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What is vaginismus?

Vaginismus is a condition where the muscles in the vagina spasm and tighten involuntarily in response to sexual penetration, gynaecological examination or insertion of a tampon. The tightening or even closing of the vagina is completely unconscious, like the reflex of the eye shutting when something comes close to it. For many women and their partners this can cause a great degree of stress and anxiety because sexual intercourse and gynaecological examinations become painful or impossible, which in turn can worsen the condition.

What are the symptoms?

The symptoms of vaginismus are the inability to have intercourse or vaginal penetration without pain. The condition is usually identified during adolescence and early adulthood with the onset of menstruation and sexual activity.

What causes vaginismus?

The causes of vaginismus is not a small vagina, women with this condition have the same size vagina, but the internal muscles are prone to involuntarily contracting. The underlying causes can include one or more of the following factors:

• Worrying that the vagina is too small
• Worrying that sex will be painful or cause damage
• History of sexual abuse
• Previous damage to the vagina, e.g. an episiotomy
• Painful conditions of the vagina or surrounding areas
• Painful/uncomfortable first experience of intercourse
• Relationship problems
• Fear of getting pregnant

What is the treatment?

Treatment of vaginismus depends on the underlying cause. It can include:

• Vaginal trainers: a series of cylindrical cones in differing sizes that are used in the comfort of one’s own home to progressively get used to inserting something into the vagina. It can take days or months, and the patient must go at her own pace.
• Pelvic floor exercise: these are recommended with the above treatment, so the patient gets used to the feeling of contracting and relaxing the muscles, with the aim to be able to voluntarily choose to relax while having intercourse for example. Sometimes a biofeedback machine can be used with a gynaecologist. This device allows the patient to be told when she is contracting (in the case that she cannot tell) and get used to the feeling so as to be able to master controlling it.
• Sex therapy: psychological therapy is a recommended option especially if the underlying cause has been sexual trauma. Dynamic analysis, counselling or CBT may be employed.
• Surgery: in some cases, where there may have been previous surgical trauma, or an obstruction which narrows the vagina, surgery may be necessary. The patient will undergo an anaesthetic and a small amount of tissue is removed.