If you’ve never heard of vaginismus at first skim it might appear as little more than a social media hashtag connoting witty female sayings. In reality, vaginismus is the inability or difficulty in penetrating the vagina. The symptoms vary from discomfort to burning or stinging, with tightness during sex, all the way to impossible penetration. Some women even have difficulty with the insertion of other objects, such as fingers, tampons or a speculum during a vaginal exam, but many are able to allow this sort of penetration, just not sex.
The cause is the involuntary tightening of the pubcoccygeus muscle (more commonly known as the â€œPC muscleâ€ within the pelvic floor). Now, there are different types of vaginismus: primary and secondary. Women who have never been able to have sex without pain because of extreme vaginal tightness may be suffering from primary vaginismus. Women who develop painful tightening after years of pain-free sex could be suffering from secondary vaginismus.
According to Vaginismus.com, secondary vaginismus commonly “strikes women experiencing temporary pelvic pain problems such as urinary or yeast infections, pain from delivering babies, menopause, or surgery.” While the initial problem may be treated successfully, difficulties with sex may continue due to a conditioned response by the body.
Dr. Madeleine Castellanos, a New York-based sex therapist, explains the body’s response in secondary vaginismus this way:
What is almost universal in women with vaginismus is the creation of a vicious cycle that goes from difficulty with penetration with or without pain, to negative thoughts about it, to increased anxiety or fear, to avoidance and hypervigilance, to guarding and muscle contraction. This cycle continues to reinforce itself and becomes increasingly distressing for the individual and the couple. Because this vicious negative cycle complicates treatment and reinforces fear, the sooner that a woman receives treatment for vaginismus, the better.
Psychology has a definite role in vaginismus. Not only does anxiety about the problem and fear of experiencing pain exacerbate the problem — it can also be at the root of the initial onset of vaginismus. A fear of pregnancy, Castellanos notes, as well as anxiety over body issues, and fear of pain, can lead to the involuntary tightening of the pelvic floor. So too can stress, issues with a partner, emotional trauma, and childhood experiences.
Despite the role psychology plays in vaginismus, it is important to remember that it is involuntary, which means that it is not a woman’s fault. But as mentioned, just as often the reasons are physical; vaginismus can occur due to any sort of pelvic surgery, urinary tract infections, yeast infections, cysts, sexually transmitted illness, the use of certain medications (side effects), childbirth, menopause, sex with little or no foreplay, among others.
Often, it is a combination of things. As Castellanos suggests, the smartest thing to do if you should experience tightening that makes sex painful or impossible is seek immediate attention. A gynecologist can help isolate the trouble and begin laying out the groundwork for treatment. The good news is that this is a highly treatable issue. Dr. Castellanos elaborates on the treatment:
Dilators are almost always used as part of the treatment for vaginismus. Progressively wider and larger dilators are used by a woman at home to provide physical stretching of the entrance of the vagina. In using dilators, women also become increasingly comfortable with the sensation of penetration. This helps decrease anxiety, reassuring a woman that she can experience penetration under her control and without pain. Therapists work not only with the individual, but also with the couple so that the partner can gain understanding of the condition and be helpful once penetration is to be attempted.
As Castellanos points out, the treatment that addresses both the physical and psychological aspects of the problem is the best course of action.