Vaginismus: Too Tight Not Right

Andrew Siegel MD   12/12/15


Vaginismus is a medical condition in which a woman’s vagina is unable to be penetrated despite her desire to be receptive to vaginal intercourse. There are often both physical and emotional factors that underlie this disorder. Spasticity of the vaginal and pelvic floor muscles as well as fear and anxiety issues are typically present. Vaginismus has significant psychological ramifications, negatively influencing self-image and potentially undermining and destroying relationships.

Even though vaginismus was initially described in the medical literature over 150 years ago, it remains a misunderstood, under-diagnosed and under-treated disorder. It renders the sufferer either unable to be vaginally penetrated or able to be penetrated, but at the cost of experiencing severe pain. This can occur whether the vaginal penetration is via a finger, tampon, at the time of a gynecological exam or with sexual intercourse. This condition causes embarrassment and frustration and is not a topic that most women are readily willing to discuss with their physician, friends or family members.

The precise underlying causes of vaginismus remain unknown, although possible contributing elements may be a history of sexual molestation,  a traumatic pelvic examination or gynecological procedure at a young age, strict sexual constraints, religious factors and excessive fear of sexual intercourse, sexually transmitted infections and pregnancy.

Men who attempt to have sexual intercourse with women suffering with vaginismus often describe “hitting a wall” or “absence of a hole down there,” reflecting the excessive tone and spasticity of the vagina and pelvic musculature.  Pelvic examination of a woman suffering with vaginismus usually demonstrates that the muscles surrounding the entry to the vagina are in spasm, akin to a tightly clenched fist.

Understandably, after attempts at unsuccessful sexual intercourse, women with vaginismus often develop an aversion to sex because of actual pain as well as anticipated pain. This sets up a vicious cycle in which emotional fear fuels more physical spasticity, further exacerbating the problem.

Fortunately, vaginismus is a manageable condition.  Treatments address both the physical and emotional aspects of the problem and include the following: vaginal dilators; pelvic floor physical therapy; sexual counseling; psychotherapy; hypnotherapy; cognitive behavioral therapy; and Botox. Combination treatment that is tailored to the specifics and nuances of the situation and individual are the most effective means of fostering vaginal and pelvic relaxation and improving this condition.

The idea behind vaginal dilation is to gradually and incrementally stretch the vagina and allow the patient to become comfortable with penetration. There are many dilation regimens varying with respect to the size of the dilators used and the length of time the dilators are retained, with some programs having the patient sleep with the dilators in place. If successful, transition to sexual intercourse can proceed.

Pelvic floor physical therapy via physical therapists who specialize in pelvic floor issues can be extremely helpful and effective, particularly trigger point release combined with pelvic floor muscle stretching and lengthening techniques to increase the flexibility of the pelvic muscles.

Psychological approaches include psychotherapy and cognitive behavioral therapy. Psychotherapy attempts to uncover deep and often unconscious motivations for feelings and behavior. Cognitive behavioral therapy aims to train the mind to replace dysfunctional thoughts, perceptions and behavior with more realistic or helpful ones in order to modify fear of vaginal penetration and avoidance behavior. 

Botox is broadly used in many medical disciplines to temporarily paralyze spastic musculature. For vaginismus, Botox is injected into the spastic vaginal muscle and adjacent pelvic floor muscles and seems to be a promising treatment.

As opposed to the chronicity of vaginismus, penis captivus is a rare acute condition in which a male’s erect penis becomes acutely stuck within a female’s vagina. It is theorized to be on the basis of intense contractions of the pelvic floor muscles, causing the vaginal walls to clamp down and entrap the penis. It usually is a limited event and after female orgasm and male ejaculation, withdrawal becomes possible. However, at times it requires emergency medical attention with a couple showing up in the emergency room tightly connected like Siamese twins.

Bottom Line:  A well-toned vagina is highly desirable from the standpoint of sexual health as well as pelvic health.  Having a fit vagina and pelvic floor muscles will often prevent pelvic organ prolapse and urinary incontinence and contribute to a healthy and enjoyable sex life. Vaginismus is an unusual–but treatable– medical problem in which the vagina and pelvic muscles are so tight that the vagina  cannot be penetrated.  The mind-body connection plays a key role in the development of this condition, which is so much more than simply a physical issue.  Vaginismus can have devastating psychological and emotional consequences, creating a vicious cycle that perpetuates the problem. 

Reference: PT Pacik: Understanding and Treating Vaginismus: a multimodal approach, International Urogynecology Journal (2014) 25:1613-1620

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works and coming along nicely is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.

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