What is vaginismus (and how can therapy help)?

There are a lot of ‘shoulds’ when it comes to sex. It ‘should’ be mind-blowing. It ‘should’ feel amazing. It ‘should’ be easy and fun. While prioritising pleasure is paramount, the truth is for some, sex isn’t as simple as the media makes out. 

Because of those ‘shoulds’, when we experience problems in our sex life, talking about it can feel difficult. We might ignore the problem, try to avoid it altogether and even experience a sense of shame. A common problem those with vaginas can face is a condition called vaginismus. So what exactly is vaginismus and how can counselling help? 

What is vaginismus?

“Vaginismus was a term used to describe the involuntary spasm of the muscles around the vagina which make penetration impossible,” explains relationship and psychosexual therapist Selena Doggett-Jones. “Penetration could include the use of a tampon, finger, sex toy, medical instrument or penis.”

Selena explains that the term ‘vaginismus’ is being used less, having been redefined in the Diagnostic and Statistical Manual of Mental Disorders (DSM V) as genito-pelvic pain/penetration disorder (GPPPD).

“The condition encompasses the following persistent or recurrent difficulties with one or more of the following: 

• vaginal penetration during intercourse
• vulvovaginal or pelvic pain during vaginal intercourse or attempts at penetration
• fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
• tightening or tensing of the pelvic floor muscles during attempted vaginal penetration

“To meet diagnostic criteria, at least one of these symptoms must have persisted for at least six months and must cause significant distress.” 

What causes vaginismus?

There can be many causes when it comes to this condition, they are often multiple and complex. Here Selena outlines possible contributing factors.

“These problems can be a result of anxiety around sex and fear of penetration or traumatic emotions as a result of previous forced or non-consensual penetration. It can be that a woman has experienced pain on penetration and thus the muscles tighten in anticipation of pain in the future. There can be guilt and shame around sex as a result of cultural or religious influences. 

“Also fear of pregnancy or not trusting the contraception being used. Fear of contracting a sexually transmitted infection. Being angry with a partner or unhappy in the relationship generally. There can be fear about being overheard of privacy around sex causing anxiety.  Also physical problems like lichens sclerosis, multiple sclerosis and other conditions and diseases that cause anxiety or pain.”

How do you know if you have vaginismus?

If you notice the muscles of your vagina tightening up suddenly during penetrative sex, or when trying to insert something (like a tampon) this could be a sign you have vaginismus. You may also experience pain, which can feel like burning or stinging. If you notice these symptoms, it’s always a good idea to visit your doctor or a sexual health clinic for diagnosis and to rule out any underlying health conditions. 

Vaginismus treatment

If you are diagnosed with vaginismus, there are several treatment options. Usually, a combination of the following is most effective:

Pelvic floor physical therapy

You can work with a physical therapist who specialises in the pelvic floor. They can teach you exercises to relax your pelvic floor, helping you to relax these muscles more during sex. 

Vaginal dilator therapy

This involves using several different-sized vagina dilators and the aim is to help you feel more comfortable during vaginal penetration. You may use the exercises you learn in physical therapy to help with this process. 

Cognitive behavioural therapy (CBT)

Helping you to understand how your thoughts affect your feelings and behaviours, CBT can support if you’re experiencing anxiety, depression or post-traumatic stress disorder (PTSD).

Psychosexual therapy

You can work with a therapist alone or alongside a partner to navigate any difficulties that come up regarding sex. Below, psychosexual therapist Natasha Anderson-Foster explains more about this approach.

How can psychosexual therapy help with vaginismus?

“A therapist qualified in psychosexual therapy can help support a client by listening to their concerns and normalising them.” Selena explains.

“They can also provide information and education around the condition and when there is a knowledge deficit around sexual intercourse they can provide objective, factual information using diagrams and photos where necessary.  

“Therapy provides a safe space to explore any fears or anxiety around any relationship the client might be in as well as their past experiences of sexual intimacy and/or fear of intimacy, negative medical experiences and religious and cultural history. Speaking about deeply personal and sexual problems disempowers the fear and then the healing can begin.  

“There are also physical exercises and physiotherapy which can be done alongside therapy to help support the work. Psychosexual therapists will also be able to assess for physical problems and make suggestions for medical tests and refer to appropriate consultants where indicated.”

When it comes to sex, the only ‘should’ we need to acknowledge is that we should speak up. We should speak up about our wants, our desires, our needs and, when necessary, our concerns.

If you’re ready to speak up and work with a psychosexual therapist, you can use our site to contact Selena or search for a psychosexual therapist near you.