What you need to know about Vaginismus

Datuk Dr. Mohammed Niraj bin Mohammed Feizal
Obstetrician and Gynaecologist

Vaginismus is a medical condition that affects 2-15% of women, making sexual intercourse painful or even impossible. In this article, we’ll explore vaginismus in simple terms, looking at what it is, its causes, symptoms, and how it can be treated.

What is Vaginismus

Vaginismus is a condition that causes involuntary muscle contractions in the pelvic floor muscles, specifically the muscles around the vaginal opening. 

These contractions can be so strong that they make any form of vaginal penetration, including sexual intercourse, difficult or extremely painful. Vaginismus is not a conscious choice; it’s a reflex reaction that the body has no control over.

Causes of Vaginismus

Vaginismus can have various causes, and it’s essential to note that it’s not typically something a person can consciously control or prevent. Some common causes and contributing factors include:

Physical Causes: 

Physical issues like infections, vaginal dryness, injuries, or medical conditions can lead to pain during intercourse and trigger vaginismus. These physical causes can make the body react with muscle contractions to protect itself from further discomfort.

Psychological Causes: 

Emotional factors can also play a significant role. Past traumatic experiences, relationship issues, anxiety, or fear can create a psychological response that causes the pelvic muscles to tighten involuntarily. Fear of pain or anxiety about sex can exacerbate the condition.

Negative Associations: 

Some individuals may develop a negative association with sex due to past painful experiences, like a history of sexual abuse or a particularly painful first sexual encounter. These negative associations can lead to vaginismus.

Cultural or Religious Factors: 

Sociocultural or religious factors can contribute to the development of vaginismus. Cultural beliefs or religious teachings about sex can create anxiety or guilt, leading to muscle tension and pain.

Symptoms of Vaginismus

Vaginismus can manifest with a range of symptoms, and the severity can vary from person to person. Common symptoms include:

Pain during Intercourse: 

The most prominent symptom of vaginismus is pain or discomfort during vaginal penetration. This pain can range from mild discomfort to severe pain, making intercourse or even gynaecology examinations challenging.

Involuntary Muscle Contractions: 

Women with vaginismus experience involuntary muscle contractions around the vaginal opening, making penetration difficult or impossible. These contractions are beyond their control.

Difficulty with Tampons: 

Inserting tampons or using other vaginal products can also be problematic for individuals with vaginismus. The same muscle contractions occur, causing pain and resistance.

Anxiety and Fear: 

Many women with vaginismus experience anxiety or fear related to sexual activity due to the pain they associate with it. This anxiety can further exacerbate the condition.

Avoidance of Intimacy: 

Some individuals with vaginismus may avoid sexual activity altogether to prevent pain. This can strain relationships and lead to emotional distress.

Diagnosis and Treatment

If you suspect you have vaginismus or are experiencing pain during intercourse, it’s crucial to consult a healthcare professional for a proper diagnosis and guidance on treatment. Diagnosis usually involves a medical history review, a pelvic examination, and discussions about your symptoms. Treatment options for vaginismus can include:

Education and Counseling: 

Understanding the condition and its causes is the first step. Many healthcare providers offer counseling or therapy to help individuals address the emotional aspects of vaginismus. This can be particularly helpful when psychological factors are contributing to the condition.

Pelvic Floor Physical Therapy: 

Pelvic floor physical therapy, often led by a physical therapist with specialized training, can help address the physical component of vaginismus. These therapists can guide you through exercises and techniques to relax and strengthen the pelvic floor muscles.

Topical Medications: 

In some cases, topical medications may be prescribed to address vaginal dryness or discomfort.

Couples Therapy: 

If vaginismus is causing relationship issues, couples therapy can be a helpful avenue to address communication, intimacy, and emotional support.

Treatment for Underlying Causes: 

If vaginismus is secondary to another issue, such as an infection or medical condition, treating the underlying cause may alleviate the symptoms.

Medical treatment included Examination under anaesthesia which takes about 20-30 minutes. Then there is the use of Botox injections to calm the muscle contractions. It is occasionally incorporated with a simple cut of the vestibule near opening of the vagina to remove the nerve filled area that stimulates the pain. 

This procedure will later need dilators to train the muscle at the opening of the vagina.

Dilators

Vaginal dilators are tools that can be gradually inserted into the vagina to help stretch and relax the muscles over time. Starting with smaller sizes and progressing to larger ones can be an effective way to desensitize the area and reduce muscle tension.

Living with Vaginismus

Vaginismus is a treatable condition, and many individuals find relief with the right approach. It’s important to remember that there’s no shame in seeking help for vaginismus, and you’re not alone. With the support of healthcare professionals, understanding partners, and patience, many people with vaginismus can enjoy pain-free and fulfilling sexual experiences. Medical treatment included examination under anaesthesia which takes about 20-30 minutes. Then there is the use of Botox injections to calm the muscle contractions. It is occasionally incorporated with a simple cut of the vestibule near opening of the vagina to remove the nerve filled area that stimulates the pain. This procedure will later need dilators to train the muscle at the opening of the vagina.