Have you ever struggled with putting something in your vagina? We know, it’s a weird question. But we’re asking because we want you to know that if you’ve ever experienced pain when putting in a tampon, masturbating, or having penetrative sex, you’re not alone! Research suggests up to 33% of people with vaginas experience pain before or during vaginal penetration, and experts suspect the number is actually higher.
If you’re one of those people, you may have a condition called vaginismus. The good news is, vaginismus is very treatable. In fact, a 2017 study published in the Journal of Sexual Medicine found that more than 90% of people get over vaginismus once they start a treatment program!
Vaginismus is a medical condition where the pelvic floor muscles surrounding the vagina involuntarily tighten, making it difficult or even impossible for anything to penetrate the vagina. People with vaginismus often experience painful muscle spasms, because the muscles in and around the vagina contract so much that any penetration they literally hurts.
But vaginismus isn’t just physical – there’s a strong psychological component as well, as many people living with it also suffer from a lot of fear, anxiety, and shame and unpleasant thoughts. The fear of penetration can actually cause those same vaginal and pelvic floor muscles to tighten up even more. This can make the discomfort worse and might make penetration even more challenging. It’s a cycle of pain, which can worsen physical symptoms, and can amongst others also lead to psychological symptoms like anxiety, depression, toxic shame, and significant interpersonal issues.
Causes and risk factors
Experts aren’t entirely sure what causes vaginismus, but research suggests that a complex combination of physical and psychological issues contribute to the condition.
Physical factors that contribute to vaginismus can include (but aren’t limited to):
- Vaginal or pelvic anatomy that makes penetration difficult
- Scar tissue from previous surgeries on the reproductive organs or childbirth
And psychological factors that contribute to vaginismus can include (but aren’t limited to):
- Pressure and expectations from society (for example, pornography)
- Negative body image
- Low self-esteem
- Fear of giving up control
- Relationship problems
- Trauma from physical, emotional, or sexual abuse
Vaginismus is rooted in the powerful connection between the mind and body. Dr. Ashley Rawlins, a pelvic floor physical therapist who specializes in pelvic pain disorders, explains that when people experience pain before or during penetration, it sends a “warning signal” to their brains that activates a fight or flight reaction. This triggers the muscles in the vagina and pelvic floor to contract.
When people experience pain before or during penetration regularly, the brain basically panics and sends a signal to tense all the muscles around the vagina, causing painful muscle spasms. This pain creates a fear of penetration, which triggers the brain to tense the muscles around the vagina when penetration is attempted, causing more pain, causing more fear and anxiety and so on.
Since vaginismus is intrinsically tied to the body’s response to the brain, the condition is more common among people who’ve experienced emotional or sexual trauma, associated sex with fear and shame, held negative beliefs about sex, had a lack of sexual education, experienced pressure around sexual encounters, or struggled with body image issues or relationship problems.
Since vaginismus is a physical and psychological condition, any successful treatment plan needs to address both the body and the mind: Studies show that the most effective vaginismus treatments are holistic ones that address both, as opposed to programs that only address one or the other. And some, like HelloGina, let you treat your vaginismus yourself.
Physical treatments for vaginismus
The goal of physical treatments for vaginismus is to lessen, and eventually stop, the painful muscle spasms that happen before and/or during penetration. These physical treatments focus on teaching you to relax and control the pelvic floor and vaginal muscles and to learn pain-free vaginal insertion step by step.
Research shows people who struggle with vaginismus often have extremely tight muscles in their vagina and pelvic floor; learning to relax those muscles is a crucial part of treatment. The easiest way to start is by practicing deep belly breathing. This relaxes the abdominal muscles, which, in turn, helps relax the muscles of the pelvic floor and vagina.
Visualization techniques can also be really helpful. You can visualize the muscles in and around your pelvic floor and vagina, then visualize letting go of the tension in those muscles, while doing deep belly breathing.
Pelvic floor exercises
Once you’ve learned to relax the muscles in the pelvic floor and vagina, you can start to do pelvic floor exercises, which teach you how to intentionally control the muscles in and around your vagina and pelvic floor. Exercises like pelvic floor breathing, pelvic floor drops, child’s pose, and piriformis stretches can help you target your vaginal and pelvic floor muscles, deliberately contract them, and then deliberately relax them. Practicing tensing and releasing your muscles will help you identify when they’re tightening up before penetration and give you the techniques you need to help them relax on command.
