Vaginismus is a female sexual dysfunction and penetration disorder caused by the involuntary contraction of the vaginal muscles. This unconscious muscle reflex causes the vagina to tighten and prevent any form of penetration, examination, or sexual intercourse.
These defensive muscular contractions in the vaginal wall can be psychologically triggered, usually in response to the anticipation of pain, fear, disgust, or anguish at the thought of touch or penetration. Often, this can be rooted in a conscious or unconscious etiology, which triggers the automatic response. Vaginismus can have a profound impact on how the women feels about herself and her body but it does not have to define your life. You might be interested in reading my article getting help for vaginismus and moving from powerlessness to empowerment.
“Vaginismus can have a profound impact on how a woman feels about herself and her body but it does not have to define your life.”
New research findings including the latest ‘Vaginismus in the Irish Context by Maria McEvoy (2021)‘ , and integrative approaches and practices are paving the way for women and their partners to find new life beyond vaginismus and lending hope to those choosing psychosexual therapy to help resolve the condition.
To begin to address the effects that vaginismus can cause, we first must understand its impact on women, her partner, and the couple. So, let’s expand on this.
There are two principal forms of vaginismus: primary vaginismus and secondary vaginismus.
- Primary vaginismus – classified as a female that has never experienced vaginal penetration, including never having used tampons or undergone an internal examination. Primary vaginismus can also be referred to as Lifelong vaginismus (LLV).
- Secondary vaginismus – classified as a female who has successfully experienced sexual intercourse in the past but develops vaginismus at some point in her life. This may be due to trauma or a traumatic experience such as abuse, childbirth, disability, health condition, psychosexual issues, or psychological trauma.
- Situational vaginismus and partial vaginismus are terms associated with secondary vaginismus and refer to symptoms, which manifest because of a specific situation, environment, or set of conditions before, or during, the time of penetration.
If you’d like to learn more, consider reading the latest guide – The Integrated Guide to Treating Penetration Disorders in Women by Maha Nasrallah-Babenko (2022). There are a number of good books about female sexology that can help you learn more about resolving vaginismus.
‘Vaginismus is a common sexual difficulty that can cause distress for the woman, her partner and their relationship. Despite its universal prevalence, vaginismus remains under-researched.’ – Maria McEvoy (2021)
Signs of vaginismus usually come to light early on, such as:
- During puberty and adolescence
- Following a failure or difficulty inserting tampons during menstruation
- During early sexual experiences and attempts of sexual intercourse
- Or during medical examinations of the pelvis and vagina, like a smear test.
Once surfaced, vaginismus can cause anxiety and pain with penetration attempts, sexual pain and discomfort, fear of intimacy, and an inability to use a tampon or to tolerate an internal pelvic examination (Pacik & Geletta 2017). My clients express statements about vaginismus such as ‘like hitting a brick wall‘; ‘my body just won’t do what it’s supposed to do‘; and ‘I feel like my body keeps letting us down‘, ‘it feels like my head, my thoughts and my body are disconnected in intimacy‘.
Sexual anxiety and an aversion to intimacy can manifest as a result of fear in anticipation of touch and sexual intimacy, which, for many women, can lead to diminished desire, sexual shame, disconnect from the sexual-self, and a negative attitude towards sex. An overwhelming sense of failure and guilt can develop around penetration leading both partners to experience emotional withdrawal when not addressed openly.
Interestingly, various research presents a prevalence towards an anxious disposition in women experiencing vaginismus, highlighting the importance of understanding and managing general anxiety as part of a holistic treatment plan. Women may also experience a disconnect, dis-association or anxiety towards their sexual selves and the genital and reproductive parts of her body.
The condition of Vaginismus can result in:
- Non-consummation of a relationship or marriage
- Inability to tolerate penetrative sex
- Inability to use tampons, dilators and vaginal trainers
- Avoidance of medical examinations
- Inability to conceive through penetrative sex resulting in fertility challenges
- May trigger fears associated with conception, pregnancy and childbirth.
- Develop a fear avoidance (FA) cycle relating to touch, pain, sex and intimacy.
While these hurdles can typically be worked through in a therapy setting with an experienced psychosexual therapist, often times, the effects of this condition can cause moderate to severe feelings like fear, embarrassment, shame, and distress that sometimes prevent women from seeking out professional help.
