Vaginismus

Vaginismus is medically defined as involuntary spasms of the pubococcygeus (PC) muscles, the muscles which surround the vaginal canal. The PC muscles are some of the many pelvic floor muscles that function to keep the bladder, bowel, rectum and uterus in place within the pelvic cavity.1  These muscles have to be active enough to keep these internal organs in the right place, but sometimes they can be hyperactive resulting in pelvic floor dysfunction and physical pain.1 Vaginismus, a symptom of pelvic floor dysfunction, is a physical disorder that can stem from psychological or physiological factors.  There is a common misconception that individuals with vaginismus have physiologically “tighter” vaginas. However, people with vaginismus have anatomically normal vaginas, rather when penetration occurs the muscles spasm making it appear as though the vaginal canal is narrower than it actually is.

On average, one in every 500 female-born individuals will experience vaginismus. However, the true number of individuals with vaginismus is estimated to be higher because many people never report their condition or seek medical care due to fear or lack of knowledge.2 Individuals with vaginismus report an increase in vaginal tightness prior to or during penetration. This may include an instance that is sexual, such as intercourse, or even non sexual, such as inserting a tampon or a speculum during a pelvic exam. This tightness can make penetration extremely painful, and in extreme cases, impossible. Although intercourse may become impossible, people who experience vaginismus are still capable of becoming sexually aroused, self-lubricating, and reaching clitoral orgasms.

There are four types of vaginismus: primary vaginismus, secondary vaginismus, situational vaginismus, and global vaginismus. Primary vaginismus refers to a condition in which an individal has never been able to engage in intercourse without experiencing spastic muscle contractions. Secondary vaginismus is a condition which emerges later in life, after a period in which an individual had been able to experience penetration without pain. Situational vaginismus is when the condition is only present under certain conditions.  Therefore, one’s vaginismus can either be present or absent depending on the scenario, such as if the penetration involves a different partner, a medical exam, or a tampon. Global vaginismus is the opposite, thus occurring in all environments regardless of situational factors. Treatment options are the same with all types of vaginismus however, primary vaginismus often requires a slightly longer treatment period than secondary vaginismus.3   Regardless, all four types are highly curable with reassuring success rates.  

 

Diagnosing Vaginismus

The first step in diagnosing vaginismus is scheduling a full pelvic exam with a gynecologist so they can identify any physical causes. If a person is experiencing any symptoms of vaginismus, a specific gynecological exam is conducted as follows:

  • The physician first conducts a general vulvodynia exam by pressing a Q-tip against areas of the vulva and measuring the patient’s level of pain.

  • The physician then places a finger inside the vaginal opening and slightly presses on the vaginal walls. For people with vaginismus, this pressure usually causes the walls of the vagina to spasm, and the individual reports a certain level of pain.

Physical factors that can cause vaginismus include, but are not limited to: urinary tract infections (UTIs) or other urinary problems, vulvodynia, vaginal atrophy, endometriosis, and  sexually transmitted diseases (STIs).4 Vaginismus can also be the result of learned muscle memory from continual straining that can cause incorrect muscle coordination.5  Although, many cases of vaginismus can be traced to anxieties associated with the act of penetration, they can also be linked to causes such as past sexual trauma or control issues within a relationship. Since the psyche is innately connected to the body, residual anxiety or negative feelings toward a past sexual encounter may interfere with the sexual response cycle. Thus, biological concerns should be approached with a psychological (as well as physiological) perspective through counseling or any other suitable treatment.

Regardless of the specific cause of an individual’s vaginismus, the cycle of pain unfortunately reinforces the dysfunctional muscle memory.  One anticipates or expects pain from penetration, causing the vaginal muscles to contract and tighten. This causes pain (sometimes described as a stabbing or burning sensation) when penetration occurs.  This pain reinforces poor muscle memory and will cause the body to tighten and brace in the future when penetration is expected. This revolving cycle can be extremely frustrating and defeating for individuals who are experiencing vaginismus.  

 

Vaginismus Treatment

 

Common treatments for vaginismus include practicing with a graded series of silicone dilators, pelvic-floor physical therapy, Botox injections with progressive dilation, and individual and/or couples therapy. Attending individual therapy can help one in working through past sexual traumas or fear of penetration (commonly caused by accidents or upbringings with strict/negative views on sex).  Attending couples therapy can allow partners to learn how to communicate better with one another, resolve specific problems, and strengthen their relationships. The individual may be advised to engage in any or all of the techniques previously mentioned by themselves at first, and then gradually incorporate their partner (if applicable).

Pelvic Floor Physical Therapy

Some people may have a difficult time using dilators and can become frustrated with their lack of progress. Pelvic-floor physical therapy, which involves massage and manipulation of the internal vaginal muscles, can be used in combination with dilators1.  At-home exercises with dilators are still crucial with this therapy, but working with a professional may help the patient in discovering what triggers spasms and how to relax the muscles properly. Just like any other muscle of the body, proper training and exercise are crucial to rehabilitation. Once the individual has completed the previous steps, they may want to incorporate their partner into these exercises. Together, they may follow the same regimen the individual has practiced alone. Open and honest communication is a vital and crucial element to this progression.

