Vaginismus is nothing to be ashamed of—this is why it happens and the best vaginismus treatments

Vaginismus treatments make recovery possible for those suffering from the symptoms of the condition. Vaginismus affects roughly two in 1000 women, but many women who suffer from the condition don’t realize it. It can be frustrating and embarrassing and cause all sorts of symptoms. 

Hannah Van-de-Peer, who suffered from the condition, describes it as “frustrating, intimate, but treatable”. Speaking about her recovering she says, “It doesn’t even feel like vaginismus was a part of my life anymore”. While at the time of symptoms, the condition can feel isolating, treatment is available, and recovering is possible. There are many vaginismus treatment options, and some are even as simple as pelvic floor therapy involving kegel exercises. Understanding what's causing your vaginismus and speaking to a medical professional about your symptoms is key to finding the right treatment. 

What is vaginismus?

"Vaginismus is a painful spasmodic contraction of the vagina in response to physical contact or pressure”, explains Dr Rachel Gelman, a pelvic floor physical therapist. During penetrative sex, many people report that it feels like their partner is hitting a wall.

“Vaginismus is now called genito-pelvic pain/penetration disorder”(GPPPD),” adds Dr Gelman. According to the Journal of Sexual Medicine, GPPPD is characterized by persistent or recurrent difficulties with at least one of the following characteristics:

• Vaginal penetration during intercourse.
• Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
• Marked fear or anxiety about vulvovaginal or pelvic pain during or in anticipation of vaginal penetration.
• Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

Types of Vaginismus 

Vaginismus can be categorized into different types, depending on the severity and frequency of the symptoms. Dr Nicole Williams, a gynecologist and author of This is How You Vagina, explains the four types of vaginismus include: 

1. Primary vaginismus—lifelong pain with attempted vaginal penetration, where someone has never been able to tolerate penetration well.
2. Secondary vaginismus—the new onset of painful vaginal penetration after being pain-free in the past.
3. Situational vaginismus—the inability to tolerate certain forms of penetration, such as intercourse, yet insertion of a finger with masturbation, or a tampon or similar device, is possible.
4. Complete vaginismus—the inability to tolerate any vaginal penetration whatsoever.

What causes vaginismus?

“There are many reasons why vaginismus may happen, the condition can be triggered by physical or emotional stressors," explains Agatha Penney, a UK-based psychosexual and integrative psychotherapist.

These physical and emotional stressors include:

• Fear and anxiety—apprehensive feelings around penetration, a fear of getting pregnant or trauma after childbirth can cause vaginismus. This is often caused by lack of knowledge, distorted knowledge, negative associations and beliefs about sex or a traumatic pregnancy/birth experience.
• Childhood or adult trauma—can cause the body to involuntarily prevent something associated with the sustained trauma. This can include assault as a child or adult, as well as traumatic pregnancy or childbirth experiences. 
• Medical conditions—conditions such as vulvodynia or vestibulodynia may contribute or cause vaginismus, as these conditions cause pelvic pain which may lead to pelvic floor muscle tension resulting in the involuntary contractions that occur with vaginismus. Other conditions such as vaginal dryness, recurrent infections causing you to suffer from a sore vagina such as thrush or UTIs. Radiation to treat types of pelvic cancer can also cause vaginismus. 

How is vaginismus diagnosed?

Getting a diagnosis for vaginismus can provide a lot of relief for the person suffering. Grace Wilkinson from the US suffers from vaginismus and says that her diagnosis made her feel “relieved to finally have a name to the problem”.  

Dr Williams explains the process for vaginismus diagnosis includes a discussion of the patient's symptoms and a physical exam. "For example, when a patient complains of pain during sex or after penetration, we examine the bulbospongiosus muscles and if we find tension, pain, or spasm, the diagnosis is made.”

The most common symptoms include:

• Fear and anxiety at the thought of vaginal penetration.
• Burning or stinging sensations during penetration.
• Pain during or after sex or other symptoms of female sexual dysfunction.
• Discomfort inserting anything into the vagina. 
• Impossibility of having successful and painless vaginal penetration.

Is there a cure for vaginismus?

