Vaginismus

Summary

• Vaginismus describes an involuntary spasm or contraction of the muscles surrounding the vaginal opening.
• It is related to excessive tension related to the expectation of penetration.
• A thorough pelvic examination by a doctor should be done to rule out any other possible physical causes of the vaginismus.
• Psychological treatment, couples therapy and gradual introduction of lubricated vaginal dilators are used to treat this condition.

Definition

Vaginismus is an involuntary spasm or contraction of the muscles surrounding the vaginal opening, making penetration of the penis into the vagina very painful or even impossible.

It may be called primary vaginismus where a woman has never been able to have sexual intercourse, and secondary vaginismus where she was able at one time to have sexual intercourse, but where this is currently prevented by the vaginismus.

Causes

In olden days, psychoanalysts thought the condition arose from a woman’s unconscious wish to prevent penetration. It does seem to be related to a degree of fear of penetration and anxiety associated with an expectation of pain or other unwelcome consequences.

Women who suffer from vaginismus do become sexually aroused, however, and can often achieve orgasm through alternative stimulation.

Sexual problems in the past, such as painful penetration, or fear of becoming pregnant, or being hurt could all be underlying reasons for this condition.

Signs and symptoms

Involuntary contractions of the muscles surrounding the vaginal opening and/or pain experienced when intercourse is attempted.

Treatment

Once a thorough pelvic examination by a doctor has ruled out all possible physical causes, it is more useful to focus on psychological factors which often include past sexual trauma, fear of pain associated with vaginal penetration and control issues within the existing relationship.

Treatment usually includes couples therapy, exercises to strengthen the pelvic muscles and the gradual introduction of lubricated dilators, which are increased in size gradually over time, as this becomes increasingly comfortable, and as the woman’s self confidence and expectation of success, increases. After a period of time, when a woman is able to comfortably insert reasonably large dilators, sexual intercourse may be attempted again.

When to see a doctor

This is not a life-threatening condition, but can seriously hamper a couples' sex life. It is a good idea to seek treatment from professionals, as this condition could reflect serious underlying trauma or unresolved psychological issues, and like so many psychologically based conditions, it is easier to treat early, before associated problems become more deeply engrained.

Reviewed by Prof M. Simpson, MB., BS. (London ); MRCS, LRCP; MRCPsych, DPM.