Pain During Intercourse? You May Have

Vaginismus

Affecting around 1-6% of women, vaginismus is an involuntary contraction of the vaginal and pelvic floor muscles which makes sexual intercourse or penetration difficult or impossible. It’s likely that more women experience this condition, but have not yet sought treatment for their symptoms.

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Quick Answer

Vaginismus is a condition involving involuntary tightening or spasms of the pelvic floor muscles around the vagina that can make vaginal penetration painful or difficult. Symptoms may include pain or burning during sexual intercourse, difficulty inserting tampons, discomfort during gynecological examinations, tightness at the vaginal opening, and anxiety related to anticipated penetration or pain. Vaginismus may occur during a person's first experiences with penetration or develop later in life following events such as childbirth, menopause, pelvic surgery, injury, infection, or other painful gynecological conditions. Pelvic floor muscle tension and pelvic nerve irritation may contribute to symptoms. Pelvic Rehabilitation Medicine evaluates a patient's symptoms, medical history, pelvic nerves, and pelvic floor muscles to identify potential contributors to pain. The PRM Protocol™, an office-based treatment approach, targets pelvic nerve irritation, inflammation, and spastic pelvic floor muscles that may contribute to pelvic pain. Treatment may be combined with pelvic floor physical therapy, relaxation techniques, and other supportive care based on the individual's needs.

What is Vaginismus? Symptoms Causes Risk Factors Diagnosis Treatments FAQ

Understanding Vaginal Pain

What is Vaginismus?

Vaginismus is a condition that causes a woman’s vagina to spasm or squeeze involuntarily when something enters it, causing discomfort or pain. While this doesn’t stop patients from becoming sexually aroused, the symptoms of vaginismus may cause anxiety about sex, making patients afraid of sex or any kind of vaginal penetration.

Vaginismus occurs in two types that can affect women of all ages, primary vaginismus, and secondary vaginismus:

  • Primary Vaginismus: Usually occurs when women have their first attempt at sex. Penetration is difficult and their partner may feel like they are “hitting a wall” at the opening of the vagina. The woman may experience both pain and general muscle spasms. Breathing may also stop temporarily. When the attempt at vaginal entry stops the symptoms stop, too. Apart from sex, primary vaginismus may also include tampon use and gynecological examinations.
  • Secondary Vaginismus: This may be experienced at any stage in a woman’s life and can affect even those who have no history of vaginismus. Often, it results from specific events such as underlying gynecological problems, menopause, infection, traumatic events, relationship issues, childbirth, surgery, tailbone or straddle injuries, chronic sitting, chronic muscle tension, among others.

Symptoms of Vaginismus

The symptoms of vaginismus vary from person to person and can arise during sexual intercourse or other forms of penetration.

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Pain During Intercourse Causes

What Causes Vaginismus?

Vaginismus is generally caused by physical or emotional triggers, and sometimes both. Our pelvic floor holds a lot of tension, such as in the shoulders and neck, and any triggers we have may cause the muscles within the pelvic floor to tighten during intercourse or other forms of penetration.

Underlying gynecological disorders that cause pelvic…

Underlying gynecological disorders that cause pelvic floor guarding

Fear, Anxiety or guilt may trigger…

Fear, Anxiety or guilt may trigger vaginismus.

Issues in the relationship. If the…

Issues in the relationship. If the woman has an abusive sexual partner or feels too vulnerable in their presence, for instance.

Traumatic events, such as a history…

Traumatic events, such as a history of sexual abuse or premature exposure to sexual imagery at a young age.

Infections, such as a yeast infection…

Infections, such as a yeast infection or Urinary Tract Infection (UTI).

Childbirth or pelvic surgery, which can…

Childbirth or pelvic surgery, which can be very traumatic.

Menopause, which may induce hypersensitivity.
Insufficient vaginal lubrication before intercourse.
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Vaginismus

Risk Factors

Because vaginismus can be caused by both physical and emotional factors, there are many risk factors involved in developing the condition.

