Is penetrative sex with your partner impossible because attempting it feels like “hitting a wall”? Have you never been able to insert a tampon? Do you skip your annual gynecological exam because the idea of having a speculum inserted into your vagina makes you extremely fidgety? If any of these scenarios resonate with you, you may have a condition known as vaginismus. Fortunately, there are treatment options.

Vaginismus is a psychological condition where the muscles of the vagina tighten up in a manner that makes the scenarios above very challenging or seemingly impossible to perform. It’s a completely involuntary response of the body triggered by fear and anxiety of penetration that affects up to six percent of women.^[1] In those with this condition, vaginismus can lead to feelings of shame, hopelessness, and body insecurity,^[4] which can result in relationship issues and mental health struggles.

The term vaginismus was first coined in 1862 by James Marion Sims, a physician and pioneer in gynecology from South Carolina. He identified several contributing factors to this condition including emotional factors (anxiety of performance, sexual abuse, sexual issues with the partner, religious beliefs, and past trauma) and physical factors (cancer, childbirth, inadequate lubrication, and insufficient foreplay).^[1]

Despite vaginismus being described over a century and a half ago, it continues to be a taboo subject, leading to significant stigma and underdiagnosis. It is rarely discussed in medical conferences, residency, or medical school. However, unlike other sexual disorders affecting women, vaginismus treatment has a high success rate.^[6]

Treatment for vaginismus often involves a combination of physical therapy and psychotherapy. It’s essential to consult with a healthcare professional to determine the most appropriate treatment plan.

Some of the Treatment Options

Kegel Exercises

Kegel exercises consist of rapidly contracting and releasing the pelvic muscles, as though attempting to stop the flow of urine. As first described by Dr. Arnold Kegel in 1948, Kegel exercises can help with more than just alleviating vaginismus. These exercises have been shown to prevent urinary incontinence and genital organ prolapse, a condition where the uterus, bladder, or rectum descend into the vaginal canal due to weakened supporting tissues.^[3] 

Vaginal Dilators

These dilators are graduated silicone or plastic tube-shaped devices that range in both size and thickness. Women insert a dilator into their vaginas and allow it to stretch the vaginal muscles for approximately twenty minutes. When they no longer experience discomfort, women can move on to the next size. This process is known as systematic desensitization.^[5] Materna Medical has come up with an ingenious vaginal dilator by the name of Milli^[TM] that gently enlarges within the vaginal area at a pace under the user’s control. In other words, Milli^[TM] does not consist of multiple dilators, rather a single dilator that women can control with the simple press of a button.

Support Online Groups/Programs

Maze Women’s Sexual Health has a comprehensive supportive forum where women can discuss their symptoms, treatment, and progress in overcoming this condition. HelloGina^[TM] offers an evidence-based digital therapy program through an app where women receive guidance from a skilled coach who supports them throughout their journey. The program, while pricey ($288), has a satisfaction rate of more than ninety-seven percent among users.

Primary Care Physician or Ob/Gyn

During the upcoming annual exam, ask your ob/gyn healthcare provider to consider using a smaller speculum. It’s also advisable to request the speculum to be warmed for added comfort. If you’ve been using dilators, you may choose to self-insert the speculum. Make sure to talk to your doctor so that the gynecological exam can proceed at a pace that is most comfortable for you.

Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is a form of psychotherapy that aims to identify and modify negative thought patterns and behaviors. It focuses on the interplay between thoughts, feelings, and behaviors, helping individuals develop healthier coping mechanisms. There is evidence that CBT may help women with vaginismus. For example, after receiving CBT for three months, eighteen percent of women were able to successfully have intercourse with their partners compared to none in the control group.^[8] 

Hypnosis

In the course of hypnosis, the underlying issues contributing to vaginismus can be examined, and efforts may be made to address, and potentially reverse, the fears and anxiety associated with the condition. Hypnosis can delve into some of the psychological causes of vaginismus, suggesting that some women have the capability of overcoming vaginal muscle spasms.^[5]

Botox

Botulinum toxin, when injected in the perineum or area between the anus and the genitals, may be an effective treatment for vaginismus based on a few studies.^[2] 

While overcoming vaginismus may initially appear quite daunting, it’s important to remember that there are available treatment options to address and manage this condition. Experiencing vaginismus can lead to feelings of shame and body insecurity, but it’s crucial to remember that you are not alone. Embracing the journey to overcome vaginismus brings the promise of empowerment, healing, and the possibility of rediscovering a fulfilling relationship with one’s own body.

References

[1] Anğın, A. D., Gün, İ., Sakin, Ö., Çıkman, M. S., Eserdağ, S., & Anğın, P. (2020). Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assisted Reproduction, 24(2), 180–188. https://doi.org/10.5935/1518-0557.20200018 

[2] Helmi, Z. R. (2022). Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus. Estudo comparativo de 150 vs. 200 unidades de toxina botulínica como tratamento para vaginismo. Revista Brasileira de Ginecologia e Obstetricia : Revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 44(9), 854–865. https://doi.org/10.1055/s-0042-1751287 

[3] Huang, Y.C. & Chang, K.V. Kegel Exercises. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555898/ 

[4] McEvoy, M., McElvaney, R., & Glover, R. (2021) Understanding vaginismus: a biopsychosocial perspective. Sexual and Relationship Therapy. 

[5] Melnik, T., Hawton, K., & McGuire, H. (2012). Interventions for vaginismus. The Cochrane Database of Systematic Reviews, 12(12), CD001760. 

[6] Pacik, P. T. (2014). Understanding and treating vaginismus: a multimodal approach. International Urogynecology Journal, 25(12), 1613–1620. 

[7] Pithavadian, R., Chalmers, J., & Dune, T. (2023). The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Women’s Health (London, England), 19, 17455057231199383. https://doi.org/10.1177/17455057231199383 

[8] ter Kuile, M. M., van Lankveld, J. J., de Groot, E., Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors. Behaviour Research and Therapy, 45(2), 359–373. https://doi.org/10.1016/j.brat.2006.03.013