What is vaginismus?

Vaginismus is when the pelvic floor muscles around your vagina involuntarily tighten. This can happen before or when you try to penetrate (put something into) your vagina. Vaginismus is a sexual health condition.

Vaginismus usually happens:

• before or during sexual intercourse (sex)
• before using a tampon
• during a gynaecological examination

There are 2 types of vaginismus:

1. primary vaginismus — where vaginal penetration has never happened
2. secondary vaginismus — where vaginal penetration has happened but is no longer possible

What are the symptoms of vaginismus?

The main symptom of vaginismus is the involuntary tightening of your vaginal muscles. This can cause pain and discomfort.

The muscle tightening can happen when you try to put something into your vagina, such as a:

• tampon
• penis or fingers
• sex toy

This may cause burning or stinging pain. You may also have fear or anxiety around sexual activity.

What causes vaginismus?

There are many causes of vaginismus. These include both physical and psychological factors.

Physical causes can be:

• medical conditions — such as yeast infections (thrush) or recurrent urinary tract infections (UTIs)
• sexually transmitted infections (STIs)
• vulval conditions — such as the changes that happen at menopause

Psychological causes can be:

• trauma during childbirth
• negative messages about sex
• painful sex
• a painful vaginal examination in the past
• rape or sexual assault

Other causes can include:

• lack of arousal
• fear of getting pregnant
• relationship problems
• anxiety or depression

When should I see my doctor?

If you are worried about your vulva or vagina, you should see a doctor.

See a doctor you can talk to openly. You can ask to be seen by a female doctor, and you can take someone you trust along for support.

How is vaginismus diagnosed?

Your doctor will usually try to rule out any underlying physical conditions that may contribute to vaginismus.

Your doctor will ask you about your symptoms and medical history. They may also ask about sexual trauma and abuse.

If your doctor thinks you may have vaginismus, they may ask if it’s okay to examine you. This is usually very quick. Your doctor will take a quick look at your vagina to check that you don’t have an infection.

Your doctor may also refer you to other health professionals, such as a:

• physiotherapist
• psychologist
• sexual health therapist

How is vaginismus treated?

There are a number of treatment options for vaginismus. These usually focus on:

• managing your feelings around penetration
• exercises to get you used to penetration

Your doctor will suggest treatment depending on your individual situation.

Pelvic floor physiotherapy

Seeing a physiotherapist who specialises in pelvic floor exercises may help. They can teach you to relax and release your pelvic floor muscles.

Your physiotherapist may also use a vaginal dilator or trainer. These are tampon-shaped objects that help you get used to putting something into your vagina.

Dilators come in multiple sizes. By slowly increasing the size of the dilator you use, you can become used to having something in your vagina.

Dilators should only be used with professional guidance.

Counselling or therapy

Psychosexual therapy can help you better understand your feelings about your body and sex.

Relaxation techniques can also help you learn to relax your vaginal muscles. These can be:

• mindfulness
• breathing exercises
• gentle touch

A sex therapists can help you and your partner learn how to limit your pain and discomfort. By talking with each other you can improve your sexual experiences.

Medicine

Your doctor may suggest treatments to temporarily relax your pelvic floor muscles. This treatment is usually used with vaginal trainers and physiotherapy. This lets your vagina slowly adjust to larger objects while the muscles around it are relaxed.

Your doctor may suggest medicine to help with any pain.

Can vaginismus be prevented?

Vaginismus cannot be prevented as it’s your body’s automatic reaction — you have no control over it. However, vaginismus can be successfully treated.

Complications of vaginismus

Undiagnosed vaginismus can affect your self-esteem. It may also lead to anxiety or depression.

If you have vaginismus, you may start to avoid all sexual intimacy. This can significantly affect your relationships, and lead to conflict.

Resources and support

If you still have questions about vaginismus, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.