Vaginismus

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What is vaginismus?

Vaginismus is a condition in which the vagina involuntarily tenses up. This could happen at the start of sexual intercourse or during a pelvic exam, or while inserting a suppository, tampon, diaphragm, or any other type of uterine device.

Experts estimate vaginismus affects up to 1% of the female population. However, statistics are not exact, as the condition may cause embarrassment that prevents women from discussing it with their doctors. Others may assume it is a normal condition, which it is not.

Most women with vaginismus develop the condition in their teens or early adulthood, and may notice symptoms the first time they have sex or use a tampon. However, it is possible to develop vaginismus later in life, after many years of not having any problems.

Vaginismus can make sexual intercourse painful, uncomfortable or even impossible to tolerate. Visits for routine gynecological exams can become stressful, and even using tampons can be an issue. Treatments for vaginismus are available that can help decrease the frequency and discomfort, depending on the cause.

Vaginismus alone is rarely a serious medical condition. However, it may be associated with symptoms of a serious or life-threatening condition. Seek immediate medical care (call 911) if you have severe vaginal pain along with a high fever (higher than 101°F), severe pain, chills, or rapid heart rate (tachycardia).

If your vaginismus is persistent or causes you concern, seek prompt medical care.

What are the symptoms of vaginismus?

Symptoms of vaginismus may be occasional or persistent. Vaginismus symptoms include:

  • Difficulty with vaginal penetration during sex

  • Discomfort or pain when inserting tampons

  • Pain with penetration or during a pelvic exam

These symptoms can cause anxiety in women regarding sexual intercourse or visits to their ob/gyn. This level of discomfort and pain is not normal and should be discussed with a physician to determine available treatment options.

What causes vaginismus?

The cause of vaginismus varies from person to person. The condition may have a physical or psychological cause. Sometimes, doctors can not determine a specific cause.

Common causes of vaginismus include:

  • Injuries that occurred while giving birth

  • Mental health issues, such as anxiety

  • Pain related to urinary tract infections or yeast infections

  • Sexual trauma or assault

  • Surgical procedures

    What are the risk factors for vaginismus?

    A number of factors can increase the risk of developing vaginismus. Not all people with risk factors will have vaginismus.

    Risk factors for vaginismus include:

    • First time having a pelvic exam

    • First time having sexual intercourse

    • Being a victim of sexual assault or trauma

    • Receiving an injury during childbirth, such as a vaginal tear

    • Anxiety or other mental health issues, such as post-traumatic stress disorder (PTSD)

    You may be able to lower your risk of vaginismus by speaking with a therapist if you have been assaulted or are experiencing mental health issues that could be affecting your ability to enjoy sex.

    How do doctors diagnose vaginismus?

    In order for your doctor to diagnose vaginismus, it is important to be open and honest about your symptoms. A diagnosis is made based on a person’s medical and sexual history, and a pelvic exam. As difficult as it may be, it is important to notify your doctor if you have experienced sexual assault or trauma, particularly if you are due to have a pelvic examination.

    It may seem intrusive to have a pelvic exam to diagnose vaginismus, but it is necessary in order to rule out any other medical problem. If your doctor is aware of the possibility that you do have vaginismus, he or she can take steps to help make the exam more comfortable.

    How is vaginismus treated?

    Treatment for vaginismus depends on the cause, which can be physical, emotional, or a combination of the two.

    Possible vaginismus treatments include:

    • Topical medications. Medicated creams or ointments, such as lidocaine, can help relieve pain.

    • Vaginal dilation. Under the direction of a physical therapist, sex therapist, or other health provider, vaginal dilation involves inserting a plastic dilator into the vagina to reduce sensitivity to vaginal penetration. This can be done with a sex partner to improve comfort with penetration and potentially may allow sexual intercourse to be possible.

    • Kegel exercises. A physical therapist can provide guidance on exercises to tighten and relax the muscles in the pelvic floor.

    • Sex therapy. Either alone or with your partner, seeing a sex therapist can help you find ways to enjoy vaginal sex or explore other ways to be intimate.

    • Cognitive behavioral therapy (CBT). This process helps connect the way you think to your actions and emotions. CBT can be an effective treatment for anxiety, depression and other mental health issues, and it may help with treatment of vaginismus.

    • Talk therapy. Going through therapy with a counselor can help you deal with psychological issues that might have triggered vaginismus.

    What are complications of vaginismus?

    While vaginismus is not a serious medical condition, the symptoms can cause significant disruption to quality of life. Loss of intimacy can affect relationships with a partner or spouse, resulting in depression, anxiety, or loss of self-esteem.

    For women who wish to become pregnant, vaginismus may make conception impossible due to the inability to tolerate vaginal penetration.

    An annual pelvic exam is an essential part of a woman’s healthcare. Avoiding annual exams due to anxiety about vaginismus pain can result in lack of preventive screening for conditions such as HPV, or even delayed diagnoses of serious conditions such as ovarian or breast cancer.

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2021 Jun 2
    THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
    1. Vaginismus. MedlinePlus, National Library of Medicine, National Institutes of Health. https://medlineplus.gov/ency/article/001487.htm
    2. Vaginismus. Merck Manual. https://www.merckmanuals.com/home/women-s-health-issues/sexual-dysfunction-in-women/vaginismus
    3. Vaginismus. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15723-vaginismus
    4. Achour, R; Koch, M; Zgueb, Y; et al. Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychol Res Behav Manag. 2019; 12: 137-143. doi: 10.2147/PRBM.S186950 Accessed via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419599/
    5. What Are the Risks of A Vaginismus? Nova IVF Fertility. https://www.novaivffertility.com/fertility-help/vaginismus-risks/