Finding sex painful? You could be suffering from Vaginismus

The pain it causes is most definitely real and is often described as burning, searing or incredibly painful. In simple terms, the cause is the muscles to the entrance of the vagina involuntarily contracting/clamping. It makes penetration very difficult if not extremely painful for many women. Partners may describe it as hitting a wall. Inserting tampons may also be very difficult. It can be present from when a woman first attempts penetration or develop at a later stage in their sex life.

Many women report struggling for some time before getting a diagnosis. It is often the case that a gynaecologist or GP cannot see a physiological cause for the pain being experienced but may notice that the woman struggles with the internal examination. This often leads them to diagnose Vaginismus. At times, this condition is overlooked so women can have medical conditions dismissed but not be told about the likelihood of Vaginismus, thereby struggling with pain that they do not understand the cause of. Vaginismus occurs as a result of the muscles at the entrance of the vagina contracting. The muscles can contract involuntarily so it is possible that the woman does not realise that they have contracted. For others, they may be aware that they are clenching/contracting them, such as if fearing pain on penetration.

The psychological causes that create Vaginismus can vary from person to person but can include (but are not limited to):

• Fear of penetration
• Anticipating pain
• Lack of arousal
• Low sexual confidence or poor self-image
• Relationship Issues
• Fear of pregnancy or sexually transmitted infections
• Previous medical conditions of the vulva/vagina
• Previous sexual trauma or invasive medical examinations

Vaginismus is not the only cause of vulval pain (dyspareunia). Other causes of vulval/vaginal pain may include:

• Medical conditions E.g. Thrush, Lichen Sclerosis, STIs (sexually transmitted infections), and UTI’s (urinary tract infections)
• Trauma to the vulva/vagina E.g. following childbirth, previous surgery etc
• A drop in estrogen, such as during menopause or after childbirth, can lead to pain for example – due to lack of lubrication, thinning of the skin etc
• Deep-set pain along with heavy periods can be associated with endometriosis
• Anxiety
• Pelvic Injuries

Symptoms will vary from woman to woman but typically you will experience one of the following:

• Pain when trying to insert a tampon
• Involuntary muscle contractions of the vaginal muscles when attempting sexual penetration
• Experiencing pain when undergoing a vaginal examination such as a smear test
• A burning or stabbing / stinging pain when having intercourse
• Difficulty actually achieving penetration

It’s important for partners of women to understand the condition as this can be very distressing for them and can affect their relationships. psychosexual therapists are the experts in dealing with Vaginismus. They treat this condition, via a non-invasive talking therapy, by seeking to understand the cause while working through a number of tools and techniques including:

• mindful self-focus exercises
• the use of lubricants
• dilators and other aids

The aim is to use these tools to enable positive sexual experiences.

Women’s health physiotherapists can also help with overcoming Vaginismus through the use of physical therapy. They can work with the individual to help them to relax the muscles through pelvic floor exercises and vaginal dilators. Vaginal dilators can be a very useful tool, alongside therapy, in treating Vaginismus. Dilators are silicone devices that come in a variety of graduated sizes and weights, designed to help improve sexual intimacy by lengthening and strengthening the pelvic floor muscles naturally.  As they are progressively larger it means that over time, and when you feel comfortable, you can gradually increase the size of the dilator allowing you to stretch the vaginal muscles and thereby train them to become more flexible. When done properly Dilator training can help lessen the ‘danger signals’ your brain sends as you create a calm and pain-free experience you are able to control.

JOOI’s sexologist – Miranda Christophers –  recommends seeking help for Vaginismus via COSRT’s find a therapist website. It is always important to rule out any physiological causes so if in doubt, be sure to see your GP or gynaecologist.