Originally published: 19.MAR.2019
Last updated: 06.SEP.2023
Pain during sex is unfortunately pretty common. In fact, according to the American College of Obstetricians and Gynecologists (ACOG), nearly 3 out of 4 women will experience pain during sex at some point in their lives. While for some this pain is temporary, for others, it is a lifelong issue.
There are a number of reasons that a woman may experience dyspareunia (painful sex) including emotional factors such as stress and trauma, and physical factors such as injury or inflammation. One of the reasons that isn’t often spoken about is vaginismus - the body’s automatic reaction to some or all types of vaginal penetration.
Vaginismus is an often misunderstood condition which is why it’s important to support the conversation surrounding it and do what we can to spread awareness. Below we cover everything you should know about vaginismus, including the common causes and symptoms. Plus, we are joined by Jade who has been living with vaginismus for nearly 6 years.
- What is Vaginismus?
- Facts About Vaginismus
- What Causes Vaginismus?
- What are the Symptoms of Vaginismus?
- Can Vaginismus be Treated?
- Living With Vaginismus: Jade's Story
What is Vaginismus?
Vaginismus refers to an involuntary muscle spasm that prevents vaginal penetration of any kind - this can include everything from sexual activity that involves penetration to contraceptives, menstrual products, or even taking a smear test.
The International Classification of Diseases (ICD)-10 categorizes vaginismus either as a “pain disorder” or as a “sexual dysfunction comprised of a spasm of the pelvic floor muscles that surround the vagina, causing the occlusion of the vaginal opening with penile entry being either impossible or painful.”
There are two strands of vaginismus and two different types of vaginismus.
Strands of Vaginismus
- Primary vaginismus is described as an inability to experience penetration without physical or psychological pain from birth.
- Secondary vaginismus occurs when a woman develops pain in instances of penetration. It can occur at any point in a woman's life even if she has had many years of pain-free intercourse.
Types of Vaginismus
- Global vaginismus occurs on each occasion of penetration, with no visible symptoms.
- Situational vaginismus occurs in some situations that may lead to penetration.
Facts About Vaginismus
- Vaginismus is the second most common sexual dysfunction in the world and is reported to affect up to 1-7% of women, though the true number is said to be higher.
- Most females who are living with vaginismus cannot have sexual intercourse, use tampons, or have a gynecological examination.
- Currently, there is no one (known) cause of vaginismus.
- The symptoms of vaginismus can range from moderate to severe during intimate contact.
What Causes Vaginismus?
Vaginismus is a physical and psychological condition as the body and mind operate in conjunction causing the vaginal walls to spasm and contract. For some women, it is possible to insert a tampon or have a smear test however intercourse is not possible. For others, it’s impossible to penetrate the vagina in any way.
The causes of vaginismus are not fully understood, in most cases, there is no one (known) cause of vaginismus. Often, there are a number of contributing factors that play a part in the development of the condition - these can be both physical and emotional.
Physical Causes of Vaginismus
- Infections including yeast infections or UTIs
- Underlying disease or condition such as lichen sclerosis or cancer
- Low amounts of vaginal lubrication
- Previous pelvic surgery
- Insufficient foreplay
- Side effects of certain medications
Emotional Causes of Vaginismus
- Fear of pain
- Anxiety and/or depression
- Low libido
- Fear of pregnancy
- Sexual abuse
- Sexual trauma
- A feeling of vulnerability
- Emotional and mental trauma from past abuse, rape, or harassment
- Negative experiences during childhood
What are the Symptoms of Vaginismus?
Vaginismus is a different experience for everyone, however, there are some common symptoms that medical professionals often ask about before they carry out an examination.
These questions might include:
- Do you experience pain before, after, or during sex?
- Do you feel anxious at the prospect of having sex?
- Do you feel your pelvic floor muscles clenching involuntarily?
If you experience the following symptoms, it is quite likely that you are living with vaginismus:
- You experience intense fear or anxiety of penetration
- You experience sharp pain if penetration is attempted
- You experience burning and stinging in the vagina
- You experience a tightening or clenching of the vaginal walls
- You experience involuntary spasms of the vaginal wall
- The thought of sex makes you feel anxious
Can Vaginismus be Treated?
