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.