Because of this, anxious or distressed women may eventually adopt the idea that the issue may resolve itself or that it or they are simply untreatable, if only to avoid intervention and fears of physical exams or discussions of intimate sexual issues. Thus, potentially leading to Lifelong Vaginismus (LLV).
Starting therapy is a new experience, it is a natural reaction to feel anxiety and nervousness meeting a therapist for the first time. These feelings will ease as you get used to the therapeutic relationship and trust in the guidance and direction from the therapist – personal therapy is a positive step.
If you find yourself stuck in some of these feelings, don’t worry – reach out for help and support.
This is why it is beneficial to explore options and embrace an integrative and holistic approach which is sensitive and respectful to the individual needs and autonomy of the woman. Because of potentially negative associations in response to sex due to cultural, social, religious, caregiver, or institutional influences, this sensitive and autonomous approach becomes even more crucial. Therapy provides a nurturing space to explore many of these factors and core thoughts and beliefs about sexuality that developed over time – or that may be blocking you from moving forward.
Self-diagnosis of vaginismus is on the rise due to increased information available to the autonomous women from the internet, research, social media, literature, women’s health clinics and of course the sex positive movement we find ourselves in right now. Health professionals are more open to self-diagnosis and collaboration rather than requiring a medical internal examination that may only serve to exacerbate the issue in many cases.
Verbal informed consent prior to an intimate examination is crucial to a sensitive integrative approach for the assessment and diagnosis of vaginismus. Where an internal examination is not viable due to a phobic response or fear of traumatisation, then a detailed verbal assessment is of course a viable option. Don’t let the fear of examination prevent you from seeking out professional help, you will never be forced to undergo an internal examination. Your health professional will be able to provide information and guidance that may be beneficial to you during your appointment.
The couple dynamic and working together to resolve vaginismus
‘Just talking about one’s deepest fears and longings with a partner lifts an enormous burden.’ – Dr. Sue Johnson (2008)
Traditionally, women would address problems and symptoms of vaginismus without their partner’s direct involvement, medically and in personal therapy. However, modern research by McEvoy (2021) indicates that vaginismus may be best resolved within a safe, intimate, and connected sexual relationship with the support of a nurturing couples psychosexual therapist. Vaginismus after all is a condition that sits within the couple dynamic- it impacts on the woman, her partner and the couples relationship.
An integrative approach would now include participation from both the woman and her partner, together and from the start of intervention in many aspects. The couple’s existing relationship dynamic will largely dictate how effectively they cope and resolve vaginismus together. There are a number of interventions which partners can be involved in and play an important role in resolving vaginismus. Research highlights the fact that successful outcomes prove less favourable when the partner is disengaged, disconnected, unempathetic, cruel or emotionally unavailable.
“One can understand that the partners may feel inadequate, helpless, and frustrated as well.” – Nasrallagh-Babenko (2022)
Redefining what couples mean by sex, eroticism and feeling intimately connected will stem from learning and developing skills talk openly about sexuality – in a gentle and positive way. The art of being patient and empathetic towards each other and not taking sexual feelings and experiences personally will foster a deep understanding of each others love maps and inner world.
Building upon these intrapersonal and interpersonal skills greatly reduces anxiety about sexual dysfunction, though the development of these skills often requires the support and guidance of a psychosexual couples therapist during the early stages.
An encouraging environment helps both the woman and her partner stay motivated and focused on the achieving goals and resolving vaginismus. And, the development of a true connection with a psychosexual and relationship therapist has proved essential, which emphasizes the role of the couples therapist in successful and positive outcomes (McEvoy 2021).
While a condition like vaginismus can certainly bring with it many challenges for women and their partners, it does not have to control and define their life or relationship.
Often, there are many conflicting feelings that arise from the thought of commencing couples therapy. I assure you, this is a normal response for many couples starting therapy. It is important that you find the right professional or psychotherapist for you both who will guide, support and reassure you through the integrative path.
Employing an integrative, sensitive, and encouraging approach to slowly build confidence and reduce anxiety can bring you further than you thought possible – time to manifest a sex positive mindset!
With the right holistic approach, a caring support network & therapist and a sex positive mindfulness mindset, you can achieve many successes within vaginismus.
You might be interested in reading these other interesting articles about vaginismus