Vaginismus is characterized by fear, pain and vaginal spasm in anticipation of gyn exam, tampon or menstrual cup insertion, or vaginal penetration with sexual activity (finger, toys, penis). They typical definition describes vaginal muscles (pelvic floor muscles) that involuntarily or persistently contract when women attempt vaginal penetration. The condition can be caused by physical or psychological factors or a combination. Some describe vaginismus and the reaction of the pelvic floor muscles as a similar response to when an object is brought close to someone's eye and there's a reflexive blink and protection/closure.
Primary vaginismus usually refers to the experience of vaginismus with first-time intercourse or other vaginal penetrative attempts. Secondary vaginismus usually refers to the experience of developing vaginismus a little later in life, after a period of pain-free intercourse, gyn exams or tampon insertion. This can relate to changes after giving birth, medical conditions that may have even resolved, trauma or abuse, surgery, or having painful penetration (dyspareunia) for years that has now transitioned to a full vaginismus response.
How prevalent is it?
Reports vary widely because many women don't share they have this treatable condition and suffer in silence. It ranges from 1 in 1,000 to 16 in 100 women.
What types of treatments are available?
The most important first step is to find a healthcare provider (GYN specialist, UroGynecologist, or a Pelvic PT) who regularly sees patients with pelvic pain conditions and vaginismus. Believe it or not, many OB/GYNs do not get specialized training in this area.
In some cases, women still have hymenal tissue that is completely or partially blocking the entrance to the vagina. I have had many patient cases over the years where the issue was not about the vaginal pelvic floor muscles or pyschological, but a true block from hymenal tissue (sometimes hidden and farther back than the entrance). The treatment may include a very minor procedure (hymenectomy) to cut some of that tissue away. There are also other medical conditions or hormonal deficiencies that should be considered as well.
Once other medical conditions are ruled out, the ideal treatment for vaginismus is specialized pelvic physical therapy. That's what we do! This is done in a private room and only one on one with someone who completely understands how to address this condition. In some cases, it may benefit you to also see a counselor who understands how to address pain and anxiety, as this combination of treatment works very well.
During pelvic physical therapy sessions, we assess you as a whole person, not simply as having vaginismus. We want to know about your experience and journey with this first. There's no rush with examinations. We make a plan based on your current status and what your individual goals are. Your primary goal may only be to have a GYN exam for the first time, while other women who have been married for years may want to have penetrative sexual activity for the first time. We provide treatments in the clinic (sometimes only 2-6 visits are needed) and also create a home program for you to do that may include vaginal dilators. Some women try vaginal dilators at home on their own, which may be enough. We often find that combining the full range of therapies and home management recommendations is usually much more effective. In some cases, you may also benefit from medications or topical creams provided by a physician as well.
We will be happy to share any other information you'd like about what to expect during treatments.
Is it ever too late to seek treatment?
No. Though this may start early in life, we see women in their 40s-60s who finally decided to get help for this. It's never too late. We encourage you to reach out early if you can (even in your teens). If any health provider tells you "it's just in your head" or " just relax more" or "drink wine," look for a new one. We hear this all too often and it is not helpful advice.
What if I've tried treatment and it hasn't worked in the past?
There's not an exact standard of care for the treatment of vaginismus. Over the years, I've heard patients share all sorts of stories about treatments and "potions" they received. Many of our patients have seen 10-15 healthcare providers before finding us. The most important piece of advice is DON'T GIVE UP. There's hope and there are people who can help you. (Refer to the directory below for healthcare providers in your area).
Here's an article I wrote that explains ways that physical therapy and dilators can help. Physical Therapy and Dilators. What's the Connection? ~ Tracy Sher
Vaginal Dilator Guide for Patients. Pain, Fear, and Anxiety
Vaginismus Website - How Many Women Have Vaginismus?
Listing of Pelvic Health Professionals All Over the World. Ultimate Directory.