Demystifying Vaginismus

When you are experiencing ‘pain in your privates’ who wants to talk about it? Well, no one really, but it is my goal to shed some light on something that has been kept a secret for far too long and has negatively affected people’s lives on many levels. Let’s open the conversation around the reasons for pain with penetration and how best to treat it, so that you can start living life fully, and stop avoiding relationships or intimacy.

In my practice, I treat many clients that initially express frustration, sadness and even anger about dealing with their reported symptoms such as:

‘I have always had trouble using tampons’;

‘I have never been able to have penetrative sex’;

’I have not been able to have a PAP smear done because it hurts too much’;

’My partner and I would like to conceive but intercourse is too painful’.

If any of these statements ring true for you, you aren’t alone and there is help. These symptoms can be indicative of a condition known as ‘vaginismus’.

What is vaginismus?

If we look at the International Urogynecological Association/International Continence Society definition of vaginismus, this condition involves ‘recurrent or persistent spasm of vaginal musculature that interferes with vaginal penetration often accompanied with phobic avoidance and anticipation/fear/experience of pain’1.

It is important that any other medical issue that may be causing the symptoms above be ruled out first. This may include infections, other structural or physical abnormalities that your OBGYN at Open Arms Gynecology may be able to assist you with.

Similarly, if we have a look at the Diagnostic and Statistical Manual of Mental Disorders (DSM), vaginismus and dyspareunia (painful intercourse) have been combined to create the category of “genito-pelvic pain/penetration disorder” (GPPPD). The criteria for diagnosis includes 2:

• Minimum duration of 6 months to be diagnosed
• A frequency of 75-100% more specifically:
• difficulty with vaginal penetration
• marked vulvo-vaginal or pelvic pain during penetration or attempt at penetration
• fear or anxiety about pain in anticipation of, during or after penetration
• tightening or tensing of PF muscles during attempted penetration

Vaginismus can be further categorized as either primary or secondary. Primary vaginismus is the presentation of pain and/or tension from the first attempt at penetration vaginally, whereas secondary vaginismus refers to symptoms that begin later in life even after many years of pain-free intercourse, insertion or penetration 3.

It is difficult to really know the population prevalence of vaginismus as it is not well studied, however the prevalence rates are thought to affect 14 to 34% of younger women and 6.5 to 45% of older women 4.

The future outlook:

Many clients ask: ‘Will my pain ever get better?’

Yes, vaginismus most definitely can be resolved. Having a doctor or an OBGYN specialist familiar with the condition can help direct you to the appropriate care. Your doctor may also suggest medication or other treatment modalities that can be helpful.

One very effective treatment option for vaginismus is pelvic floor physiotherapy. A pelvic floor physiotherapist can help guide you through understanding vaginismus better, physically assessing the muscles and tissues that are contributing to the tension and pain, as well as help you through an appropriate plan of care to rehabilitate the tissues affected.

Your treatment will be geared towards your personal goals whether it is to be able to insert a tampon or toy, or being able to have penetrative intercourse. Whatever your goals may be, a pelvic physiotherapist can help you achieve them by taking a graded, non-threatening and gentle approach.

Vaginismus can be scary at first, especially when you have no idea what is causing your pain and distress; but there is hope as it is highly treatable. To learn more about pelvic floor physiotherapy for the treatment of vaginismus, visit us at www.proactiveph.com

1. Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K, Graziottin A, Heiman JR, Laan E, Meston C, Schover L, van Lankveld J, Schultz WW. Revised Definitions of Women’s Sexual Dysfunction. J Sex Med. 2004; (1):40-48
2. IsHak and Tobia, Reprod Sys Sexual Disorders 2013, 2:2
3. https://vaginismus.com/
4. van Lankveld J.J., Granot M, Weijmar Schultz WC, Binik YM, Wesselmann U, Pukall CF, et al. Women’s sexual pain disorders. J Sex Med. 2010;