Vaginismus

Vaginismus is when the pelvic floor muscles around your vagina tighten involuntarily (without your control). This happens when you try to penetrate (put something into) your vagina such as:

• before or during sexual intercourse (sex)
• before using a tampon
• during a gynaecological examination

It makes vaginal penetration difficult, painful or impossible.
There are 2 types of vaginismus:

1. primary vaginismus — where vaginal penetration has never happened
2. secondary vaginismus — where vaginal penetration has happened but is no longer possible

Vaginismus is one of the leading causes of painful sex for females.

The main symptom of vaginismus is the involuntary tightening of your vaginal muscles. This can cause pain and discomfort.

Muscle tightening can happen when you try to put something into your vagina, such as:

• a tampon
• a penis or fingers
• an object

This may cause burning or pain. You may be afraid or have anxiety around sexual penetration.

There are many causes of vaginismus. There are physical causes such as sexually transmitted infections (STIs) or medical conditions such as:

• yeast infections (thrush)
• urinary tract infections (UTIs)
• persistent pain syndromes
• endometriosis

Psychological (emotional) causes may also play a role. For example, fear due to trauma during childbirth or negative messages about sex.
Fear might be due to past experiences of:

• painful sex
• an uncomfortable vaginal examination
• rape or sexual assault

Other causes may include:

• lack of arousal
• fear of getting pregnant
• relationship problems
• anxiety or depression
• fear of intimacy

If you are worried about the health of your vulva or vagina, or if you have symptoms of vaginismus, you should see a doctor.

See a doctor you can talk to openly. You can ask to see a female doctor, and you can take someone you trust along for support.

To diagnose vaginismus, your doctor will ask you about your symptoms, medical and sexual history. They may also ask about sexual trauma and abuse.

Your doctor will usually try to rule out any physical conditions that may contribute to vaginismus.

If your doctor thinks you may have vaginismus, they will ask for your consent to do a physical exam. Your doctor will look at your vagina to check if you have an infection. They may recommend vaginal swabs to rule out other causes. They may insert a finger to assess your pelvic floor muscles, although this may not be possible.

You have the right to refuse examination, ask for a female doctor and for a support person to be with you during a medical examination.

Your doctor may also refer you to other health professionals, such as a:

• physiotherapist
• psychologist
• sexual health therapist
• gynaecologist — a doctor who specialises in female health

There are many treatment options for vaginismus including education, pelvic floor physiotherapy, counselling and medicines.

Your doctor will suggest treatment depending on your individual situation.

Pelvic floor physiotherapy

Seeing a physiotherapist who specialises in pelvic floor exercises may help. They can teach you to relax and release your pelvic floor muscles.

Your physiotherapist may teach you exercises to do on your own using your fingers or using a vaginal trainer (previously known as a dilator). These are plastic or silicone rods with a round end used to put pressure at the entrance of your vagina and, if possible, inserted into the vagina. They help you get used to putting something into your vagina.

Trainers usually come in different sizes. By slowly increasing the size of the trainer, you can become used to having something in your vagina.

Counselling or therapy

Psychosexual therapy can help you understand your feelings about your body and sex better.

Relaxation techniques such as mindfulness and breathing exercises can also help you learn to relax your pelvic floor muscles.

A sex therapist can help you and your partner learn how to limit your pain and discomfort. By talking with each other, you can improve your sexual experiences.

Medicine

Your doctor may suggest injections of Botulinum toxin type A, for example Botox, into the pelvic floor muscles. There is still limited evidence to support how effective this is.

Your doctor may suggest medicine to help with any pain.

Undiagnosed vaginismus can affect your self-esteem. It may also lead to anxiety or depression.

People with vaginismus sometimes have fear and anxiety when it comes to vaginal penetration. This may affect relationships, and you may start to avoid all sexual intimacy.

Vaginismus cannot be prevented as it is your body's automatic reaction — you have no control over it. However, vaginismus can be successfully treated in most cases.

If you would like more information or support, the following organisations and services can help:

• Jean Hailes for Women's Health has more information about vaginismus, as well as resources for Aboriginal and/or Torres Strait Islander peoples.
• The Royal Women's Hospital has more information about vaginismus.
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

Languages other than English

• Family Planning Australia has information on common vaginal and vulval conditions available in many languages.
• Jean Hailes for Women's Health has fact sheets on vulval and vaginal health in several community languages.