The FBI Files: Vaginismus
- General and extreme vaginal tightness, burning or stinging with any vaginal entry (by a penis, tampon, fingers or something else)
- Great difficulty or an inability to allow entry
- Severe pain during attempted intercourse
- Inability or profound difficulty inserting tampons or cups
- Emotional distress during intercourse or entry that is clearly not about relationship distress or other identifiable issues
Many people who have difficulty with first intercourse or vaginal entry are often quick to suspect their hymen isn't "broken." However, in some instances in which a receptive partner is aroused, lubricated well, and has a patient and sensitive partner, and there are no issues with the hymen/corona at all, great pain or discomfort still occurs with attempted vaginal entry.
The hymen, or corona -- a thin membrane partially covering the vaginal opening at birth -- usually doesn't break or tear at all, not even with intercourse. At birth, the hymen begins already having very tiny openings already in it, which not only allow for menstrual flow, but for proper health of the vagina. Over time, that membrane slowly erodes, those tiny holes getting gradually larger, wearing away to the sides of the vaginal opening. That erosion is helped along by vaginal fluids, hormones, general physical activity, masturbation, tampon use and aging. In some cases (about one in two thousand), the hymen does not erode, or does not have the necessary openings, but it cannot be "broken" by forcing it via intercourse. A doctors visit and a minor surgical procedure are what are called for in that instance.
So, if the hymen isn't to blame, what is? There are a few possibilities, but it may also be Vaginismus, an involuntary spasm of the muscles around the vagina that force it to close so that it causes entry to be difficult, painful, or utterly impossible -- remember, the vagina is a muscle, so it shouldn't be too surprising that when it clamps up, it can clamp up very tightly. It's estimated that somewhere between 1-7% of people in the world have vaginismus.
Vaginismus isn't a physical condition, per se, though it has physical symptoms. It is considered a psychological (and thus, psychosomatic, meaning the psychological condition causes the physical symptoms) syndrome that is usually based in one of the following:
• past sexual trauma, such as rape or sexual abuse
• strong inhibitions (whether you recognize them or not) about sex or the vagina arising from an upbringing in which sex or the vagina were portrayed as dirty, sinful, taboo or bad
• severe body image issues
• a reaction to painful intercourse experiences had in the past
• as a result of another physical condition
• fears, phobias or neuroses about sex and/or sexual intercourse in general
• or because of interpersonal issues, like being with a person sexually someone is not attracted to, is afraid of, or has a strong negative reaction to.
Vaginismus usually ONLY applies to intercourse or vaginal entry. Most people who suffer from this condition are not anorgasmic (unable to orgasm), nor are they unable to participate in and enjoy a myriad of other sexual activities. Most can orgasm freely and have plenty of sexual fulfillment so long as intercourse is not involved. In other words, people suffering from vaginismus should not be assumed to be asexual or sexually dysfunctional.
Someone suffering the symptoms on the top of the page should visit a gynecologist. Testing for vaginismus is fairly simple: after taking a health history, a gynecologist usually simply inserts a finger into or just around the vaginal opening and watches for a tight, involuntary muscle contraction.
Treatment for vaginismus is usually done by a sexual therapy provider, who may do a number of different things.
They may opt to use therapy that includes vaginal dilation exercises by using a series of plastic dilators, beginning with a small size, and working up to a larger one over a series of appointments. The therapist may include masturbation therapy, in which the patient is slowly taught to masturbate in a way that does not illicit the response, but instead allows for healthy, comfortable sexual enjoyment. If a couple is involved, the couple may be coached on other sexual activities (such as manual or oral sex) to work up to intercourse over time. In addition, many people suffering from vaginismus have a great amount of sexual misinformation, or a lack of basic sexual information including anatomy, sexual response, and other sexuality basics. A therapist will also work to counter these. Sometimes, hypnosis is used in addition to the above treatments.
If someone suffering from vaginismus has had previous sexual abuse experiences or other sexual traumas, they are usually encouraged to get counseling to supplement the physical therapy.
Most people diagnosed with vaginismus are strongly advised not to attempt intercourse or entry until treatment has been completed. If you are experiencing the symptoms associated with vaginismus, and haven't yet been seen for a diagnosis, it's best to stop doing anything causing you pain until you can get seen.
Level of Danger
Vaginismus can be highly frustrating if not diagnosed and treated, because a person with it or their partner(s) will probably assume they are doing something wrong, or that there is something physically wrong with them if they are attempting intercourse or other vaginal entry. Trying to force intercourse when someone is suffering from Vaginismus is not only physically painful, but because it is based in psychological and emotional factors, it may be very emotionally trying. If someone continues to attempt intercourse or other vaginal entry when this sort of pain continues, it can make the response get even worse, and make treatment more difficult.
If intercourse attempts cease while treatment is pursued, there are no physical dangers whatsoever. And in about 98% of cases, just a few months of treatment can cure vaginismus.
As a note, vulvodynia, a severe and constant burning, pain or itching in the vulvar area is sometimes related to Vaginismus, occurs as a secondary condition, or can cause the kind of symptoms vaginismus does. Vulvodynia can make even sitting or walking difficult, and is reported to affect as many as 200,000 women in the United States alone. A doctor will usually screen for vulvodynia and other vulvar pain conditions when evaluating possible vaginismus.
Because vaginal tightness and painful entry can also be symptoms of sexually transmitted diseases, it is important that when seeing your doctor for these symptoms, you let he or she know if you have been sexually active and/or have engaged in unprotected sexual activities in the past.
One cannot really prevent vaginismus in oneself, as it is a result of past experiences, traumas or upbringing.
However, it can be prevented in children and young adults simply by raising children in a setting with healthy, open and relaxed attitudes about sexuality, and without attaching taboo to basic sexuality. Protecting children and young adults from sexual assault or abuse is also highly important. If a person has been a victim of sexual assault, preventing vaginismus is one of many reasons to seek out support, counseling or therapy to heal from the assault psychologically, even if the abuse or assault was in the past. As well, avoiding or stopping any vaginal activity which is painful or uncomfortable, rather than continuing to engage in it, or thinking anyone has to do it, even though it's painful, is one more way of preventing vaginismus.
For more information on vaginismus, see:
- Vaginismus at MedlinePlus
- Information from Langone Medical Center
- The Vaginismus Awareness Network
- Video on vaginismus treatment at Discovery Health