If you experience severe pain during vaginal penetration or if you just can’t seem to get anything in there, then you might have vaginismus. This condition causes involuntary muscle contractions in the vagina before or during penetration, making penetration difficult or even impossible. These contractions can get in the way of certain practices and pleasurable activities, like penetrative sex, penetrative masturbation, inserting tampons on menstrual cups and receiving pelvic exams. But with the right guidance from a doctor and/ or a physical therapist, vaginismus can be treated.
What Causes Vaginismus?
Experts speculate that a variety of factors can lead to vaginismus, but like most conditions that affect vaginas, the precise cause of vaginismus is grossly under-researched. People with primary vaginismus have never been able to experience vaginal penetration, while people with secondary vaginismus developed symptoms later in life. Sometimes vaginismus occurs in response to a physically and/ or emotionally traumatic event, like sexual assault, childbirth or a surgical procedure, but sometimes the symptoms can pop up without a known cause. It’s estimated that up to 17% of vagina-owners experience vaginismus, but given that the stigma associated with the condition (and with vaginal health in general), some experts believe that the actual numbers are much higher.
What we know for sure is that once a person has vaginismus, the muscle contractions can feel impossible to control. Dr. Anna Yam, PhD, a clinical psychologist who specializes in pelvic pain, told Bustle that the muscle contractions associated with vaginismus are similar to an eye blink. Think about it like this — if an object is moving towards your eye, you instinctively blink to protect yourself. The same thing happens with vaginismus. If you’ve experienced painful penetration, your body perceives any penetration as a threat, so your muscles involuntarily contract to prevent the pain from happening again. As Dr. Yam explains, “Biological muscle contraction is reinforced by the psychological fear, and vice-versa.” Without treatment, this cycle can cause people to suffer from vaginismus for years or even for a lifetime.
How Is Vaginismus Diagnosed?
Gynecologists can diagnose vaginismus after listening to a patient’s symptoms and performing a pelvic exam. Unfortunately, not all doctors understand this condition, and some people struggle to get an accurate diagnosis. Some people with vaginismus have been told to “use more lube” or “just have a glass of wine and relax” when they tell their doctors about their pain. If you experience pelvic pain and your doctor doesn’t take your symptoms seriously, find another practitioner who can give you the kindness and care you deserve.
Why Treat Vaginismus?
Much of the writing about vaginismus is 1.) Directed at straight, cisgender women and 2.) Steeped in the false narrative that “sex” equals penetration. Unless you’re trying to get pregnant, penetration isn’t a necessary part of a healthy, fulfilling sex life. But if you think you might have vaginismus and you’re curious about the pleasures of penetration, then that’s a totally valid reason to seek medical help.
Even if you’re not trying to get pregnant and don’t want to add penetration into your sexual repertoire, there are other reasons to get some answers about your pelvic pain. While vaginismus isn’t directly life-threatening, some other conditions that cause pelvic pain are, so it’s important to get your vaginal health assessed by an informed, attentive medical professional. Additionally, some of the problems associated with vaginismus — like not being able to receive regular pelvic exams — make it hard or impossible to track other aspects of your reproductive health. Sometimes gynecologists can find ways to perform pelvic exams that are more comfortable for people with vaginismus, but if your muscle contractions make penetration impossible, treating vaginismus can help you tolerate pelvic exams and stay full informed about your well-being. If your doctors can find safe and effective ways to perform pelvic exams if and when you need them and if you don’t have any other reason to include vaginal penetration in your life, then you don’t have to treat vaginismus unless you want to.
How Is Vaginismus Treated?
If you’re experiencing vaginismus in response to a traumatic event, therapy is probably an important tool for your healing journey, but it isn’t going to stop those involuntary muscle contractions. For that, you’ll need to retrain your pelvic floor. The most common course of treatment for vaginismus is the use of dilators, or a series of dildos that range in size. Most doctors have their patients begin with inserting a very slim dilator while lying comfortably on their back at home. The dilator should be left in for whatever amount of time has been designated by your doctor (usually around twenty minutes) before it is removed. Patients are asked to repeat this practice daily, moving up a size when they’re ready.
The regular use of dilators creates new muscle memories, helping your body understand that penetration is not a threat. After regular dilator use, people with vaginismus can have better control over their pelvic floor muscles, preventing the involuntary contractions that prevent or complicate penetration.
In some cases, you might need to see a pelvic floor physical therapist in order to make a full recovery. A pelvic floor physical therapist can use exercises and internal massage to relax and retrain your muscles. The idea of a stranger massaging the inside of your vagina might sound a little strange, but pelvic floor physical therapy is extremely effective. In addition to treating vaginismus, pelvic floor PT can help all kinds of pelvic floor conditions, including pelvic floor weakness, constipation, vulvodynia and endometriosis. Additionally, physical therapists typically spend more time getting to know their patients than doctors, so a PT might be able to better understand your history and provide more individually-tailored care.