If you are concerned that you may be dealing with vaginismus, speak with a healthcare provider you trust. They will speak with you about your medical and sexual history and you may be referred to a specialist who will be able to support you in the best next steps for you.
It’s important to know that vaginismus is treatable. Although the specific treatment will typically depend on the underlying cause, it may involve:
- Psychosexual therapy
- Relaxation techniques
- Pelvic floor physical therapy
Living With Vaginismus: Jade's Story
What does vaginismus feel like?
If you were clenching your vaginal muscles, it’s like that, but all the time. I’m doing it right now, I have to remind myself to relax. You hear about people with hidden traumas and that connection to vaginismus but this just appeared out of nowhere for me.
Have you had to overcome emotional and physical barriers living with this disorder?
Yes, the condition has negatively affected relationships I’ve had with people who refuse to understand it.
It took me a long time to accept that I had vaginismus myself and to accept that treatment wasn’t something that was going to work for me right now.
Vaginal sex is impossible for me so that’s not something I consider when I’m having sex. Accepting that took a long time too, but eventually, it became second nature and allowed me to stop focusing on the condition as a negative.
What happens if there is a potential for penetration?
Whenever anything comes into contact with my vagina it seizes up, it’s an involuntary spasm, even if you’re relaxed it just happens. Even when I want to have sex I just think "No, it’s not worth it, it’s going to be sore." A wall appears. It’s just like a block.
Do you find it hard to explain vaginismus to other people?
It depends on who asks. Sometimes people are genuinely interested and willing to listen and then others point blank refuse to understand. I’ve experienced people getting angry and aggressive in the past, totally misunderstanding what I’m trying to tell them.
How did you overcome your diagnosis?
My first boyfriend couldn’t accept it and I think he believed it wasn’t a real relationship if there was no sex. I was so young and because he was my first boyfriend I believed it and thought every man was going to be like that and no one would ever be with me because I am like this.
I thought I needed to get fixed. Eventually, after we did break up, I realized this wasn’t the case. You’re starting college and everyone is talking about sex asking you if you have done it yet. In your head, that’s scary because you don’t want to say no.
It took a while to get to a place where I wasn’t ashamed of it but it’s something I have accepted now.
Jade can’t use tampons or have penetrative sex. The sheer sight of a condom is anxiety-inducing and the thought of a smear test is terrifying. The doctor told her that receiving a cervical check would involve the insertion of a vaginal swab. For Jade, this scenario seemed to be something she would never be able to go through with.
This procedure is nearly impossible for Jade due to her vaginismus. HPV is responsible for nearly 100% of all cervical cancers. It is so common that nearly all sexually active women will be infected with it at some point in their lives.
Testing for HPV involves vaginal penetration but for people living with vaginismus, this is no easy feat. On this basis, Jade decided to try a home HPV screening test.
By removing the stress of a clinical environment and someone else controlling the process, she thought it might give her a better chance of successfully testing for HPV.
Have you been able to get a cervical test before?
Is being in a physician’s office in that situation a cause of distress?
Asking my nurse about getting a smear was nerve-wracking because I knew she wasn’t going to offer an alternative I was okay with. Having past vaginal examinations has been extremely stressful too.
What was it like using the LetsGetChecked cervical swab?
It was a lot easier than I thought it would be and seeing as I was in complete control of the situation, I was relaxed and there was no pain at all. I was convinced I had collected the sample wrong though and that I hadn’t inserted the swab far enough.
How did it feel to get your result?
My result came back clear so I was obviously delighted as I had started to get paranoid once I sent my sample back, especially as there has been so much controversy around cervical cancer recently.
Would you recommend the product?
Definitely. It was easy to use and the instructions were thorough. It eliminated the hassle of having to book an appointment or take time off work.
As well as vaccination, one of the most reliable ways to avoid any complications associated with HPV is through regular testing - this can be done with your doctor or from home with a LetsGetChecked HPV Screening Test. This test is currently only available in Ireland and the U.K. This test is not a replacement for regular cervical (pap) smear tests.