Vaginismus Treatment

Common indicators of vaginismus include:

• Difficulty inserting tampons
• Challenges with gynecological examinations
• Struggles with vaginal penetration during sexual intercourse
• Experiencing a burning or stinging pain during sexual activity
• Painful sexual intercourse

Both vaginismus and dyspareunia were older terms for what is now classified as genito-pelvic pain/penetration disorders in the DSM-5. This was amended after the inability to determine significant differences between both dyspareunia and vaginismus. They were both characterized by:

• An inability to achieve penetration or intercourse
• A significant fear or anxiety towards penetration or intercourse
• Tensing or contracting of vaginal muscles during or before intercourse
• A significant vaginal/pelvic pain during intercourse or penetration

However, a slight difference exists between the two in regards to when the pain presents itself during penetration. In vaginismus, the pain typically occurs when penetration is attempted, whereas dyspareunia encompasses the pain that occurs during deep penetration.

Vaginismus can be classified into two types: primary and secondary. Primary vaginismus occurs when women have never been able to achieve vaginal penetration and have experienced pain and discomfort from an early age, such as when attempting to use a tampon or undergoing their first gynecological examination. Secondary vaginismus develops when women who have previously experienced vaginal penetration can no longer tolerate it due to factors like childbirth or hormonal fluctuations.

The causes of vaginismus can vary among individuals, and it may be a combination of different factors for each person. Most importantly, physical factors contributing to vaginismus must be ruled out, such as thrush, urinary tract infections or anatomical abnormalities. As such, the symptoms are medically unexplained, and are primarily rooted in psychological factors. Anxiety surrounding sex often plays a significant role, and addressing and managing these fears is crucial in changing negative perceptions related to sexual activity and penetration.

Previous sexual trauma or experiences of pain during vaginal penetration, such as painful intercourse or medical procedures, can create a fear response, causing the pelvic floor muscles to involuntarily contract in anticipation of pain. Sociocultural or religious beliefs and taboos surrounding sex may also contribute to the development of vaginismus, and negative or restrictive views about sex can lead to anxiety during sexual activities.

Cognitive Behavioural Therapy (CBT) is commonly used to explore our thoughts and emotions and their influence on our behaviour. Empirical evidence supports CBT as an effective treatment for the underlying issues associated with vaginismus, including psycho/sex education, and challenging negative thoughts (also called cognitive restructuring) surrounding sex. Some typical examples of unhelpful thoughts include:

• Sex is dirty and shameful
• I had a negative experience during sex, all sex must be bad
• My first time having sex hurt, I won’t ever enjoy it

However, the most common thinking error in people with vaginismus (particularly primary vaginismus) is that their vagina is too small to fit a penis, which mostly stems from a lack of education surrounding sex and female anatomy. This is why sex education is so important in order to have a sense of the vagina’s structure and functionality, and engage in body awareness by exploring your own vagina using a mirror. As such, cognitive restructuring is imperative in breaking the vicious circle of vaginismus.

Gradual exposure is also proven to be one of the more effective interventions for vaginismus, as it involves confronting the fears around penetration by gradually exposing yourself to it, starting with your pinky finger and working your way up to something more penis-like. This can also be achieved through the use of vaginal dilators, starting with the smallest size. You may have to try this a few times until you feel comfortable. If anxiety comes creeping in, start investigating your experience: what thoughts are you having? What are you feeling? Could you replace any negative thoughts with more positive or balanced ones? If the exercise becomes painful, revert back to a previous stage that you know you can handle, or just stop and try again another time.

Additionally, incorporating pelvic floor exercises has been proven to help with vaginismus by strengthening the pelvic floor muscles surrounding the vagina. Start by tightening and relaxing the pelvic muscles periodically, around 10 to 15 times. After this, tighten the muscles and hold it for three seconds before letting go again for another 10 to 15 times. If you have trouble knowing whether you’re tensing the right muscle, try gently placing your fingers over your vagina – you should be able to feel it contracting.

At Private Therapy Clinic, our therapists will discuss sex education, and collaborate with you to understand the types of thoughts/beliefs you have around sex, the main emotions present, and the behaviours which ultimately stop the vaginismus from improving. The most typical behaviour is avoidance, where an individual avoids any sexual activities due to the fear of pain. Our therapists will assign action plans for you to do outside the sessions to confront your fears and avoidant tendencies, such as using dilators, pelvic floor exercises, or relaxation techniques.

If appropriate, our therapist may also ask your partner to be present during a few of the sessions, to communicate the rationale for treatment and to encourage their involvement in your recovery. As such, many action plans may include your partner’s input or presence, therefore it is important for them to be on board with the treatment alongside you.

If you would like to talk to someone about vaginismus treatment, please get in touch with the Private Therapy Clinic on Whatsapp message at: +447511116565 email, chat bot or book online to arrange an appointment.

Ford, V. (2010). Overcoming sexual problems : a self-help guide using cognitive behavioral techniques. Robinson.

Lahaie, M., Boyer, S. C., Amsel, R., Khalifé, S., & Binik, Y. M. (2010). Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology and Treatment. Women’s Health, 6(5), 705–719. Link

NHS. (n.d.). Vaginismus. NHS choices. Retrieved March 1, 2022, from Link

ter Kuile, M. M., van Lankveld, J. J. D. M., Groot, E. de, Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors. Behaviour Research and Therapy, 45(2), 359–373. Link

Singh, V., Padhy, S. K., Sahoo, M. K., & Biswas, H. (2014). Primary Vaginismus and Associated Phobia: Successful Treatment with Behavior Therapy. Journal of Postgraduate Medicine, Education and Research, 48(3), 151–153. Link

Vaginismus: Symptoms, Causes, Treatments, and More. (2012). Healthline. Link