How Do You Psychologically Heal From Vaginismus?
If you’re experiencing vaginismus, you’re not broken. Vaginismus is your body’s way of protecting you from pain — your muscles are just overdoing it. But even if you have all of the facts, vaginismus can be hard on your mental health and your relationships. In addition to the physical pain, people with vaginismus often experience anxiety, shame and isolation. Once you associate certain sexual activities with pain, it’s hard to experience sexual pleasure with a partner or by yourself. Some people with vaginismus find themselves avoiding sex entirely and worry that they’re disappointing their partners, even after they’ve recovered from the disorder. If you are living with pelvic pain and you’re struggling with any of these feelings, talk about it with a therapist, your partner(s) and other people you trust. Physically and mentally healing from vaginismus is possible if you’re willing to open up and get the support you need. And once you start talking openly about your experiences, you might find that some of your loved ones are dealing with similar symptoms. Vaginismus and other pelvic pain disorders are more common than most of us realize — they’re just not openly discussed.
I really wish you hadn’t so strongly stated that treating vaginismus is necessary for your health. I’ve had plenty of talks with doctors about my health, related to vaginismus, and for my own well-being I’ve chosen not to treat it. Those Drs have taken this condition into account when scheduling and performing pelvic exams, they put me on a schedule that works for my body and work with me in a way that takes into account my vaginismus. I’m in my mid-40s and after quite a few unsuccessful attempts to treat early in my life (as I was told it was necessary) that has been taken completely off the table and now my health includes this condition and works with this condition. It is no longer something I have to work through in order to have a healthy life, it is just a part of my health and my life.
It is up to you whether you want to do the treatments for this, for some, the work and trauma of treating it is worth it, for others coming to an acceptance that your body is just this way, and lovers and health professionals can work with your unique body is what will need to happen. Each person should work with their healthcare provider and then do what is best for them. You can still live a healthy life even if you choose not to treat it.
Thank you so much for your comment! I’m thrilled to hear that you have doctors who take your condition into account and that you’ve found safe and effective ways to have pelvic exams.
You are absolutely right that treating vaginismus is not necessary for health, and that’s not at all what I was trying to get across in this article. I intended to convey that treating vaginismus might be necessary for people who A) can’t tolerate any penetration at all under any circumstances and B) are interested in receiving regular pelvic exams as part of their healthcare.
I updated some of the language in the article so that this is more clear for future readers. Thank you again for sharing your experience!
after reading this, i also definitely have vaginismus! i haven’t been interested in treating it (and don’t have necessarily queer-competent OBGYN providers/haven’t brought this up to them, aside from commenting that procedures were very painful and i can’t use tampons)and i was still able to get a trans-vaginal ultrasound (for a possible PCOS diagnosis) and regular pap smears.
i think it’s important to talk about this in queer spaces because it can be very alienating and be seen as something only cis/straight women need to treat (yes, this also ignores bi+/trans people and their partners entirely!). but if anyone else is considering treatment purely for health reasons, i agree that it’s 100% possible to have severe primary vaginismus and still undergo recommended vaginal health screenings. it may be excruciatingly painful, but it’s also not regular dilation so i think the trade-off can be worth it!
Yep! For exams I have some techniques to help and usually something I can squeeze and a doctor who apologizes for the trauma (her words) that she is inflicting on my body. She also schedules them less frequently for me as long as other health indicators are okay.
I’m the commenter above, it took me over 25 years to find someone to work with me. For so long I thought I had to be fixed. But finding that dr (and online resources that helped me realize that many people never get treated which taught me how to speak up for myself) let me realize that I don’t have to be fixed and it’s up to the dr to work with who I am. I suggest talking with any new dr about this early (like even phone call early) and asking them their experience and how they would work with your body, being sure that they know you are not interested in dilator treatment.
I completely agree with you that the temporary trauma and searing pain is a worthwhile trade-off to the dilation process for me which was painful and frustrating as hell.
I suffered through 4 dilators and was still super anxious about penetration with fingers during sex and then just got really upset when I couldn’t do it because I had been working so hard! Which kind of killed the mood! My sex life improved enormously when I stopped using them and seeing it as something that had to be fixed.
I’ve been super lucky with doctors – I live in a big city, and have had to bounce around because of insurance issues so I’ve been to a lot of them. They’ve all had a speculum designed for children that they’ll use on me. I’m small so I don’t know if that’s an option for everyone, but it’s worth asking!
This doesn’t add anything that I hadn’t read on numerous straight-centric sites (beyond acknowledging the fact that queer people exist I guess). I expect more from Autostraddle!
