Understanding Vaginismus: Causes, Symptoms, and Effective Treatments

June 5, 2024 |
Pelvic Floor Health

Table of Contents :

What is Vaginismus?

Symptoms of Vaginismus

Causes and Risk Factors

Getting a Diagnosis

Vaginismus Treatment Options

Vaginismus is a distressing sexual health condition that affects many women worldwide. Characterized by involuntary spasms of the vaginal muscles, vaginismus can make sexual intercourse, gynecological exams, and insertion of tampons or menstrual cups extremely painful or even impossible. While often misunderstood, vaginismus is a treatable condition with various effective options for long-term relief.

What is Vaginismus?

Vaginismus refers to persistent or recurrent difficulties in allowing vaginal entry or penetration, despite the woman's expressed wish to do so. It is classified as a sexual pain disorder and is the result of automatic contraction of the pelvic floor muscles surrounding the vagina when entry is attempted.

These involuntary muscle spasms make penetration either very painful or completely impossible. Women with vaginismus often describe the vaginal opening as being tightly "closed" or "clamped shut." The severity of vaginismus can vary – some women are unable to tolerate any penetration at all, while others can manage some degree of penetration but with pain.

Vaginismus can be labeled as either primary or secondary:

• Primary vaginismus occurs when the sufferer has never been able to have penetrative intercourse or experience vaginal penetration of any kind. It often begins with the first attempt at tampon insertion or sexual activity.

• Secondary vaginismus occurs when a woman has previously been able to achieve penetration but is no longer able to. This may happen after an infection, trauma during childbirth, or surgery such as an episiotomy.

Symptoms of Vaginismus

The main symptom of vaginismus is difficulty with vaginal penetration. Symptoms can include:

• Pain during intercourse or attempted penetration

• Tightening of vaginal muscles around the opening

• Burning, stinging or aching pain

• Involuntary spasms of pelvic floor muscles

• Feeling of the vagina being tightly "sealed"

• Fear, anxiety and avoidance of intimacy or sexual activity

• Recurrent urinary tract infections (UTIs)

Causes and Risk Factors

Vaginismus is a complicated condition with both physical and psychological components. Some key factors that can contribute to vaginismus include:

Physical Causes

• Past trauma or injury to the vagina, perineum or pelvic region, e.g. childbirth complications, pelvic surgery, or accidental injury

• Menopause-related vaginal atrophy causing dryness and fragility

• Vestibulodynia or Vulvodynia - increased sensitivity and pain in the vulva or vaginal opening

• repeated urinary tract infections or yeast infections causing fear of penetration

• Congenital abnormality of the vagina or vulva

Psychological Causes

• Anxiety or fear related to penetration, often due to a lack of knowledge about female anatomy

• Negative first experiences with tampon use or sexual activity

• History of sexual trauma or abuse

• Strict religious beliefs about premarital sex or sexuality

• Relationship issues or negative feelings about a partner

• Poor body image or low self-esteem

Getting a Diagnosis

To diagnose vaginismus, the doctor will typically:

•Take a medical history and ask about symptoms, including difficulties with penetration or using tampons. Details of relationship status and sexual activity are needed.

• Conduct a pelvic exam to check for any physical abnormalities. This may show tightened pelvic floor muscles which spasm when touched.

• Insert a finger inside the vagina to assess penetration ability and pelvic floor muscle resistance.

• Rule out other conditions like yeast infections or dermatitis.

• Refer to a pelvic floor physical therapist for assessment therapy if muscle spasms are confirmed.

Vaginismus Treatment Options

The good news is that vaginismus is highly treatable through techniques like pelvic floor therapy, dilator use, and counseling. With consistent effort, most women with vaginismus can overcome their symptoms entirely and enjoy healthy sexual intimacy. Common vaginismus treatment or you can call it vaginismus cure options include:

Pelvic Floor Physical Therapy

Pelvic floor PT is considered the first-line treatment for vaginismus. A specialist pelvic floor physiotherapist will perform manual therapy like soft tissue mobilization and trigger point release to relieve tightness and spasms of the pelvic floor muscles. They will also teach relaxation techniques, provide nerve desensitization, and instruct on training the muscles to tolerate vaginal penetration through insertion exercises. With regular pelvic floor PT, about 80% of women with vaginismus can achieve full penetration.

Use of Dilators

Vaginal dilators are smooth, tapered inserts in graduated sizes that a woman can use at home to gently stretch and relax the vaginal opening. The dilator is inserted and left in place for 10-15 minutes as the user breathes deeply. Over time, the vaginal tissues become desensitized and the mind/body association can be reset to expect pleasure rather than pain from penetration. Dilators are often used in conjunction with pelvic floor PT.

Counseling and CBT

Cognitive behavioral therapy (CBT) helps identify and reframe negative thought patterns like fear of pain that fuel the intensity of vaginismus symptoms. Emotional blocks are worked through and healthy coping strategies are developed. Partners may also join counseling sessions if relationship issues are contributing to the problem. Talk therapy gives women the tools to overcome the distress around sexual activity.

Botox Injections

Some doctors may use targeted Botox injections into the pelvic floor muscles to temporarily paralyze the spasming muscles and relieve vaginismus symptoms. However, effects wear off within 4 months so additional pelvic floor therapy is recommended for long-term success.


Oral antispasmodic drugs or anti-anxiety medications may be prescribed to help relax the vaginal muscles or reduce performance anxiety. These are usually supplemental to physical therapy rather than a solution alone.


In the most severe cases not improved by other therapies, a surgical procedure can partially cut the pelvic floor muscles to permanently stop spasms. However, surgery may lead to weakened vaginal walls or incontinence so it is rarely a first option.

The most effective vaginismus treatment typically combines pelvic floor physical therapy with a gradual program of dilator insertion and counseling to address both the physical and emotional components involved.

For personalized treatment and support in overcoming vaginismus, schedule a consultation with Dr. Leena, an experienced pelvic floor physiotherapist. With her compassionate approach and expertise in treating sexual pain disorders, she can help you find relief and regain your intimacy.

Contact Us

Dr. Leena Daware - Pelvic Floor Physiotherapist

Follow Me

Contact Us

Contact Us For Free Consultation