When you’re comfortable with controlling your vaginal and pelvic floor muscles, you can start to reintroduce penetration using your fingers or vaginal dilators, which are tube-shaped devices made of silicone or plastic that come in multiple sizes.
The purpose of vaginal dilators isn’t to change your vagina. Your vagina isn’t too tight and it doesn’t need to change! Your vagina feels tight because of the muscle spasms triggered by the fight or flight response in your brain.
Vaginal dilators help teach your body and brain that penetration can be pain-free. After successfully inserting a vaginal dilator, your brain registers that the dilator is in your vagina without pain. Successful penetration with vaginal dilators also reduces the anxiety and fear of penetration, and eventually, your brain learns to stop triggering muscle spasms before and during penetration.
We also know that dilator therapy can seem scary, so we’ve prepared a series of articles specifically designed to help guide you through every step of the way. Take a look under the “vaginismus” tab on our blog homepage to learn more.
To truly overcome vaginismus you’ll need to combine physical treatments with some psychology-based treatment. A few techniques have proven particularly successful.
Mind-body relaxation techniques
Our brains are designed to protect us from harm. When an activity hurts, our brains trigger responses like fear and anxiety to prevent us from engaging in that activity again. Part of retraining how your brain responds to penetration is moving through that fear and anxiety, at your own pace.
One of the best ways to accomplish this is through mind-body relaxation techniques. Mindfulness and meditation practices can trigger feel-good hormones that ease the fear and anxiety, which can interrupt the brain’s signals to tighten the pelvic floor and vaginal muscles. These relaxation techniques also help you tune into your body so you can experience what it feels like for your pelvic floor and vaginal muscles to relax.
Progressive muscle relaxation, a mind-body relaxation technique in which you purposely tense then relax your muscles, is another particularly helpful mind-body relaxation technique for vaginismus because it demonstrates that you have the power to control the contraction and relaxation of your vaginal and pelvic floor muscles.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy, or CBT for short, is a therapeutic approach widely utilized for addressing various mental health concerns. Emerging research indicates that it can be a potent tool in the management of vaginismus. The primary objective of CBT is to disrupt the cycle of pain associated with vaginismus by challenging and altering the negative thoughts, emotions, and physical responses that are intertwined.
If vaginismus has been a part of your life, it's likely that the mere thought or attempt of vaginal penetration triggers a series of negative emotions and thoughts. You may find yourself thinking, "I will never be able to have penis-in-vagina sex," "My vagina is too tight," or "There's something fundamentally wrong with me because I can't insert anything into my vagina."
While these thoughts might have originated from past experiences, it's important to understand that they are not entirely accurate. Holding these beliefs can actually amplify vaginismus symptoms, as they lead to a self-fulfilling prophecy where the body responds by tightening the vaginal and pelvic floor muscles, culminating in pain.
During CBT, mental techniques are learnt and employed to help identify these detrimental thoughts. The aim is to logically scrutinize them, challenge them using factual information, and substitute them with more constructive and helpful thoughts such as "I can't predict the future, so it's not certain that penetration will always be painful," "There is nothing wrong with me or my body," "There's no need to rush, it's a step-by-step process," or "It's okay to experience pleasure. Patience is key."
By shifting the perspective about the body and its symptoms, and most importantly, understanding why these symptoms manifest, it becomes possible to retrain the mental and physical responses to penetration. This fosters a healthier relationship with intimacy.
Holistic digital programs
Holistic treatment approaches that address both the psychological and physical symptoms of vaginismus tend to be the most effective. But accessing all these treatments usually involves seeing multiple providers.
Luckily, holistic digital programs, like HelloGina, are addressing that by giving you access to multiple treatment techniques from your smartphone or computer. HelloGina is a holistic treatment program that includes mind-body relaxation techniques, pelvic floor exercises, CBT-based education and exercises, and eventually, the use of vaginal dilators. During the program users are guided by a trained psychologist, psychotherapist or psychotherapist in training, who motivates and supports them along the way. Through the web platform or app, people can connect with their coaches any time to ask questions or get support. Each step of the treatment plan is guided by the program, at the person’s comfort level. If you’re curious to learn more about this approach, feel free to fill out our HelloGina health assessment, to see if we can help.
