Vaginismus: Treatment, Causes and Symptoms
Vaginismus is a medical condition in which the muscles of the vaginal opening tighten or contract spontaneously, which makes it difficult and extremely painful for the woman to have sexual intercourse. The exact cause of vaginismus is unknown, but it is essentially a psychosexual issue and is not caused due to any structural abnormalities in the vagina. This makes it is possible to be managed with the help of non-surgical methods which include the use of a vaginal dilator and sexual counselling.
Typically, vaginismus does not affect fertility in women but over time, it can reduce a couple’s chances at having children[1] due to general lack of sexual intimacy between couples. Due to this, it is even known to be a risk factor for depression, anxiety and other mental health disorders in women.
At advanced stages, vaginismus can also disturb normal activities such as medical pelvic examinations or the insertion of tampons thereby affecting the overall vaginal health and quality of life of women. If not treated, it can further lead to complications like stenosis wherein the vaginal opening is narrowed and non-surgical treatment methods of treatment are not sufficient. This is why early management of the condition is recommended with the help of vaginal dilators. Vaginismus is completely manageable if you are compliant with the therapy and are patient with your results.
Let’s learn more about the condition and guide you through the possible treatments.
What is vaginismus?
Vaginismus is a psychologically-induced sexual condition caused due to fear or anxiety related to the penetration of the vagina occurring during sexual intercourse. There are no underlying pathological causes or structural abnormalities associated with the condition.
Do I have vaginismus?
If you are experiencing extreme pain during sexual intercourse with your partner or you have excessive fear or anxiety related to sex, which is hampering your sexual life, it is probable that you have vaginismus. Understanding the signs and symptoms of vaginismus and knowing its prevalence will help you in evaluating your condition.
- What are the symptoms of vaginismus?
Pain
Painful penetration is the first and the most common sign of vaginismus, which is experienced differently by all women. In some, the pain subsides upon the withdrawal of the penis while in other women, it may persist much later. The degree of pain experienced due to vaginismus also varies. You could either face mild discomfort during sexual intercourse or the symptoms could be more severe. If you are suffering from extreme vaginal pain, it may also become progressively difficult to undergo medical examinations or perform normal activities like inserting a tampon. It may even be tough to insert a finger without experiencing any pain.
Tightening and spasm
Tightening or feeling of ‘closing’ of the vaginal wall or feeling that the penis will not be able to go inside the vagina is another common sign of vaginismus. Spasm and contraction of the muscles in the vagina is observed in response to penetration attempts by the partner, which hinders sexual activity.
Fear and anxiety related to sexual intercourse
Fear and anxiety are common among women suffering from vaginismus as they find it difficult to share their issues with their sexual partners.
- Who can have vaginismus?
Absolutely anyone can suffer from vaginismus. It is a common condition and is not linked with any particular demographic group, individual medical or family history or even any specific age group.
Vaginismus is generally more common in younger women from late teenage years to early 20s. In this age group, women mostly suffer from primary vaginismus and it is almost impossible to introduce anything to the vagina. No specific cause of primary vaginismus is known.
Vaginismus affects all age groups including women in the reproductive age group and even post-menopausal women. If sexual intercourse suddenly got painful for you even when you have had it before or after you had your kids, you must know that it is completely possible to develop vaginismus later in your life. This is termed as secondary vaginismus, which is often associated with a specific cause[2]. This cause could be a traumatic event that violates your genitalia, increased stress and anxiety or menopause. Due to a plethora of hormonal changes occurring around menopause, the lining of your vagina gets thinner and less lubricated increasing pain and friction during sex. Hence, a lot of women suffer from painful intercourse following menopause.
- Is vaginismus common?
According to recent statistics, approximately 20% of all women worldwide suffer from vaginismus as reported in sexual dysfunction clinics. In some regions, a prevalence rate as high as 50% has also been reported. Although, we can expect the numbers to be only higher due to the fear and stigma associated with conversations around sexual issues[3]. While vaginismus is a common condition, a lot of women go undiagnosed and untreated, which hampers their relationship satisfaction, sexual function, long-term fertility, mental health, wellness and overall quality of life. Being a common condition that has a simple, at-home treatment, it is expected that the knowledge of vaginismus will help avoid this fate.
