What is vaginismus, and how is it treated?

Vaginismus is involuntary spasm of the vaginal/pelvic floor muscles that prevents or makes painful vaginal penetration. It may be primary or secondary (secondary often with dyspareunia), usually with a psychological cause (e.g. extreme fear of penetration).

Treatment is systematic vaginal desensitisation (graded trainer insertion under relaxation, progressively sharing/transferring control), with drugs/surgery of very limited use.

Clinical relevance. Recognising vaginismus and treating it with systematic desensitisation (graded trainers, transferring control) addresses this distressing but treatable condition.

More Detail

Vaginismus

Vaginismus is a sexual pain disorder treated mainly by behavioural desensitisation.

What it is

• Involuntary spasm of the vaginal (and pelvic floor) muscles that prevents or makes painful vaginal penetration.

Types

• Primary (penetration has never been possible) or secondary (develops later - often associated with dyspareunia).

Causes

• Usually psychological - e.g. extreme fear of penetration (often from a wrong belief that the vagina is too small, or fear of pregnancy/intimacy), past trauma, or anxiety.
• Sometimes secondary to a painful condition (causing protective spasm).

Treatment - systematic vaginal desensitisation

• Step 1 - insertion of vaginal trainers (dilators) under controlled relaxation (the woman in control).
• Step 2 - sharing control with the partner.
• Step 3 - insertion of the penis with the woman in control.
• Step 4 - transfer of control of insertion to the partner.
• Combined with education, relaxation, and addressing the underlying fear/anxiety (psychosexual counselling).
• Drugs and surgery have very limited use.