Synonyms
Spastic vagina, vaginal spasm, Brick wall vagina
Subdivisions
There are two types of vaginismus, primary and secondary. People who suffer from primary vaginismus have always encountered pain with vaginal penetration due to involuntary spasms of the vaginal musculature. With secondary vaginismus, individuals have experienced painless vaginal penetration prior to the onset of symptoms.
General Discussion
People with vaginismus tend to have pain with any type of vaginal insertion, both from sexual and non-sexual activity, such as undergoing a pelvic exam or putting in a tampon. Some individuals are able to relax their muscles enough to allow some penetration, while for others, even the thought of penetration may cause pain or anxiety. When attempting penetrative activity, people may feel like they are “hitting a brick wall” and may describe sensations such as “rubbing on broken glass” or “sandpaper in my vagina,” especially if they try and push through the spasmed muscles. Unconscious contraction of the muscles at the entrance of the vagina can be visualized during pelvic exams, and with more severe types of vaginismus, involuntary closing the legs (leg lock), or evasive movements such as climbing up an exam table, may be seen.
Signs & Symptoms
Difficulty or inability to engage in penetrative vaginal activity due to pain or the fear of pain
Involuntary spasming or closure of the muscles at the entrance of the vagina
Expulsion of inserted objects from the vagina due to muscular contraction
Causes
While the exact cause of vaginismus is unknown, there are many factors that may contribute to its occurrence. A history of trauma, such as emotional or sexual abuse, or fear or preconceived notions about sexual activity – such as “I know it’s going to hurt the first time,” may predispose one to developing vaginismus. For people with secondary vaginismus, a specific event, or series of events, can often be identified that lead to the occurrence of the symptoms.
Affected Populations
Anyone with a vagina may experience vaginismus, although the disorder is most common in people who have gone through puberty. The exact prevalence of vaginismus is unknown, although it is estimated that between 0.5-17% of people with vaginas worldwide may be affected by the disorder. Unfortunately, this number most likely much higher, as many individuals do not feel that they can safely or effectively report their symptoms. Individuals with a history of trauma or sexual abuse, as well as those who experienced a very rigid or strict upbringing, are at a higher risk for developing vaginismus.
Diagnosis
Vaginismus is diagnosed based on a patient’s history and physical exam. There are no laboratory tests or imaging studies that can diagnose vaginismus. In research facilities and specialized treatment centers, electromyography (EMG), a measurement of muscle contraction, may be used to determine the strength of the spasmed muscles, but diagnosis is still made from clinical history and observation.
Standard Therapies
Historically, treatment for vaginismus has been directed by either pelvic floor physical therapists or mental health counselors. While these specific treatment avenues remain the most common methods of addressing symptoms, current research also points towards the use of dilators to help patients not only overcome their fear of vaginal insertion, but also desensitize the tissue to penetration. In addition, muscle relaxants have often been prescribed to aid in these treatment protocols, although no specific gold standard of pharmacologic therapy exists. It should be noted that surgical excision of vaginal or vestibular tissue is not considered a treatment of choice, and should only be performed by experienced surgeons in specific circumstances.
Investigational Therapies
Multimodal therapeutic approaches are being studied, with combination treatments such as OnabotulinumtoxinA (Botox) injections combined with dilator use and pelvic floor therapy. Trauma-focused psychotherapy, such as EMDR (Eye Movement Desensitization and Reprocessing) is also being investigated for the treatment of vaginismus
Support Available
The Vaginismus Network - The Vaginismus Network
Hope and Her – Vaginismus Support Group – Hope&Her (hopeandher.com)
Lady Parts Gone Wrong – Vaginismus Support Groups (ladypartsgonewrong.com)
Patients Like Me – Vaginismus symptoms, treatments & forums | PatientsLikeMe
References
1. Pacik PT, Babb CR, Polio A, Nelson CE, Goekeler CE, Holmes LN. Case Series: Redefining Severe Grade 5 Vaginismus. Sex Med. 2019 Dec;7(4):489-497. doi: 10.1016/j.esxm.2019.07.006. Epub 2019 Aug 28. PMID: 31473152; PMCID: PMC6963107.
2. Zarski AC, Berking M, Fackiner C, Rosenau C, Ebert DD. Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial. J Sex Med. 2017 Feb;14(2):238-254. doi: 10.1016/j.jsxm.2016.12.232. PMID: 28161080.
3. Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 2017 Jun;5(2):e114-e123. doi: 10.1016/j.esxm.2017.02.002. Epub 2017 Mar 28. PMID: 28363809; PMCID: PMC5440634.
4. Maseroli E, Scavello I, Cipriani S, Palma M, Fambrini M, Corona G, Mannucci E, Maggi M, Vignozzi L. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med. 2017 Nov;14(11):1392-1402. doi: 10.1016/j.jsxm.2017.09.015. PMID: 29110807.
