Vaginismus: Definition, Symptoms, and Treatment

One of the most common difficulties people have in sexual relationships is vaginismus. Contrary to what it may seem, it’s actually quite common, though it goes unrecognized often. Vaginismus is a common sexual dysfunction that can cause problems in a relationship due to the loss of self-esteem, anxiety, communication problems, and frustration on both sides.

Approximately one in three couples has a sexual dysfunction problem. Many women feel uncomfortable or embarrassed when it comes to talking about issues related to sex, pain and an inability to enjoy sex with penetration. However, we shouldn’t downplay these situations since a problem that does have a solution can turn into a physical and psychological nightmare.

What is vaginismus?

Vaginismus is an involuntary contraction of the pelvic floor muscles that surround the vagina. This causes partial or total closure, which can be painful and make penetration impossible. The contraction of these muscles can be mild or intense. Hence the discomfort and inability to have sexual relations through penetration.

It falls within what the DSM-V calls “pain-related disorders” (dyspareunia and vaginismus). These are combined under the name of “genito-pelvic penetration/pain disorder” (Moyano and Sierra, 2015, p.277-286).

Despite the new category, it’s normal to call it vaginismus. It is hard to diagnose since it’s almost always done based on what the woman reports feeling. A health assessment would be necessary but a pelvic exam isn’t usually an option due to the muscle contractions.

Types of vaginismus and pain

Per to the latest studies, there are two types of vaginismus. According to Engman (2007), these are:

• Total vaginismus: in this case there is an intense fear of penetration that causes a woman to avoid any attempt. There is a total contraction in the area of ​​the pelvic floor. It is completely beyond the woman’s control.
• Partial vaginismus: in contrast to the former, this is only a partial muscle contraction. The vagina is closed during penetration (or any attempt), creating significant discomfort.

On the other hand, we must distinguish if it is primary or secondary vaginismus. Primary has to do with psychological or combined factors. Secondary vaginismus appears after an injury, surgery, a fall, or from candidiasis or recurrent cystitis.

Why is this happening to me?

90% of sexual dysfunction problems have a psychological origin. The main causes identified are past trauma or sexual abuse, and mental health factors. It could also be a response to continued physical pain.

Despite now fearing penetration, vaginismus is not related to a loss of desire. A woman may feel desire and excitement perfectly normally, and can reach orgasm with clitoral stimulation.

According to Barlow’s model (1986), sexual dysfunctions happen because of a multidimensional process involving cognitive interference and anxiety. The process continues something like this:

• A woman responds negatively to explicit sexual situations.
• This in turn causes her to focus on irrelevant stimuli or circumstances, or negative expectations.
• Therefore, negative emotions will increase.
• The negative process continues and may interfere with the sexual response (Carrasco, 2001).

According to the DSM-V, it may be a lifelong problem or an acquired problem. If it is acquired, either by continuous discomfort caused by penetration or by having been sexually abused, it can turn into trauma itself and then sustain the dysfunction.

Thus, it is always a good idea to see a doctor to rule out organic factors.  These may include atrophic vaginitis or even diabetes (which can cause dryness and irritation), infections or endometriosis.

Personal and impersonal factors

According to Master and Johnson (1970,1987) there are personal and impersonal factors. Personal ones have to do with information problems, cultural myths, fears, rejection, pain, etc.

Although their studies are almost forty years old, the truth is that there are still problems regarding myths and bad information. We’re in a different generation, but disinformation from years ago has become even more distorted. We could blame movies, porn, “fashions”, social media, etc.

Impersonal problems have to do with communication in the relationship, power roles between the two, aggressiveness, loss of physical attractiveness, distrust, and having different attitudes toward sex. These things can lead to dyspareunia problems (physical pain when having sex).

How do I fix it?

A multidisciplinary approach is recommended. But what does that mean? It means addressing the problem from the perspective of multiple medical disciplines. It’s ideal to work with a gynecologist, a physical therapist, and a psychologist.

By drawing on these three disciplines, you can work on your muscles as well as your thoughts, attitudes and sexual skills. This will help you individually and you as a couple to get better.

At the muscular level, physical therapists work with things like  ​​hormonal changes, muscle fibers, calcium release and inflammation. They usually use techniques like sensory discrimination, manual pressure, dilators, pelvic floor strategies, postural reeducation and work on the abdominal area for recovery and long-term prevention.

The psychological part is essential for good recovery. Remember that 90% of these cases have a mental origin. Plus, the percentage rises when we talk about the conditions and circumstances that keep the problem going or make it worse. Treatment involves working on three dimensions: thoughts, emotions and behavior.

Objectives of psychological therapy

On the thought level, myths, beliefs, and fears related to sex must be addressed. Working on obsessions and negative thinking is also necessary in order to move forward. Sex and and problems with sex play a big role in psychological problems.

Relationship problems and distrust are two more things therapy will help a couple work through. Finally, expectations regarding pain are reviewed. In respect to emotional issues, a woman and her therapist will also work on her anxiety, fear and self-esteem.

Both individuals and couples will work with techniques involving real-time exposure and psycho-education. Sometimes women are the least familiar with the vagina’s anatomy.

Therapists may recommend training in self-exploration and self-stimulation. Here the aim is to improve self-knowledge about the reactions and responses of the body to stimulation. In addition, the idea is to reduce anxiety surrounding sex, learn to give and receive sexual pleasure, and communicate better (Olivares Crespo and Fernandez – Velasco, 2003, p.67-99). All this is combined with techniques such as muscle relaxation.

Our relationship, our support

The truth is that resolving sexual problems has the power to greatly improve a couple’s relationship. But careful — this doesn’t mean that sex can solve all relationship problems. Treatment of vaginismus has a high success rate. It is more the shame or fear that prevents many women from getting help.