Building a support system
Overcoming vaginismus also involves a lot of emotional work. So, you’ll need all the support you can get. The fear, embarrassment, and shame that often accompany vaginismus can make it difficult to talk about, but moving through the discomfort and reaching out is crucial for success.
Your partner if you have one, other people with vaginismus, and professionals can all be essential parts of your treatment support system.
Talking to your partner about your vaginismus symptoms and the emotions that go with them is probably the last thing you want to do, especially if sex has been a point of conflict in your relationship. But helping them understand what vaginismus is, how it affects your body, and the feelings it brings up gives them the context they need to understand why sex has been so difficult for you.
When you let your partner in on your daily struggles with vaginismus, they’ll be able to approach you with more compassion and understanding, and you can work together to move through sexual situations in a way that facilitates your healing.
If you don’t have a partner or you don’t feel ready to open up to your partner, there are many other great support groups and resources that might help you. You are not alone!
Support groups and resources
There are people out there who really get what you’re dealing with. The easiest way to connect with them is actually social media. On Instagram and TikTok people like Azia Mery and companies like HelloGina share their experiences with having vaginismus and overcoming their symptoms as well as helpful tips. On Facebook, there are multiple vaginismus groups with thousands of members supporting each other. The communities are powerful places to get practical information and, more importantly, connect with people who really understand and are in the same situation as you are.
Depending on where you live, there may be in person support groups as well. Your gynecologist is probably the best person to ask.
Seeking professional help
Though self-treatment for vaginismus can be extremely successful, you may reach a point where you need some professional help. Vaginismus is a complex condition to manage and there’s nothing wrong with asking for extra help, especially from the experts!
If your gynecologist is knowledgeable about vaginismus, they can help you out. But if they’re not, ask if they can refer you to a specialist. If you’re in any vaginismus support groups, in person or online, the other group members might be able to help as well. Often, support groups for chronic medical issues keep group-sourced lists of experts.
Embracing a positive mindset during recovery
Cultivating a positive mindset is an important part of getting over vaginismus. It’s okay to have hard days and struggle, but deliberately cultivating a positive mindset will allow you to move through those hard days and continue to work on getting better.
Setting realistic expectations
Overcoming vaginismus is a marathon, not a sprint. You’re not going to go from painful penetration to pain free penetration by next week. Just like training for a big race, getting over vaginismus is going to take time and a lot of work on both your body and your mind.
So, it’s important to set realistic expectations. An expert, like the HelloGina coaches, can work with you to set goals that are achievable and appropriate for each stage of your treatment journey.
Whenever you’re working on a big goal that’s going to take a long time to achieve, it’s easy to get discouraged or lose motivation. That’s why it’s so important to celebrate every little achievement along the way. Maybe you get a pedicure if you do your pelvic floor exercises every day for a week or go to your favorite restaurant if you reach out to someone in an online support group. Knowing that you have a celebration to look forward to can help you progress toward your goals.
Celebrating your achievements also honors the fact that you’re working really hard to get better. It takes a lot of courage to take the first step toward overcoming vaginismus, and it takes a lot of grit to continue on that journey. You deserve to celebrate every step.
- Determination of Sexual Attitude, Sexual Self-Consciousness, and Sociocultural Status in Women With and Without Lifelong Vaginismus: A Case-Control Study Vaginismus,
- Dyspareunia and Abuse History: A Systematic Review and Meta-analysis
- Prevalence of Depression and Anxiety Disorders and Their Relationship with Sexual Functions in Women Diagnosed with Lifelong Vaginismus
- “Being a Woman” in the Shadow of Vaginismus: The Implications of Vaginismus for Women
- Vaginismus: An overview Physiotherapeutic resources in vaginismus
- Vaginismus Treatment: Clinical Trials Follow Up 241 Patients
- Cognitive-Behavioral Therapy for Women With Lifelong Vaginismus: A Randomized Waiting-List Controlled Trial of Efficacy
- Dr. Ashley Rawlins, a pelvic floor physical therapist who specializes in pelvic pain disorders