I didn’t see the article before it was edited, but I’m another one who can get through a pelvic exam and has opted not to treat it. One of the perks is being queer is that I’ve always had partners who know that there’s lots of different ways besides penetration to have sex.
If we want to encourage queer people to share their experiences and be more open about it, why not have queer people … share their experiences? It’s clear from the comment section already that there’s a lot of difference experiences out there. I would much prefer to read other queer people’s experiences and how we’re navigating this than a super clinical article I can read anywhere.
yep, and also I’m generally confused as to why penetration in this article refers to a penis. What about dildos, sex toys, strapons? Even fingers. Those can all be really uncomfortable with vaginismus.
my comment was mostly responding to this, I guess. I know that masturbation, menstrual products are mentioned..
“Unless you’re trying to get pregnant, penetration isn’t a necessary part of a healthy, fulfilling sex life. ”
Agreed about the need for penetration if that is what makes a healthy sex life for the individual. Having that from a queer perspective would be great as our needs (as you said, fingers even) are different then the stories you read on the forums.
And I’ll add on the other side that I know people who have vaginismus who have gotten pregnant without penetration as penetration is not something that is going to happen in their life.
Also agree about the article needing an overall more focused queer perspective. I submitted one to this website when ‘sex education’ did its queer vaginismus storyline (which was both good and really annoyingly bad) which was more personal and less clinical and I hope that they do put out a call for some of the people in the community to maybe help create something. It seems there’s a lot of stories here and as we are a small-ish community it’s been cool reading y’all’s in the comments.
And at least two people going by S which is fun?
Little s – I didn’t process that before. I feel like a lot of readers here aren’t planning to get pregnant via penis..? Another example of how this article is frustratingly generic.
Big S – I wish they had published your piece instead! I’m much more curious about how we manage our sex lives and day-to-day than being told I should talk to a doctor about a medical condition.
I was relieved to get to the comments and find others who were equally disappointed with this article. I can see that there’s an attempt at using inclusive language but like, somehow that makes the tone of this even more insulting?
Even the word vaginismus is super triggering to me, given its origins. I get that’s the clinical term but do we have to use such a cisheteropatrical label? Not everyone is comfortable using words like vagina to name our parts and I thought AS would be more sensitive to that. Let’s always be working to decolonize and deconstruct.
Thank you <3 I have a question: my problems with penetration are so terrible that I can't even insert a finger. Pelvic exams are absolutely impossible. My gynecologist refered me to a clinic to get checked bc she didn't want to cause me pain, the thing is this clinic already requires a pelvic exam having been done to even consider me for assessment to see what my issues are. How can I get a pelvic exam to be treated for an issue that causes me to be unable to get pelvic exams? What can I even do? This has become even more urgent for me since penetrative sex was never something that I aspired to be able to have but now it is. Add to that the problem that the doctor considers me a "virgin " bc of my lack of experience with penetration and doesn't think I need pelvic exams and even thinks they're dangerous for me. As a disabled queer person the structural violence I experience from gynecologists is incredible. Mostly, they think I don't have sex. When I tell them I do, they think I exclusively date cis men. I have a theory that vaginismus is more prevalent in people with CP like me but obviously can't find anything about this. Any other people with CP here can support my claim?
A competent gynecologist should at least be able to determine whether you have an partially or completely imperforate hymen that could be surgically opened. As a pediatrician (retired) I had to refer a couple of young patients to the gynecologist when they had fully developed secondary sex characteristics and were not having periods. I assume since you have not mentioned you were not having periods that you might have a partially imperforate hymen. This would obviously be easier to treat than vaginismus, with a simple procedure.
In rare cases pelvic exam patient can be done under sedation or anesthesia, in order to determine things like the axis and length of the cervix, or the size position and mobility the uterus.
One more perspective in case it can be helpful—I assumed I had vaginismus for years, because pelvic exams were so painful and I wasn’t able to use tampons. But in the end the issue was that my hymen was almost completely intact (though not entirely- I still got my period) and also very thick and rigid. I ended up having a surgical procedure called a hymenectomy to remove most of the hymen, and once I had healed from that, I was able to undergo pelvic exams, use tampons, and have penetrative sex. (Of course, a person could have a largely intact hymen AND vaginismus and might want to pair surgery with other treatment.) A more queer competent (or just competent) OBGYN might have diagnosed earlier, but could be worth raising with your doc if you have painful pelvic exams.
I have no idea how common this is—anecdotally, I seem to know a lot more people who have vaginismus. But wanted to let others with pelvic pain know about the range of things that might be going on!
I’ve never seen an article about vaginismus from a queer point of view, so thank you. However, the idea of using dilators makes me want to throw up. :D So creepy and medicalized. I wish there were more study on alternative ways to treat it.
I’ve had vaginismus since my teenage years. I’ve never heard of another treatment besides the Physical Therapy Ro mentioned.