Dilators

Using a set of graded vaginal dilators may also help an individual steadily learn how to comfortably accommodate an object, finger, or penis. These devices are available in various diameters and lengths and are inserted in a way similar to tampons. Dilators can be purchased online or can also be provided by a physician or physical therapist. Again, it is important to be relaxed and comfortable prior to beginning a dilator session as anxiety can trigger the spasming of the pelvic floor muscles. The steps to a successful dilator session are as follows:

  • Place a generous amount of artificial lubricant (KY Jelly or Astroglide) on the smallest dilator available to begin. Find a comfortable position and try to relax the PC muscles that surround the vaginal canal. Slowly insert the dilator. Numbing lubricant or lidocaine cream can be used in the first session in order to achieve penetration if it is extremely painful or impossible.

  • Slightly apply pressure on the pelvic floor muscles with the dilator while relaxing all other muscles.

  • The dilator is left in for a period of 10-15 minutes and the process is repeated every day until the person is able to insert the largest dilator without experiencing pain or muscle spasms.

  • If insertion is painful one should wait to upgrade their dilator size as to avoid reinforcing the cycle of pain.

By using progressively larger vaginal dilators, an individual learns to keep the PC muscles relaxed during penetration. They may then begin self-exploration, external genital stimulation, and eventually insert a finger into the vagina. Over time, dilators can help one in overcoming fear of penetration. These progressive steps allow the individual to become more comfortable with their body and ultimately decrease anxiety and fears that may lead to vaginismus spasms.

Note that vaginal dilators are typically ineffective when used without medical guidance. They should not be used without proper physical instruction and technique. Dilators are simply one aspect of treatment that will only be effective with correct pelvic control techniques. The main focus of using a dilator properly is gaining pelvic control, not stretching the vaginal opening.

 

Botox Injections with Progressive Dilation

 

Botox injections that are administered intravaginally have recently been used as a treatment for vaginismus. This treatment is usually reserved for patients with severe vaginismus who have not shown improvement with other treatments. Botox works by paralyzing the injected muscles, therefore one cannot contract their muscles consciously or subconsciously.6  While the injections only last for 2-4 months, patients tend to report the positive side effects of botox for vaginismus last much longer. Botox provides a short window for patients to become comfortable with vaginal insertion.  Therefore, when the injections wear off one hopefully has been able to work through psychological fear and pelvic floor dysfunction. Botox injections are typically administered by a plastic surgeon. The steps for Botox therapy are as follows:

  1. The areas of the vaginal muscles that experience the greatest amount of spasm are identified under sedation. Botox injections are administered to these areas.

  2. A long-lasting local anesthetic is also injected intravaginally.

  3. Progressive dilation is then performed while the patient is still sedated. Vaginal dilators similar to those used in at-home treatments are coated with a topical anesthetic. The dilators are inserted progressively until the largest dilator is accommodated.

  4. The patient is then taken to recovery while the largest dilator is still in place, and she begins supervised dilation for two to three days. The physician or nursing staff instructs the patient on how to properly use dilators until the patient is able to dilate to the largest dilator without pain.  The patient usually leaves the hospital with a medium-sized dilator in place that is later removed.7

  5. This treatment is usually coupled with sex therapy and counseling and continued use of dilators is recommended.8

 

Concluding Remarks

Although vaginismus is an extremely frustrating and misunderstood condition, research shows that individuals who are treated by a professional can expect an 80-100% improvement rate. It is imperative to seek medical help in order to properly treat vaginismus. Many people suffer longer than they have to from this disorder because they are ashamed or embarrassed to seek health care. No one should ever be ashamed of taking control of their health and sex life.

 

References

  1. “Pelvic Physical Therapy: Another Potential Treatment Option.” Harvard Health. June 2018. Web. Date Accessed: 14 Apr. 2019.  
  2. “How Common is Vaginismus?” When Sex Hurts – Vaginismus. The Society of Obstetricians and Gynecologists of Canada. 2014. Web. Date Accessed: 23 Feb. 2016.
  3. “Differences in Treatment.” Vaginismus Treatment. Women’s Health Rehab & Supply. 2016. Web. Date Accessed: 23 Feb. 2016.  
  4. “Examples of Physical Causes.” What Causes Vaginismus? Women’s Health Rehab & Supply. 2016. Web. Date Accessed: 23 Feb. 2016.
  5. “Pelvic Floor Dysfunction Outlook / Prognosis.” Cleveland Clinic. 12 Dec. 2017. Web. Date Accessed: 14 Apr. 2019.
  6. Boskey, Elizabeth. “Botox Is One of the Treatments That Can Help Vaginismus Symptoms.” Verywell Health. 5 Apr. 2019. Web. Date Accessed: 14 Apr. 2019.  
  7. Pacick, Peter T. “Vaginismus Treatment.” Vaginismus MD. 2016. Web. Date Accessed: 14 April. 2019.    
  8. “Botox Injection for Treatment of Vaginismus.” ClinicalTrials.gov. U.S. National Institute of Health. 10 Dec 2012. Web. Date Accessed: 23 Feb. 2016.

Last Updated: 2 May 2019.

You voted 'no'. Thanks for your feedback!
Feel free to leave us feedback here!