“There is no magic pill for vaginismus,” says Dr Williams. However, there are a number of treatments available that can help alleviate symptoms and allow you to live pain-free. Most vaginismus cases can be successfully cured, but we are all different. That's why it's important to seek medical advice from your doctor or gynecologist. With their help, you can discover the root cause of your vaginismus and decide on the best treatment plan for you. According to Dr Gelman, most treatment plans involve a multidisciplinary care team, primarily pelvic floor physical therapy and a sex therapist or cognitive-behavioral therapist.

The most common treatments for vaginismus include: 

1. Dilator therapy
2. Psychosexual therapy
3. Pelvic floor therapy

The treatments for vaginismus 

1. Dilator therapy

What it is:

Dilator therapy is often used by post-menopausal women but can be beneficial for those with vaginismus, too. It works by stretching the vaginal opening and aims to make things like penetrative sex and pelvic floor exams more comfortable. 

How it works: 

“Dilators are graduated cylinders that are inserted vaginally to help stretch the vaginal opening and promote relaxation of the pelvic floor. They can help to decrease sensitivity and increase a person's tolerance to penetration,” explains Dr Gelman. 

There is no set treatment plan for this type of therapy, Dr Gelman explains. Instead, with the help of a pelvic floor specialist, you'll be guided through a dilator program created to suit your individual needs. 

2. Psychosexual therapy

What it is:  

Psychosexual therapy is a talking-based therapy treatment that helps support a person as they delve into their awareness of their own feelings about their body image and sexual experiences. It is facilitated by a qualified counselor or sex therapist who is there to discuss your symptoms and experiences and help you understand them. 

How it works: 

Your doctor or gynecologist may refer you to a specific counselor as part of your treatment plan. Psychosexual therapy is often a long-term program that allows you a safe space and plenty of time to overcome your sex-related problems. 

"This kind of therapy will sometimes include the educational element of using vaginal trainers in your own time (similar to dilator therapy). However, the difference is that the patient may talk about their experiences with the therapist during the next session," says Penney. 

“A qualified psychosexual therapist may also introduce the intervention called Sensate Focus, which aims at gaining understanding and knowledge of the patient’s own body, reactions and limitations,” adds Penney. 

3. Pelvic floor therapy

What it is: 

Dr Williams describes pelvic floor therapy as a medication-free and high effective treatment for vaginismus. "If we start patients on medications, they often ask 'How long do I have to take this?' With pelvic floor therapy, the therapist will work with the patient until they reach their goals," says Dr Williams. 

How it works: 

Pelvic floor therapy is physical therapy and is often used during rehabilitation for pelvic floor dysfunction or injury. Using small strengthening movements, during this type of therapy you'll work to strengthen your pelvic floor and learn to relax your muscles with the aim of improving symptoms. 

Kegel exercises and kegel balls are a popular form of pelvic floor therapy that can help reduce pain during sex and manage incontinence. This is a long-term solution to vaginismus, and with the help of a pelvic floor expert, can be effective in relieving symptoms and allowing you to have a better quality of life. 

Moving forward after a vaginismus diagnosis  

Getting a vaginismus diagnosis can be overwhelming, and it can seem like a long road to recovery. However, Dr Williams wishes to remind those with vaginismus that "you are not broken. Your vagina is not broken. It's just muscles, and they and you can get better.”

“Do not feel ashamed about the problem and focus on the journey to its resolution and not on the final results. It can affect any woman at any stage of their lives in a different way,” adds Penney.        

Reflecting on her vaginismus recovery, Wilkinson explains she wishes she “had known that it was going to be okay and that this is my body’s way of protecting itself. For so long, I hated my body and felt like my vagina was a foreign object that didn’t belong to me”. 

Like many women, she found vaginismus to be a daunting and isolating condition but wants to remind us all that with the help of specialists, a full recovery is possible. 

w&h thanks pelvic floor physical therapist Dr Rachel Gelman, Dr Nicole Williams, gynecologist and author of This Is How You Vagina, and Agatha Penney, psychosexual and integrative psychotherapist for their time and expertise. 

Many thanks to Hannah Van-de-Peer and Grace Wilkinson for sharing their experiences.