• Bladder and Pelvic Health
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Painful Sex? Vaginismus Could Be the Culprit

The sexual revolution of the 1960s and 70s may have made talking about sex more comfortable. But for women suffering from vaginismus, just thinking about sexual intercourse can trigger tangled feelings of frustration, embarrassment and confusion.

Vaginismus is a reflex contraction, or spasm, of the vaginal muscles. As clinical understanding around this condition grows, an expanded definition has developed: Persistent or recurrent difficulties of a woman to allow vaginal entry of a penis, finger and/or an object, despite her expressed wish to do so.

It’s a pretty intense contraction, says William Rush, MD, female pelvic medicine specialist with Lifestages-Samaritan Centers for Women, in Dayton, Ohio. “It’s not like a contraction that most of us think of.”

Understanding Vaginismus

A combination of physical or non-physical causes can lead to vaginismus.

Sometimes, physical issues can cause pain with vaginal penetration. If these issues cause you to anticipate pain and your vaginal muscles to spasm, or tighten, in response, you may be developing vaginismus. This information may help shed more light on vaginismus:

• It’s a type of sexual dysfunction that can interfere with your relationship and quality of life.
• It has been described as painful sexual intercourse with no identifiable physical cause.
• It can occur at any time, even if vaginal penetration has been comfortably achieved in the past.
• It doesn’t interfere with sexual arousal but can prevent penetration.
• Treatment typically includes education, counseling and physical therapy.
• Some research suggests that fear and avoidance of vaginal penetration can lead to vaginismus.

Getting Diagnosed

It’s important to make an appointment with your gynecologist to begin your journey toward diagnosis and treatment. Dr. Rush advises you should see your doctor if you experience continuing pain or discomfort during sexual activity or other vaginal penetration, such as with tampons.

If you’re feeling embarrassed about discussing the topic with your doctor, Dr. Rush says don’t be.

“It’s a real thing. It’s happening to you.” Based on his practice experience, he estimates that vaginismus affects two to three patients per thousand.

“It’s very important for a woman’s partner to be involved and aware that this is happening with her and to understand any issues she’s having.”

According to the American College of Obstetricians and Gynecologists, important factors in determining the cause of your pain are your medical and sexual history, signs and symptoms, and findings from a physical exam.

Dr. Rush explains, “Vaginismus needs to be differentiated from other sexual pain disorders, and that is done by a thorough physical exam and history, including a pelvic exam. It’s also important to rule out any other physical causes of pain.”

Physical conditions that can cause pain and discomfort with intercourse include infections, tumors, cysts or pelvic inflammatory disease, for example. Even past surgeries, childbirth, medications and menopause can cause changes in vaginal comfort, and these changes can lead to vaginismus.

Can Vaginismus Be Treated?

Dr. Rush reaffirms the importance of a physical exam as a first step to treatment. If a physical problem is found and treated, yet your symptoms do not go away, a referral to a physical therapist and/or psychologist is a reasonable next step, he says.

Physical therapy may include pelvic floor exercises and desensitization therapy, which begins with self-touching and advances to vaginal dilators. The dilators get progressively larger to help muscles stretch and become more flexible.

A psychologist specializing in sexual disorders can help uncover other issues that may be affecting your sexual function. Either or both specialists may also provide tips for relaxation and comfort that may be helpful before and during intercourse.

Dr. Rush emphasizes the importance of also talking with your partner for the best outcome.

“It’s very important for a woman’s partner to be involved and aware that this is happening with her and to understand any issues she’s having,” he says.

If you haven’t already shared your issues and concerns with your partner, remember that doing so can bring you one step closer to a healthier relationship.

Source: Healthline.com; Medscape.com; American College of Obstetricians and Gynecologists; William Rush, MD, Lifestages-Samaritan Centers for Women