Causes of vaginismus
A history of sexual abuse, trauma or generalised anxiety due to penetration are common risk factors associated with vaginismus; however, there is no particular cause of the condition. Relationship conflicts, shame and stigma around sex and conservative religious thoughts are also some factors that can cause a woman to feel more anxious about sex leading to vaginal tightening during penetration, or vaginismus. While treatment with vaginal dilator helps all cases of vaginismus, evaluating individual history and risk factories can immensely help in better management of the condition through counselling.
Management and treatment of vaginismus
Vaginal dilators
Vaginal dilators form the mainstay of treatment for vaginismus. It is the safest and the most effective treatment for the condition, which can be comfortably done at your home. You do not even require any guidance or assistance from a medical professional or partner. Yes, it is that easy. All it demands is that you be patient.
- Do vaginal dilators work?
Being a clinically approved treatment, there are several clinical studies and trials that have time and again proven the efficiency of dilator therapy for vaginismus. These studies have established that the regular use of a dilator offers much higher improvement in sexual function by gradually training your vaginal muscles to accept penetration. They work exceedingly well when compared to informal therapies such as training with fingers[4]. Also, you are also more likely to stick with the treatment if you opt for a dilator as they help in establishing a great routine and they come in set of varying lengths and thicknesses allowing you to gradually train your vagina.
There are several types of dilators including plastic, silicone, glass or metal, which you can choose depending upon your needs and preference. Plastic and silicone dilators are the most commonly used ones and offer the best interpersonal experience making the therapy feel comfortable and natural. These days, vibrating dilators are also available to closely imitate coital activity. They further help in making the treatment more pleasurable and reducing anxieties around sex. But, it is the best to start with the traditional therapy ensuring that you purchase a good quality medical dilator.
You must start with the smallest length and thickness of dilator from your dilator set while gradually training your vagina for the bigger sizes as the previous one feels absolutely comfortable.
It is recommended to use a dilator in conjunction with a water-based lubricant for the ease of insertion and avoidance of any wear or tear in the process. Oil-based lubricants must be avoided since they pose a risk of infection.
Counselling, therapy and education
Being a psychosexual disorder, counselling and therapy also form an important component in the treatment of vaginismus in conjunction to dilator therapy, especially if desired results are not achieved despite regular training. If you are hesitant about talking to a therapist, you can simply reflect on your sexual to understand what causes your symptoms to get worse and can gradually work on those causes. If you have a history of sexual trauma or abuse, it is recommended that you see a therapist, which will immensely help in dealing with your vaginismus. You can also join online support groups, which will help you in understanding your condition as well as in reducing stigma around sexual conversations. It is crucial to properly educate yourself on the condition, understand your symptoms and have an open dialogue with your partner so that you have the necessary support and motivation for continuing with your dilator treatment and enhancing.
In individuals with a prolonged history of vaginismus who have not had sexual intercourse for several years, treatment regimens such as cognitive behavioural therapy and relationship therapy may also be recommended alongside dilator therapy, if it alone does not help manage the condition.
Bottom line
Despite being painful, vaginismus is not attributed to any underlying structural pathologies and can be easily managed at home with the help of dilator therapy provided you are patient with the treatment. Any woman can develop vaginismus at any point regardless of her sexual history and dilators help in all cases. If you are anxious about the use of a dilator, setting yourself a particular time for the treatment and indulging in a relaxing routine such as meditation or listening to music can really help. You can also seek the help of your partner for additional support and comfort.
Although you may start feeling lesser discomfort within a few weeks of the use of a dilator, complete management of vaginismus can take longer in certain women. If it is taking more than a few months to a year and the pain is too severe, it is recommended to talk to your gynecologist for ruling out any other gynecological conditions.
[1] Melnik T, Hawton K, McGuire H. Interventions for vaginismus. Cochrane Database Syst Rev. 2012 Dec 12;12(12):CD001760. doi: 10.1002/14651858.CD001760.pub2. PMID: 23235583; PMCID: PMC7072531
[2] Achour R, Koch M, Zgueb Y, Ouali U, Ben Hmid R. Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychol Res Behav Manag. 2019 Mar 12;12:137-143. doi: 10.2147/PRBM.S186950. PMID: 30881157; PMCID: PMC6419599
[3] Anğın AD, Gün İ, Sakin Ö, Çıkman MS, Eserdağ S, Anğın P. Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assist Reprod. 2020 May 1;24(2):180-188. doi: 10.5935/1518-0557.20200018. PMID: 32301599; PMCID: PMC7169926
[4] PMID: 32052704 DOI: 10.1080/0092623X.2020.1716907