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Vaginismus Content Supplied by NHS Choices
Introduction

Vaginismus is the term used to describe recurrent or persistent involuntary tightening of muscles around the vagina whenever penetration is attempted.

It can disrupt or completely stop your sex life, and can lead to distress, a loss of confidence and relationship problems. It may even prevent you starting a family.

The condition can also make gynaecological and pelvic examinations difficult or impossible.

The symptoms can vary from one woman to the next. Some women are unable to insert anything into their vagina because it closes up completely, while others can insert a tampon but are unable to have penetrative sex, and other women are able to have sex but find it very painful.

Read more about the symptoms of vaginismus.

When to seek medical help

See your GP or visit a sexual health clinic if you think you might have vaginismus. You may feel embarrassed about seeking help, but vaginismus is a common sexual problem that can get better with appropriate support and treatment.

If your GP or doctor suspects vaginismus, they may be able to refer you to a specialist who can treat the problem, such as a doctor with training in sexual medicine, a gynaecologist, or a sex therapist.

Read more about diagnosing vaginismus.

What causes vaginismus

Many factors can play a part in the development of vaginismus, although it's not fully understood why the condition happens.

Factors can include:

  • thinking the vagina is too small
  • negative sexual thoughts (thinking sex will be painful and cause damage)
  • previous sexual abuse
  • damage to the vagina (for example, during childbirth or an episotomy)
  • painful conditions of the vagina and surrounding area, such as vulvodynia (see below)
  • painful first intercourse
  • relationship problems
  • fear of pregnancy

Vulvodynia is the term used to describe the sensation of vulval burning, soreness or pain in the absence of any obvious skin condition or infection. Symptoms may be constant (unprovoked vulvodynia) or only occur with touch, inserting a tampon or penetrative sex (provoked vulvodynia).

Provoked vulvodynia can lead to vaginismus.

Read more about the causes of vaginismus.

How vaginismus is treated

Vaginismus can be treated. How it's treated will depend on the cause.

If there's an obvious physical cause, such as an infection, it can be treated with appropriate medication.

If the cause is psychological, sex therapy may be recommended. This may include counselling, brief dynamic psychoanalysis, or cognitive behavioural therapy (CBT), as well as treatments such as vaginal trainers and relaxation techniques.

Vaginal trainers are smooth, cylindrical dome-tipped shapes, usually made of plastic and in four graduated sizes that allow gentle progression of treatment. They can be used at home to help you get used to having something inserted into your vagina.

Read more about treating vaginismus.

Symptoms of vaginismus

The main symptom of vaginismus is tightening of the vagina, which can make penetration difficult or even impossible.

The severity of the problem can vary from one woman to the next.

Some women are unable to insert anything into their vagina. Others can insert a tampon and are able to have a gynaecological exam, but sex is not possible. Some women with vaginismus are able to have sex, but find it very painful.

Other symptoms of vaginismus can include:

  • a burning or stinging pain when the vagina is penetrated
  • an intense fear of penetration and pain, which makes you avoid sex
  • loss of sexual desire if penetration is attempted

The tightening of the vagina is involuntary and you cannot do anything to stop it. The body has learned to associate penetration with pain and, whenever penetration is expected, the vaginal muscles tighten as a protective reaction.

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

Seeking medical help

You should see your GP or visit a sexual health clinic if you think you may have vaginismus, as it's unlikely to improve without appropriate support and treatment, and it can lead to long-term emotional and relationship problems if not dealt with.

Try not to feel embarrassed about discussing the issue with your doctor. Seeing a doctor about it can be the first step towards overcoming the problem.

Read more about diagnosing vaginismus and treating vaginismus.

Causes of vaginismus

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

Sexual issues

Vaginismus is often associated with past sexual experiences or other sexual issues.

For example, an unpleasant experience at a young age, such as a clumsy, painful sexual encounter or gynaecological examination, can make the body respond in a protective way to prevent further pain.

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:

  • have had a very strict upbringing where it was never discussed
  • have been told that sexual desire is wrong or that sex is painful
  • are affected by cultural or religious taboos around sex

Sexual abuse, assault or rape may also sometimes lead to vaginismus. Read more about getting help after a rape or sexual assault and recognising the signs of domestic violence.

Pain during sex

Experiencing pain during sex (dyspareunia) can contribute to vaginismus.

The following may all cause painful sexual intercourse:

Endometriosis and pelvic inflammatory disease (PID) can also cause pain during sex, although the pain tends to be felt deeper within the pelvis.

