When a woman has vaginismus, the muscle walls of her vagina contract or spasm in response to attempted insertion, for example, with a tampon or penis. This involuntary muscle contraction can be mildly uncomfortable or it may cause searing or tearing pain.
Vaginismus can interfere with normal activities like sex or getting a pelvic exam at the doctor's office.
By Hilda Hutcherson, M.D.
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Painful sex is often the first sign that a woman has vaginismus. The pain occurs only with penetration. It usually, but not always, goes away after withdrawal.
Women have described the pain as feeling too small for a man's penis. The pain has also been described as a tearing sensation or a feeling like the man is "hitting a wall."
Many women who have vaginismus also experience discomfort:
when inserting tampons
during a doctor's internal exam
Other medical problems like infections can also cause painful intercourse. So it's important to see a doctor to determine the underlying cause of pain during sex.
Causes of Vaginismus
The causes of vaginismus aren't fully understood. The condition is considered a sexual dysfunction. It is usually associated with anxiety and fear about having sex. But it's unclear whether the anxiety is a cause or a consequence of the condition.
Vaginismus is sometimes associated with a history of sexual abuse.
Vaginismus can be primary, meaning it's something a person has had their whole life. Or it can be secondary, occurring after a period of normal function.
Vaginismus may be called "global," meaning it occurs in all situations with any object. Or it may be "situational." That means it happens with one partner but not others -- or only with sexual intercourse but not with tampons or exams.
The condition usually begins after the first attempt at having intercourse. It may also develop after periods of stress. The vaginal walls may tighten automatically when sex is painful for any reason, compounding the difficulty.
Treatment of Vaginismus
Treatment of vaginismus involves "progressive desensitization" exercises. These exercises help women learn to control and relax the pelvic floor muscles around the vagina.
The exercises can be done at home. When practiced regularly they typically take effect over a period of weeks to months.
To try progressive desensitization, first practice basic Kegel exercises. Kegel exercises involve squeezing the same muscles you use to stop the flow of urine when urinating.
To do a Kegel exercise, take these steps:
contract the muscles
hold for two seconds
Do about 20 contractions at a time. You can do them as many times a day as you think to do them.
After a few days, do the exercises with a finger inside the vagina. It's a good idea to clip your fingernails and use a lubricating jelly. Or do the exercises in a bathtub, where water can be a natural lubricant.
Your finger needs to be inserted five or six centimeters. That's up to about the first knuckle joint.
Start with one finger and work your way up to three. Fingers are preferred because they allow you to feel the muscles contracting. They are also easy to remove if you start to feel any discomfort.
Women with vaginismus may also benefit from therapy to ease fear and anxiety about sex or sexual functioning.