Vaginismus: Causes, Symptoms and Treatment Options

In this guide to vaginismus, often referred to as vaginal spasm, I explain the causes, diagnosis, background and treatment options for this so-called “sexual dysfunction”. Through my work with affected women – both as a midwife and as a sex therapist – I know that most women initially want above all to get rid of the physical symptoms. For long-term treatment success, however, it is equally important to understand the underlying causes. For women who have already gathered sufficient information and are primarily looking for an effective product to treat the symptoms, I would like to introduce the new FMS dilators (devices for gentle stretching). Their design and application are based on my experience as a midwife and therapist. As certified medical devices, their effectiveness has been demonstrated. Many positive reviews and testimonials confirm the often very rapid treatment success. For those who are just beginning to seek information about their condition, this guide provides all the essential facts about the definition, causes and treatment of vaginismus, also known as vaginal spasm.

Contents:

What Is Vaginismus?

Vaginismus and vaginal spasm describe the same phenomenon: an involuntary contraction of the pelvic floor muscles. For affected women, it may feel as though the entire vagina is painfully cramping. This condition is classified as a sexual dysfunction and can significantly reduce quality of life. Because pain-free insertion of objects into the intimate area becomes impossible, even everyday situations – such as inserting a tampon or menstrual cup, undergoing gynaecological examinations and, of course, sexual intercourse – become major challenges. Partners, most often men, also suffer considerably from this problem.

Vaginismus is not the same as dyspareunia. Even healthcare professionals often have difficulty distinguishing between these two conditions. You can learn more in my separate guide to dyspareunia.

Causes of Vaginismus

Unlike dyspareunia, vaginismus rarely has purely physical causes. Different forms are recognised, but psychological factors generally underlie them. On the one hand, fear of penetration (for example by a penis, finger or other object) plays a major role. On the other hand, difficulties relating to female identity may also be a contributing factor. The roots often lie in childhood, when a girl did not fully perceive herself as female – frequently as a result of parental influences affecting attitudes towards the body and femininity.

What Symptoms Occur With Vaginismus?

The pronounced fear of pain during penetration leads to a painful reflex contraction of the pelvic floor muscles. This fear is psychologically extremely distressing. Fear and muscular contraction reinforce one another until they occur independently of any specific situation. This means that the pelvic floor muscles do not only spasm during sexual intercourse but that a spasm may occur at any time. A vicious circle of fear, contraction and pain develops. It is urgently necessary to remove the taboo surrounding this dysfunction. Following diagnosis, comprehensive treatment should address the physical, psychological and sexual aspects alike.

How Long Does a Vaginal Spasm Last?

The duration of a spasm varies from person to person and may range from a few seconds to several minutes. It is influenced by the situation, the individual's condition and their psychological tension. There is little that can be done to influence the duration in advance. During a spasm, relaxation techniques may help. Rather than tensing up in anticipation of pain, it is advisable to focus on breathing, conscious muscle relaxation and mental calmness to achieve relief.

Type I and Type II Vaginismus

Type I Vaginismus

This form, also known as “phobic vaginismus”, is characterised primarily by fear of penetration. A distinction is made between primary and secondary vaginismus. Primary vaginismus is diagnosed when symptoms are present before first sexual intercourse. Secondary vaginismus develops after a traumatic sexual experience. Of course, many women do not enjoy their first penetrative sexual experience yet never develop vaginismus.

For women with this form, sexual intercourse or vaginal examinations are generally impossible. The penis is perceived as threatening. Some experience sexual arousal, while others do not. A desire to have children may nevertheless be present.

Type II Vaginismus

This form of vaginismus is associated with identity-related difficulties. The affected women are unable fully to accept their own sex. After sexual maturity, a diffuse fear of motherhood often develops. These women frequently use multiple methods of contraception simultaneously when they have sexual intercourse. A certain degree of emotional immaturity may be observed. In addition, it is not so much penetration that causes anxiety, but rather “bringing something out”, for example childbirth. As a result, sexual intercourse is often impossible, whereas gynaecological examinations may still be tolerated.

Physical causes are also possible, such as a very rigid hymenal ring (formerly referred to as the hymen or maidenhead), which prevents penetration. Anatomical abnormalities such as a vaginal septum, infections, hormonal changes and dysfunction of the pelvic floor muscles may also contribute – regardless of sexual activity.

In secondary vaginismus, psychological factors are usually responsible, such as traumatic sexual experiences, negative birth experiences or an upbringing that portrays sexuality negatively. Life events such as breastfeeding, postmenopause, surgery, cancer treatments or sexually transmitted infections may also trigger vaginismus. These experiences can leave psychological traces that associate the genital area with fear or negative feelings.

