate focus

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.

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Surgery

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

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.


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.