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    Experiencing a traumatic event relating to sex

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    Going through menopause

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    Taking certain medications

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    Certain diseases, such as lichen sclerosis or cancer

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    Underlying Gynecological conditions that cause chronic guarding of pelvic floor such as prolapse, Endometriosis, and others.

Do You Think You Have Vaginismus?

Diagnosing Vaginismus

Depending on the severity of your pain and your history, diagnosing vaginismus may involve other care team specialists in addition to our pelvic pain specialist. Usually, the condition is diagnosed through elimination. The success of the diagnosis is determined when the underlying pain trigger is properly treated.

Here’s what you can expect when you are a patient at Pelvic Rehabilitation Medicine:

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    Step One – First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.

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    Step Two – Next, an external exam of your hips, abdomen, and posterior sacrum.

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    Step Three – Next, your pelvic nerves are evaluated externally with a soft cotton tip.

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    Step Four – Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.

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    Step Five – Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on exam.

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    Step Six – Oftentimes, treatment can be started the same day as there is no down time. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.

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PRM Protocol™
Behavioral Therapy Techniques
Nutrition Health Coaching
Women’s Health

Vaginismus Treatment Options

Once a proper diagnosis has been given, we offer a proprietary office-based procedure to treat the vaginismus by reversing the contracted-spastic nature of the pelvic floor muscles that are clamping down involuntarily during penetration, resetting dysfunctional pelvic nerve firing which will allow for retraining of  the pelvic nerve and and muscle connection for optimal pelvic floor functionality.  This treatment consists of a series of pelvic nerve and muscle treatments to directly target spastic pelvic floor muscles, inflammation in the pelvis, and nerve pain. Depending on the individual case and underlying cause of vaginismus, other modalities may be needed in addition to our treatment.

  • Insertion and dilation training
    The healthcare provider may recommend supervised use of vaginal dilators. The patient inserts cone-shaped dilators into the vagina. The dilators get bigger as the treatment progresses to assist with stretching and flexibility of vaginal muscles. This helps reduce the patient’s sensitivity to penetration.
  • Therapy and Counseling
    The patient is educated about their anatomy and what happens inside her body during intercourse, including the muscles that are affected during vaginismus. Counseling may involve just the woman or both her and her sexual partner.
  • Emotional exercise
    To combat the emotional triggers, the patient is taken through a series of exercises that help her identify and resolve emotional factors that could be contributing to the vaginismus. At PRM, our behavioral health and sexual health courses such as Retrain Your Pelvic Pain, Re-igniting Intimacy, and Let’s Talk about sex all can assist with relaxing the pelvic floor muscles involved in Vaginismus.

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Frequently Asked Questions

What are the symptoms of vaginismus?

Vaginismus causes involuntary tightening or spasms of the pelvic floor muscles around the vagina, which can make vaginal penetration painful or difficult. Symptoms may include pain or burning during sex, difficulty inserting tampons, discomfort during gynecological exams, a feeling of tightness at the vaginal opening, and anxiety related to anticipated penetration or pain. Symptoms can occur during a person’s first experiences with penetration or develop later in life.

What causes vaginismus?

Vaginismus can involve physical, emotional, and situational factors. Potential contributors include pelvic floor muscle tension, previous painful intercourse, infections or other gynecological conditions, menopause-related changes, childbirth, pelvic surgery or injury, and traumatic experiences. Stress and fear of pain may contribute to a cycle of muscle tightening and discomfort, but vaginismus is an involuntary response and is not a person’s choice.

How can Pelvic Rehabilitation Medicine help treat vaginismus?

Pelvic Rehabilitation Medicine evaluates symptoms, medical history, pelvic nerves, and pelvic floor muscles to identify factors that may contribute to pain and involuntary muscle tightening. The practice offers the PRM Protocol™, an office-based treatment approach that targets pelvic nerve irritation, inflammation, and spastic pelvic floor muscles. A comprehensive treatment plan may also include pelvic floor physical therapy, relaxation techniques, or other supportive care tailored to the patient’s needs.

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