Diagnosis of Vaginal Spasm

The diagnosis of vaginismus, dyspareunia or vulvodynia (extreme sensitivity of the vulva) is initially based on the woman's description as well as her medical and sexual history – including childhood and adolescence. It must then be ruled out that purely physical abnormalities are causing the pain. However, vaginal examination is often difficult because it may be extremely painful or unbearable for those affected. It is important to consult an experienced gynaecologist.

To reduce the fear of “penetration”, the patient can take as much control as possible – for example by sitting upright in front of a mirror, observing what is happening, spreading her own labia and carefully inserting a finger (her own or that of the healthcare professional) with a latex glove and lubricant. Gentle pushing, similar to having a bowel movement, can make the process easier. It is important that the healthcare professional explains every step beforehand and proceeds with particular care. Questions about the woman's current sensations are essential. The reaction of the vagina may ultimately confirm the suspected diagnosis.

If you do not feel comfortable with a doctor, speak openly about it or change doctor before undergoing an examination. A first appointment should always be for consultation only, so that you can calmly decide whether you are in the right place.

Preparation Aids: For gynaecological examinations, you can use glass dilators in a suitable size. By gently pre-stretching the tissues, they also make everyday situations easier, such as inserting tampons or applying ointments – for example in cases of vaginal flora problems or lichen sclerosus. FMS dilators (devices for gentle stretching) made from high-quality borosilicate glass are extremely smooth, durable, hygienic and easier to clean than silicone dilators. Always use a high-quality lubricant to make insertion easier.

What Can Be Done About Vaginismus?

For affected women, it is often difficult to talk about their symptoms and seek help. Shame plays a major role – particularly because vaginismus can place a heavy burden on sexual intercourse and relationships. Comprehensive counselling is therefore especially important, including discussions about sexuality with a partner.

Treatment consists of several components. The decisive factor is finding a competent and experienced therapist. Experience and empathy are essential in the field of sexuality. The following steps are common:

First, physical causes are investigated (see “Diagnosis”). If no organic cause is found, the psychological component becomes the focus. For psychotherapy, you should carefully choose the method that suits you best. Relaxation exercises and body-awareness exercises can also be helpful, for example consciously feeling the vulva, vagina and lower abdomen. Gentle exploration and positive experiences of erotic stimulation may also help – all at your own pace and without pressure.

Problems for Partners and Couples

Vaginismus, vaginal spasm, dyspareunia and vulvodynia are also stressful for partners. Men often develop erectile dysfunction because sexual intercourse is painful or impossible. Honest communication is essential. Experienced couples therapists can help you and your partner before the relationship suffers.

Erotic Treatment by a Partner

FMS dilators can also be used together as part of sexual activity. Their special shape allows a gentle approach that simulates penetration. You can find more information under Use of FMS Dilators for Couples.

How Common Is Vaginismus?

The number of unreported cases is high and reliable data are lacking. Estimates range from 4% to 42% of women experiencing occasional symptoms. Even an average estimate of around 20% shows: you are not alone.

Support Groups

Exchanging experiences with other affected women is very helpful, ideally in a support group. However, be cautious with websites where alleged sufferers recommend only one specific product – these are often disguised advertising platforms. Check credibility, for example through direct telephone contact. If possible, look for a real group in your local area.

Effective Help Through FMS Dilators

With 27 sizes starting at 14 mm in diameter and a wide range of sets, FMS dilators (devices for gentle stretching) offer the world's largest product range for vaginismus, vaginal spasm, pain during sex and other dysfunctions of the vaginal or rectal area. Our Theros® Vagina Stents can help stabilise the results over the long term.

“FMS” stands for Flexibility and Massage System.

The effect is based less on stretching and more on gentle mobilisation of the muscles through movement of the dilators.

Innovative Shape, New Material

FMS dilators are not conical like conventional products. Their streamlined head glides gently, while the straight shaft protects the tissue. Glass dilators made from borosilicate glass are exceptionally smooth – it is difficult to imagine a gentler material.

Certified Medical Device

The FMS dilators are certified medical devices. Their safety and effectiveness have been clinically confirmed.

Cooling or Warming Element

FMS dilators can be cooled or warmed. Heat is ideal for vaginismus because it relaxes the muscles. Afterwards, Theros® Vagina Stents help maintain the results over the long term.

Further Questions? Therapeutic Support

Do you have questions? Write to me at hsw@theros.de – I will be happy to reply.

Hera Schulte Westenberg, Midwife and Therapist

Further Guides:

• Pelvic Floor Exercises With Kegel Balls for Women and Men
• Kegel Balls: How To Use Them, Effects, Safe Materials And How To Choose
• What Is Dyspareunia? Definitions, Causes and Treatment Options for Pain During Sex