Vaginismus: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 12, 2023

Vaginismus is a conditioned reaction that probably results from the association of pain and fear with attempts at vaginal penetration or even with penetration fantasy alone

The original negative stimulus may have been physical pain or psychological distress.

The painful condition can in some cases still be present, but in other cases it is not detectable.

Anatomically, the genitals of the vaginismic woman are normal

However, in the case of vaginismus, when penetration is attempted, the vaginal access narrows so much that sexual intercourse is impossible and even vaginal examinations often have to be performed under anesthesia.

Symptoms of vaginismus

This condition is due to an involuntary spasm of the muscles surrounding the vaginal access, which occurs whenever an attempt is made to introduce an object into the vagina.

In some women, even the idea of inserting something into the vagina can cause muscle spasm.

In vaginismus, the contraction can vary from a mild form, which induces some tension and discomfort, to severe forms, which impede penetration.

In addition to the primary spasm of the vaginal access, patients with vaginismus usually also have phobias of coitus and vaginal penetration.

This phobic reluctance makes attempts at coitus frustrating and painful.

Penetration phobia is often a secondary reaction to primary vaginismus, but sometimes it can precede it and be a primary reaction.

Types of vaginismus

A woman can suffer from permanent vaginismus if this dysfunction is present from the beginning of sexual activity.

Conversely, if the disorder developed after a period of normal functioning, vaginismus is acquired.

Furthermore, this dysfunction can be situational (if it occurs only with a certain type of stimulation, in certain situations and with certain partners) or generalized (if it always occurs regardless of the situation, the type of stimulation and the partner).

Sexuality and vaginismus

Many women with vaginismus are sexually responsive and can orgasm with clitoral stimulation, can derive pleasure from erotic play, and can seek sexual contact until all of this leads to coitus.

This condition can have a disastrous psychological effect not only on the woman but also on the partner.

The partner’s penetrative efforts, in addition to creating severe physical pain for the woman, can make her feel frightened, humiliated and frustrated by these attempts.

Furthermore, the recurring failures give rise to a sense of inadequacy resulting from the vaginismus itself.

To avoid confrontation with these painful experiences, the couple often ends up avoiding any sexual encounters.

Causes of vaginismus

Medical conditions

Any pathology of the pelvic organs which simultaneously makes penetration or sexual intercourse painful, or which has caused pain in the past, can set the stage for the development of the vaginismic reaction.

Among the physical factors most commonly cited as a cause of vaginismus are excessive stiffness of the hymen, painful hymenal remains, endometriosis, inflammatory diseases of the pelvis, senile vaginal atrophy, pelvic tumors, etc.

Obviously, if the local pathology is still the cause of pain during sexual intercourse, it is necessary to begin by curing or improving the patient’s morbid state if a good outcome of the vaginismus therapy is to be desired.

Psychological and social factors

Much more often vaginismus is due to a variety of psychological and social factors:

strictly religious upbringing
inadequate sexual information (distorted, unclear information can create feelings of discomfort and shame)
partner’s erectile dysfunction
psychological consequences of abuse

In general, any negative stimulus associated with sexual intercourse or vaginal penetration can be responsible for acquiring this reaction.

This regardless of whether the negative contingency is real or imaginary and whether the patient is aware of it or not.

The factors, therefore, can be varied but the immediate cause is specific: vaginismus occurs when a negative contingency is associated with the act of vaginal penetration or even just with the mental image of her.

Finally, stress, anxiety, depression, low self-esteem and hypercontrol/difficulty relaxing are also possible factors predisposing to the disorder.

Vaginismus treatment

The treatment of vaginismus has as its primary aim the modification of the immediate cause of the disorder: the conditioned reaction.

Treatment consists of progressive deconditioning of the involuntary spasm of the muscles of the vaginal entrance.

However, before this goal can be achieved, the phobic reluctance to vaginal penetration must be removed through psychotherapeutic procedures.

In particular, according to the classical methodology, the procedure for extinguishing the conditioned response of spasm can include the use of dilators of increasing size.

These are inserted into the vagina gradually, under the supervision of the patient, the gynecologist, the woman herself or her partner.

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