How to treat vaginismus

What is vaginismus?

The main symptom of vaginismus is your vaginal muscles tightening in anticipation of penetration. If you attempt penetration, it typically causes a stinging pain.

Vaginismus can happen when:

• Inserting a tampon.

• Having a smear test.

• Attempting vaginal penetration during sex, whether with a penis, finger or sex toy.

• Something is put near your vagina.

Anxiety or fears around sex are often the cause of vaginismus, so you will likely feel anxious too.

Types of vaginismus

There are two types of vaginismus: primary and secondary.

Primary vaginismus is when you’ve always experienced difficulty with vaginal penetration. This is the type that the media most often focus on.

Secondary vaginismus is when you’ve experienced normal vaginal penetration previously, but vaginismus has since developed. This can be total or partial too, where some penetration is possible, but often with pain.

Vaginismus can also occur intermittently - in certain contexts and circumstances only.

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How to treat vaginismus

NHS guidelines for vaginismus treatments focus on the use of vaginal dilators for desensitisation, psychosexual counselling, and relaxation techniques.

Vaginal dilators

These are smooth plastic devices that help to gently stretch the vaginal tissue in people who have pain during sex or penetration. They come in various sizes, allowing you to progress at your own pace.

Helen Forth is a specialist pelvic and women's health physiotherapist with 20 years' experience treating vulval pain issues like vaginismus, and hypertonic pelvic floor muscles. She says: "Always use dilators within your comfort zone and increase your tolerance slowly: the same goes with any myofascial release of the pelvic floor muscles. This is only something you should do when you've had some guidance from a specialist pelvic health physiotherapist."

Psychosexual therapy

This is a type of therapy that aims to address the psychological and physical aspects of vaginismus. It focuses on managing fear and anxiety around vaginal penetration through education and relaxation.

"What you're wanting to do is chalk up positive experiences when something is inserted into the vagina so that the brain stops anticipating that insertion relates to pain," Forth adds.

Medication

Drug treatments for vaginismus are less common but include local anaesthetics and muscle relaxants. Injected Botox is also sometimes used, but remains an experimental treatment.

How to treat vaginismus at home

Not all treatments for vaginismus require seeing a doctor. There are several things you can try at home to help you relax too.

Pelvic floor exercises

Pelvic floor exercises, (also known as Kegel exercises), strengthen the muscles that support your uterus, bowels, bladder and rectum. They can help retrain and relax the pelvic muscles to allow penetration.

Relaxation techniques

Relaxation techniques such as deep belly breathing, and yoga positions like child’s pose, encourage relaxation and lengthening of the pelvic floor. These techniques allow you to keep calm, leading to pain free and pleasurable penetration.

Forth says, "Using specific breathing techniques and yoga positions are a vital part of treatment too, as they encourage relaxation and lengthening of the pelvic floor. Combining all this with psychosexual counselling (if indicated) will really help."

Where to seek help for vaginismus

If you think you may have vaginismus, visit your doctors or local sexual health clinic to rule out any other cause of your symptoms, such as an underlying infection.

You may be referred to a gynaecologist or vulval pain clinic and can ask to be assessed by a specialist pelvic health physiotherapist. Some vulval pain clinics will offer this service on the NHS, or you can seek a private consultation.

What causes vaginismus?

Vaginismus can be caused by physical or psychological factors, or a combination of both. These factors include:

• A traumatic gynaecological examination (smear test).

• A painful sexual experience.

• Sexual abuse.

• Medical conditions such a thrush.

• A belief that sex is shameful and unpleasant.

Though distinct from vaginismus, difficulty achieving vaginal penetration can also be caused by an hypertonic pelvic floor. This is when the vaginal muscles become overactive and tight, causing pain when stretched. Forth explains:

"Vaginismus is the spasm of the muscles at the entrance of the vagina. Often women will describe the sensation of a physical block when they try to insert something. That's different to overactive pelvic floor muscles that may be in a constant, chronic state of increased tension a lot of the time, which does seem to be the case for some women."

Forth often sees patients with secondary vaginismus who have also been diagnosed with vulvodynia and vulval pain syndromes. "There can be more than one thing going on - potentially a wider pelvic dysfunction alongside psychosexual issues and neuropathic pain, so it is important to take a multidisciplinary approach to treatment for the best results."

Sam's story

Sam Evans had secondary vaginismus for many years and still has episodes from time to time. She says the condition was triggered initially by using an intimate lubricant containing additives that contributed to recurrent bouts of bacterial vaginosis, thrush and urinary tract infections.

"Every time we used this lubricant during sex I would get irritation or an infection and that made me start to view sex and my vagina in a negative way," she says. "I still wanted to have sex and I tried to relax, but my vaginal muscles were so tight that penetration was either impossible or really painful. On some level, I was worried about getting another infection and over time those worries had become a body response that I couldn't consciously control."

Evans saw her GP who diagnosed vaginismus and suggested a psychosexual approach to reduce stress. It was only when she removed the initial trigger for the vaginismus that she started to recover, explains Evans.

"It was using a lube that didn't irritate that made the difference because then I stopped getting infections and eventually my body got the message that I didn't have to clamp up and protect myself from sex anymore. Also, realising we could still enjoy ourselves through mutual masturbation took the pressure off having penetrative sex every time."