Maybe for you, sex has always been painful. Maybe you haven’t been able to use a tampon (like, ever) and figured “this is just how it is for me.” Or maybe at some point, pain-free vaginal penetration was possible — until it wasn’t anymore. You may not be chatting about it over coffee with friends — or even broaching the topic with your doctor. But it’s nothing to be ashamed of. What you’re experiencing may be vaginismus. 

Vaginismus occurs when pelvic floor muscles around your vagina automatically become tight or contract with penetration. That’s what makes sexual intercourse, inserting a tampon, or even having a gynecological exam uncomfortable for some people and impossible for others. Here is why you should talk about it: vaginismus is treatable. Read on to learn about vaginismus, its symptoms and causes, the benefits of pelvic floor physical therapy, and the best exercises to control and help relax your pelvic floor muscles.

What Is Vaginismus?

Vaginismus is a condition that causes pelvic pain and pain with vaginal penetration. It occurs when pelvic floor muscles contract with penetration. The spasms are involuntary — meaning you can’t stop them — and they make the vagina narrower and tighter. As a result, you may experience discomfort or pain with intercourse, while inserting a tampon, or during a pelvic exam. In some cases, the contractions completely prevent penetration. You may also experience anxiety due to anticipation of discomfort.   

There are two main types of vaginismus: primary and secondary. 

• Primary vaginismus is when you have always experienced spasming and pain with penetration. 

• Secondary vaginismus is when penetration was possible in the past, but pain or discomfort developed after some event (perhaps childbirth, surgery, or another event).

Vaginismus can also be described as global, when symptoms occur with all types of penetration. Or it may be situational, meaning it only happens in certain circumstances.

Vaginismus Symptoms

Vaginismus can feel different depending on how it develops and your body’s response to penetration. It often involves:

• Painful intercourse (dyspareunia), which may feel like burning or stinging or as though something is “hitting a wall”

• Penetration that is difficult or impossible due to muscle spasms or pain

• Pain or discomfort when inserting a tampon

• Pain or discomfort during a pelvic exam

Vaginismus doesn’t prevent you from becoming sexually aroused. It may, however, lead to anxiety, fear, or embarrassment about sexual intercourse. This can affect your libido and cause some people to avoid sex or vaginal penetration altogether.

Causes of Vaginismus

Doctors don’t know exactly why vaginismus happens. Different physical and emotional factors may play a role, such as:

• Fear of pain or pregnancy

•  Prior pelvic surgery

• Childbirth injuries (such as vaginal tears)

• Anxiety-related disorders

• Negative feelings or fears toward sex, perhaps due to past sexual abuse or trauma

• Infections (such as urinary tract or yeast infections)

• Health conditions that cause pelvic pain or cramping (such as endometriosis)

To make a diagnosis, your healthcare provider will review your symptoms and your medical and sexual history. Your doctor may also do a pelvic exam, sometimes using a topical numbing cream to make the process more comfortable for you.

It can be uncomfortable answering your provider’s questions about topics which may feel very personal or intimate. But it’s important to be as honest and forthcoming as you can. 

“Vaginismus can be difficult to talk about, especially if trauma is part of your story. But remember that conversations with your provider should be a safe space,” says Gina Clark, PT, DPT, a physical therapist at Hinge Health who specializes in women’s pelvic health. “I tell people that there’s no pressure to say what you don’t want to say. Just share as little or as much as you need so your doctor has the information to help address the factors that may be contributing to your symptoms.”

Vaginismus Treatments

Treatments for vaginismus can help reduce the automatic tightening of your pelvic floor muscles and address the anxieties and fears that contribute to the condition. Your provider will create a plan based on the cause and nature of your symptoms as well as your personal goals — whether it’s sexual intercourse, the ability to have a gynecological exam for health screenings, or some other goal. Treatments for vaginismus may include a combination of:

• Pelvic floor physical therapy and exercises to help to control and relax your pelvic floor muscles

• Vaginal dilation therapy using dilators to gradually allow penetration

• Prescriptions creams or injections to help decrease sensitivity

•  Mental health support to address psychological issues that may be contributing to your symptoms

• Sex therapy, which can include education and cognitive behavioral therapy to help you understand and improve feelings about your body and sex life

Benefits of Pelvic Floor Physical Therapy for Vaginismus

Your pelvic floor muscles stretch like a hammock from your pubic bone to your tailbone. They help support your vagina, bladder, and other pelvic organs, and play a role in bladder and bowel control and sexual response. When the muscles contract and spasm, it can lead to pain and other pelvic and sexual problems. Pelvic floor physical therapists (PTs) provide education and exercises to help you relax your pelvic floor muscles and reduce the tightening and contractions that can occur with penetration. Vaginal dilator therapy is often part of your PT treatment plan. This therapy is designed to very slowly and gently stretch tight pelvic floor muscles. Even more important, it can help rewire how your nervous system processes non-painful vaginal stimuli so you gradually become less sensitive and more comfortable with vaginal penetration. 

“Dilators don’t have to be scary or intimidating,” says Dr. Clark. “They come in various sizes and materials. You’ll start with the smallest dilator and go at your own pace to work your way up to the largest size you need to reach your goal.”

Pelvic health PTs take a holistic approach to your pelvic health treatment. They consider other musculoskeletal injuries that could contribute to vaginismus and address bladder and bowel symptoms that may be occurring as a result of it. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

There are many exercises to help stretch and relax pelvic floor muscles. These relaxation exercises are most effective when you, quite simply, remember to breathe. Your diaphragm (the muscle that sits on top of your rib cage) and your pelvic floor (at the bottom of your core) move together. When you inhale, your diaphragm moves down. At the same time, your pelvic floor drops and lengthens. Be conscious not to hold your breath during exercises. Instead, focus on breathing down into the pelvic floor when you inhale to help enhance the stretch. 

These gentle exercises from Hinge Health are commonly used to prevent and treat   vaginismus.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Take It One Day at a Time

“Treatment for vaginismus can sometimes feel like a rollercoaster, with good and bad days,” says Dr. Clark. “Be gentle with yourself. Allow yourself the space you need to heal. And know that with time, patience, and help from your providers, you can ease symptoms and achieve your goal.”

Learn More About Hinge Health for Pelvic Symptom Relief

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Betjes, E. (2012, June 25). What is vaginismus? ISSM. https://www.issm.info/sexual-health-qa/what-is-vaginismus 

2. McEvoy, M., McElvaney, R., & Glover, R. (2021). Understanding vaginismus: a biopsychosocial perspective. Sexual and Relationship Therapy, 1–22. doi:10.1080/14681994.2021.2007233 

3. NHS Choices. (2019). Vaginismus. NHS. https://www.nhs.uk/conditions/Vaginismus/ 

4. Pacik, P. T., Babb, C. R., Polio, A., Nelson, C. E., Goekeler, C. E., & Holmes, L. N. (2019). Case Series: Redefining Severe Grade 5 Vaginismus. Sexual Medicine, 7(4), 489–497. doi:10.1016/j.esxm.2019.07.006 

5. Pacik, P. T., & Geletta, S. (2017). Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sexual Medicine, 5(2), e114–e123. doi:10.1016/j.esxm.2017.02.002

6. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current opinion in obstetrics & gynecology, 31(6), 485–493. doi:10.1097/GCO.0000000000000584