You’re not alone in loathing the dialator idea. It seems too “straight sex” oriented to me.
Thank you for this article,
I have struggled with this condition for years and it has been my own liberation from trauma to recover. I have been to a physical therapist and it changed my life. In my experience, both physical and emotional dynamics are at play here and I wouldn’t feel fully integrated in my own self if it hadn’t been undergoing treatment.
What I would say however, is that this is a highly personal journey. Memories and ways of being will arise, and for me at this point I felt ready to embark, and as though this was what I needed to feel liberated. I can understand if it’s not part of your current experience, but what a powerful tool for release for folx who are seeking a next step for healing.
Please keep writing- we deserve liberation in whatever form that takes-
I SUPER appreciate autostraddle posting about health stuff (physical, mental, emotional) – it’s been so helpful. Ro I appreciate a lot of your past advice/how-tos/info about – organizing life around one’s menstrual cycle, and filet of fish are recent ones! Those two came thru as really grounded in your personal experience – they came across as “this is something i found helpful, sharing in case it’s helpful for you.” i know the menstrual cycle one ended with questions inviting different experiences, and I’d like to see more of that. I hope future articles will be more like that one – really gender & preference inclusive language, etc, and a lot of openness to a variety of experiences. This one was hard for me to read because it came across as overly prescriptive & had less of the enthusiasm for a variety of experiences I enjoy in AS writing. For my own data point, i probably ‘have’ vaginismus. I’ve had a couple of typically awful gyno experiences in the past. I’m not doing anything to ‘treat’ it. My latest gyno visit was with someone who was like ‘safety and function – are you safe? are you able to do what you want? if yes to both, you’re all set.” she may disagree with me about the “safety” in my approach of declining pap smears. my personal risk for HPV is not zero, but very, very, very low, so I may get one or two more pap smears in my life, but definitely not every 1 yr or even every 3. my choice about this is somewhat informed by past discussions (i think here?) about insurance policies artificially incentivizing the official AMA recs for pap smears . . . anyway, cheers to more info & open ended, non prescriptive convos here.
I just wanted to say how much I appreciated this article. I was at the doctor getting a pelvic exam a few months ago, crying a bit out of embarrassment and fear and pain, and she asked me if it was always this painful. She was the first doctor ever to ask me. I cried more out of gratitude for the question!! She told me she wanted me to look into pelvic floor therapy- this article is reminding me that I can do it now that I’m vaccinated. Thank you for writing about it. No, I don’t need to be penetrated to live my life, but jeez if I can do something so that it’s an option or so that I can feel ok in the doctors office, then I’m going to do it. I’ve also wondered how this could be contributing to or stem from other areas of my health- so it is probably good for me to look into. I really appreciate this article. I’ve spent my whole adult life feeling afraid of penetration and ashamed of there something being wrong with me, so it really means a lot.
I cannot thank you enough for this article. Coming out in the late 1980s was, based on the comments I’m reading,
clearly much different from now. Back then, and through the 1990s, there was such a stigma (at least in the NYC lesbian community) for lesbians who didn’t like penetration. That created a feeling of isolation and embarrassment for sure. And my doctors –three different ones, were 1) rude and impatient, 2) told me I needed rougher sex (!?), 3) just didn’t listen.
There was also, thanks to the horrible L-Word wanna be show called X’s & O’s, a stigma about women who “squirt”, which I do. And I never know when it’s going to happen.
With me being told by friends in NYC and in the media that my two “issues” were 1) ridiculous, and 2) gross, it’s a wonder I ever found a girlfriend who accepted me for who I am.
Thank you for this wonderful article, Ro. I’m so thankful you’re teaching women to honor their bodies, no matter what. I didn’t find at all that your article suggested everyone must get medical help for vaginismus: you stated where and how to get it should someone decide to.
I’m no longer in NYC (we had a wonderful community there); but I’m glad to hear that within the gay community (ha! That’s what the entire community was called when I was growing up and then came out. Then Lesbian and Gay Community, as a thanks to the lesbians who helped take care of and love our gay male friends who were HIV positive or dying of AIDS. Im so glad the community is so all inclusive now)… I’m glad to hear that within the LGBTQI+ community there are less stigmas.
And Ro, I heard you on a podcast recently; the liquid that comes out when women ejaculate/squirt is considered “rasa” (nectar of the Gods) in many Hindu cultures.
If I find an article on here regarding that issue I will share more. It is important to “urinate” after sex to empty all of that fluid from the bladder; although, as you know, it’s not urine.
Again, thank you for bringing up the issue of vaginismus. It was difficult to find a girlfriend who understood that not everyone likes penetration, or when very aroused, not much.
I wish Suzie “Sexpert” Bright spoke about this at her lectures back in the day (she was our analog ‘autostraddle’ back then! )