Understanding Vaginismus – What’s Going on Down There?!

***Content Warning: This article discusses sexual violence in the context of medical conditions. 

Do you experience consistent vaginal pain and tightness? Is it hard for you to use tampons and menstrual cups? Is it nearly impossible or incredibly painful for you to have penetrative sex?

If you answered yes to any or all of these, you may be suffering from Vaginismus. 

Vag-i-what-mus?

Yes, Vaginismus. It’s a real disorder that has a real impact on people’s lives. 

Vaginismus is a condition that causes the muscles surrounding the entrance to the vagina to involuntarily tighten, causing penetration to be extremely difficult and uncomfortable. 

Some medical providers also refer to the condition as Genito-Pelvic Pain or Penetration Disorder, GPPD, as well as Sexual Pain Disorder. 

While the exact number of people that experience symptoms of Vaginismus is not known, an estimated fifteen percent of women in North America have consistent pain with intercourse. 

For some people with Vaginismus, they may be able to use tampons with no issues, but have difficulty and pain with penetrative sex. This roadblock to intercourse can interfere with their ability to have healthy, thriving relationships – although of course, it’s totally possible. 

GPPD is most commonly diagnosed in people who are in early adulthood, or in their perimenopausal or postmenopausal years.

It’s All in Your Head

Believe it or not, Vaginismus is actually caused by a dysregulation in the limbic system: the group of structures in your brain that regulate motivation, memory, and emotion. 

In the case of GPPD, the limbic system reacts to the idea or act of penetration by involuntarily tightening the vaginal muscles, as a way of protecting itself from potential harm or pain. Some studies indicate that people with Vaginismus exhibit structural abnormalities in the hippocampus and amygdala, two areas of the brain that help regulate fear. 

Just because it starts in your head, does not mean the pain, emotional hardship, and other difficulties experienced with GPPD aren’t very real. 

Symptoms of Vaginismus (GPPD)

While symptoms may slightly range from person to person, these tend to be the most common ones: 

• Dyspareunia, aka painful intercourse.
• Reduced or no sexual desire.
• Pain upon penetration.
• Vulvovaginal and pelvic pain when attempting intercourse.
• Fear and/or anxiety surrounding penetration.
• Tensing and tightening of the pelvic floor muscles during penetration.

Diagnosing Vaginismus 

Diagnosing GPPD is fairly straightforward. Someone who is experiencing the symptoms listed above that are causing clinically significant distress persistently for at least six months, will most likely be diagnosed with Vaginismus.

Just because someone has been diagnosed with GPPD, does not mean that treatment will be so straightforward. When diagnosing someone, their provider will also take into account the many compounding factors that exacerbate or cause their symptoms. 

Providers will take note if there are other factors that could be causing discomfort with intercourse like those caused by severe relationship distress including domestic violence, or by medication or another other medical condition.

They will want to know the context of someone’s cultural and religious attitudes towards sex, as culturally embedded shame around sex can cause a limbic system response leading to Vaginismus. Prior mental health disorders and traumatic events including physical or emotional abuse, as well as poor body image can be causal factors. Has this patient experienced rape or another form of sexual abuse/violence?

Other prior physical conditions can lead to Vaginismus like vaginal infections and conditions in genital-pelvic area, including endometriosis. GPPD can also develop in the postpartum period after someone has a baby.

Vaginismus can be a lifelong or acquired disorder.

Treating Vaginismus 

Because this disorder involves examining the body-mind connection, it may take multiple levels of treatment in order to find relief. Treatment will also be dependent on the cause or causes of someone’s individual case. 

In the case of symptoms appearing after pregnancy and birth, time and patience are two of the biggest factors. Some women may also be helped through pelvic floor physical therapy.

No matter the cause, people may find relief by seeing a licensed sexological bodyworker. These practitioners uses internal massage in the vaginal and anal area, along with communication and education to help them heal holistically.

For people who have Vaginismus as a result of endometriosis or another gynecological disorder, surgery or treatment of the underlying condition can help to relieve symptoms. 

Using vaginal dilators can help people with GPPD gradually increase their comfort levels with varying sizes of penetrative objects. Hope and Her, an organization that provides information and treatment for pelvic disorders, features a Vaginismus video series to help people use dilators and other methods for at-home treatment. 

Another tool to help heal Vaginismus is using a device like Intimina’s KegalSmart, as well as practising kegels without a device. 

No matter the cause, Vaginismus can be an incredibly emotionally tolling disorder, and patients may find the most relief by combining treatments with ones that help to treat them psychologically as well. That may very likely mean seeing a licensed therapist or psychologist, especially if abuse or violence is one of the underlying factors. 

Sex and Vaginismus

As you can imagine, or know from experience, Vaginismus can cause someone to avoid sex, and possibly romantic relationships overall.

This is why it’s important that if someone has a partner, to include them in the healing process.

Going to a specialist like a couple’s therapist or sex therapist will help a couple to develop communication and understanding around the condition and how to navigate it together.

Having adequate foreplay and stimulation can help the body ease into the experience, and produce enough lubrication to help with penetration. Using the right lube for your body can also help to decrease discomfort. 

Remember also that penetration is not required to have sex or meaningful intimate experiences. Here are plenty of tips to get sexy sans penetration.

Whatever your journey with Vaginismus looks like, we encourage you to seek professional help, listen to your bodily intuition, and approach treatment from a holistic lens.