What is vaginismus, what causes it and how can it be treated?

Vaginismus is a very painful and distressing medical condition where the muscles of the vagina tighten or tense or contract in anticipation of pain. It makes penetrative sex very painful and often impossible. Patients describe a burning sensation and often cannot use tampons or have any kind of gynaecological examination or investigation, such as a smear test. Dr Anusha Dias, a leading obstetrician and gynaecologist, describes this common condition and explains that whilst it can be very distressing, it can be treated.

It is important to remember that this is something that is happening automatically in the muscles of your vagina as a muscle spasm. It is something you have no control over. As it is such a sensitive subject, patients find it hard to talk to anyone about it. Vaginismus can cause so much distress and upset, causing relationships to breakdown, it makes it very difficult to have children, and patients often feel very much alone and isolated and feel as if they're the only one with this condition, which is not the case.

What causes vaginismus?

There is often no explanation as to why vaginismus has occurred. There may be some fear or anxiety around penetrative sex. There may have been an experience that was traumatic or painful in the past and this can cause primary vaginismus. Less commonly, patients have no difficulties at all with penetrative sex and then develop a medical condition, such as an infection like thrush, and then have an experience of pain which then results in vaginismus. This is secondary vaginismus.

What is the treatment for vaginismus? Can it be cured?

The good news is that vaginismus is a treatable medical condition. Treatment depends on the cause and needs to be tailored according to the patient's needs. Firstly, it is important to manage feelings of fear and anxiety around penetrative sex and sometimes treatment can be focused on identifying, understanding, and changing those negative perceptions about body image and penetrative sex. Relaxation and mindfulness techniques can help with this.

Sometimes, though, treatment is focused on retraining those muscles that are held in tension and this can be done in a variety of ways. One such way is practising pelvic floor exercises. The pelvis is the part of the body that contains the vagina, the uterus, the bowel and the bladder. The floor of the pelvis is a sling of muscle and learning pelvic floor exercises or Kegels exercises can help with vaginismus. For some, the vaginal muscles themselves need to be targeted which can be done very effectively using graduated vaginal trainers.

How common is vaginismus?

It is difficult to estimate how common vaginismus is, because so many women don't seek medical treatment for it and it is hidden because patients find it quite embarrassing or sensitive to talk to even a health professional about. Hence, estimates do vary, but it is thought that about 27,000 women in the UK have vaginismus and certainly 10 to 15 percent of all women at some point in their life experience pain during penetrative sex.

Can I ever have sex again?

Vaginismus is a treatable medical condition, so absolutely, yes, you can have pain-free sex. A specialist in psychosexual medicine will work with you to develop a programme that will meet your needs and is likely to be successful. I think the hardest step is taking that first step and asking for help.

If you experience pain during sex, make an appointment with an expert now.