Other causes

Other possible causes of vaginismus may include:

  • fear that your vagina is too small for sexual intercourse
  • fear of getting pregnant
  • damage to the vagina and surrounding muscles during childbirth
  • relationship problems
  • tiredness or depression
Diagnosing vaginismus

You should see your GP if you have symptoms of vaginismus.

They may be able to make a diagnosis based on your symptoms, medical history and, if possible, a physical examination.

Your GP may need to ask you 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
  • Are 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

A vaginal examination will be necessary at some point to rule out a physical cause of vaginismus, such as an injury, infection, or oversensitive nerves at the opening of the vagina (provoked vulvodynia).

This doesn't necessarily need to be done during your first appointment and it may be better to wait until you feel ready and comfortable.

You can request a female GP if you prefer, and they should explain exactly what they will do. The examination can be stopped if you experience discomfort at any point.

Referral to a specialist

If your GP is not sure why you find penetration painful or difficult, you may be referred to a doctor who specialises in vulval problems. This may be a gynaecologist (a specialist in treating conditions that affect the female reproductive system), a genitourinary medicine (GUM) clinician, or a dermatologist (a specialist in skin conditions).

If vaginismus is thought to be the cause of the pain, your GP may refer you to a psychosexual doctor, sex therapist, or gynaecologist.

You may also need to be referred for counselling, and you may want to talk to your partner about them being involved as well.

Read more about treating vaginismus.

Treating vaginismus

Treatment for vaginismus will largely depend on what's causing it.

If there is an obvious physical cause, such as an infection or oversensitive nerves at the opening of the vagina (provoked vulvodynia), this may be treated with medication at the same time the vaginismus is treated.

If the cause is less obvious, you may be taught self-help techniques to try to resolve the problem.

Sex therapy

A specialist in psychosexual medicine or sex therapy may offer you sex therapy in the form of counselling, brief dynamic psychoanalysis, or cognitive behavioural therapy (CBT).

These therapies can help to address any underlying psychological issues, such as fear or anxiety, tackle any irrational or incorrect beliefs that you have about sex and, if necessary, be used to educate you about sex.

Sex therapy is available privately. In many parts of the UK, it's no longer available through the NHS.

The specialist can also talk to you about techniques that can eventually stop your vagina closing involuntarily, such as using vaginal trainers and pelvic floor exercises.

Vaginal trainers

Vaginal trainers can be used to help you relax the muscles in your vagina by gradually getting you used to having something inserted into it. These are a set of four smooth, plastic penis-shaped objects in different sizes, which can be used in the privacy of your own home.

The smallest trainer 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's important to go at your own pace, and it doesn't matter how long it takes - whether it's days, weeks, or months.

When you are able to tolerate the larger trainer without any pain or feelings of anxiety, you and your partner may want to try having sex.

Vaginal trainers are not used to "stretch" a vagina that is "too narrow". Women with vaginismus have normal-sized vaginas. The trainers are simply a method of teaching the vagina to accept penetration without automatically closing.

If you prefer, you can try using your fingers instead of vaginal trainers.

Relaxation and touching

You may also find that relaxation and exploration exercises help. Having 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's 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 pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily.

These exercises are usually recommended while using vaginal trainers.

Occasionally, a technique called biofeedback may be recommended. A small probe is inserted into your vagina, which monitors how well you are doing the exercises by giving you feedback as you do them. The probe senses when you squeeze your muscles and sends the information to a monitor.

However, biofeedback isn't always available, and some practitioners don't consider this approach to be useful.

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 do 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). The idea is to explore your bodies, knowing that you will not have sex.

After the agreed period of time, you gradually start touching each other's genital areas, which should eventually build up to penetrative sex.

Surgery

Very few cases of vaginismus require surgery. However, it may be useful if a physical problem is causing pain during sex and is contributing to your vaginismus.

Treating endometriosis

Endometriosis is a possible reason for surgery, as it can cause pain in the pelvis during sex.

Endometriosis causes small pieces of your womb lining to grow outside your womb. Surgery can be used to remove or destroy these areas of tissue. Read more about treating endometriosis.

Enlarging the vagina

Surgery is sometimes used to enlarge the vagina. This may be necessary if, for example, previous surgery has left scar tissue that either restricts or blocks your vagina, such as an episiotomy during childbirth.

A small operation can remove the scar tissue. It involves neatly cutting out the scar tissue and sewing together the clean-cut edges using small, dissolvable stitches. The operation can either be carried out under a local anaesthetic or a general anaesthetic.

 
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