These FAQs were developed by N. Turner (PhD). This information should not be construed as medical advice. Patients should consult their physicians before undertaking any treatment.
- If I have pain with intercourse, then do I necessarily have vaginismus?
What is vaginismus?
Vaginismus is a spasm in the musculature of the outer third of the vagina which makes insertion difficult or impossible. For some women, this muscle spasm is painful; for others, it is not. Most women experience pain if they try to insert something in spite of this spasm.
Is vaginismus always caused by abuse?
No. Some research suggests a correlation between vaginismus and abuse, and other studies show no relationship. Many women with vaginismus have been abused, and many have not. Just because you've never been abused doesn't mean you can't have vaginismus, any more than being abused would guarantee vaginismus.
What causes vaginismus?
It is widely believed that in most cases of vaginismus, the spasm is triggered either by pain or the anticipation of pain (emotional or physical pain). Much like the way an eyelid closes when something comes to close to the eye or a muscle flinches in response to an imminent punch, vaginismus is like a vaginal flinch.
It is in some sense protecting the area, even though the woman doesn't want it to. Some women have fears or guilt regarding intercourse, others have physical pain problems, and still others have no obvious cause for their condition. One perplexing aspect of vaginismus is that often the spasm remains long after the woman has dealt with any anxieties or physical problems. So learning to control and eliminate this spasm is how one cures vaginismus.
If I have pain with intercourse, then do I necessarily have vaginismus?
Not necessarily. Painful intercourse can be caused by any number of factors, and vaginismus isn't even the most common. Often, painful sex due to other conditions may lead to vaginismus, so even if you do have vaginismus, you may have another underlying primary cause of pain.
The most common cause of chronic painful sex (or painful attempts at sex, depending on the severity) is vulvar vestibulitis syndrome (VVS), which is one of a number of vulvar pain disorder. VVS can occur at any age, and often with no obvious cause and usually no visible symptoms. It is simply an enhanced sensitivity in, on, or near the vaginal opening.
It should not hurt to touch any part of your vulva. If it does, you should look into the possibility that you may have a vulvar pain condition. They are extremely common, and only seldom diagnosed. Most women suffer in silence. Most doctors do not routinely test for VVS, but the test simply involves poking certain areas (corresponding to your vestibular glands) with a Q-tip and seeing if you have pain. There are other problems which can cause painful intercourse as well, including lichen sclerosis (a skin condition), interstitial cystitis (involves the bladder), essential vulvodynia (which causes nearly constant pain), and others.
These conditions are not widely understood or even recognized by many doctors, so most women with these disorders (especially young women) are likely to be misdiagnosed initially with vaginismus. If you suspect you have one of these disorders, treatment by a specialist is recommended.
In short, if you have pain that is not the result of a muscle spasm, then you have something besides (or, possibly, in addition to) vaginismus.
How can I cure this?
Many women, though not all, find it necessary to treat the underlying causes of their vaginismus. For some this will involve therapy if emotional issues are involved, and for others they will have to treat vulvar pain conditions, while still others may not need to focus on what initially caused their problem (some may not even know their cause), and just focus on controlling the muscle.
Learning to control the muscle can be done in many different ways. The most common way is to gently insert progressively larger objects (called "dilators") into the vagina so that the muscle spasm is unlearned. Two excellent sources on the web for instructions on how to use dilators are www.med.umich.edu/obgyn/vulva/sandp.html (you have to scroll down a bit to find the right section), and www.marriagebuilders.com/graphic/mbi5049a_qa.html (scroll here too).
Other techniques our members have found helpful include relaxation exercises, stretches, biofeedback-assisted muscle rehabilitation, and focused exercises such as in Pilates.
What are dilators and where can I get them?
"Dilators," in this context, don't actually dilate, so it's kind of unfortunate terminology. The word refers to any objects inserted vaginally to slowly condition the vaginal muscles to not tense up during penetration attempts. These can be candles, fingers, tampons, vegetables, dildoes, vibrators, or so-called "medical dilators." The medical ones aren't significantly different from dildoes, except that often a prescription is required, they are not available in festive colors, and in some cases, your insurance may cover them.
All of the different options listed here have been tried with some success. Depending on your financial situation, whether you are being treated by a doctor or self-treating, and your personal preference, any of these may help you. Some women prefer vibrators because they find the vibration tends to relax the muscles, while others prefer non-vibrating dilators.
Medical dilators are typically provided by physicians or therapists, and dildoes and vibrators may be purchased at sex shops. Two shops that have online ordering and discreet delivery are A Woman's Touch and Good Vibrations, but nearly every sex shop will carry products of this sort.
Should I use lubricant? If so, what kind?
Yes. Especially if you are just practicing with dilators, you may not be aroused enough to provide adequate lubricant. Many drugstores carry personal lubricants. The most common ones available are KY (liquid is more highly recommended than the jelly) and Astroglide (also recommended). Many women prefer lubricants that are available at sex shops, for various reasons. Visit any online sex store and you will see many possibilities to choose from, and often the stores have good descriptions to help you choose. One popular lubricant is called Liquid Silk, and is only available from sex shops.
Are there any good vaginismus resources on the web? In print?
Yes. But they are few and far between. If you join the Vaginismus Internet list, you will have access to links their members have found useful.
One resource that many women have found incredibly useful is support groups. There are three main support groups for vaginismus. One group is just for women with vaginismus, and is on egroups.com under the name Vaginismus. Another is just for partners of women with vaginismus, and is called VaginismusPartners. A third is for women with vaginismus, their partners, and medical professionals. It is called 1Vaginismus.
There is only one book about vaginismus, and it is out of print, though you may be able to find it at a used book store or a library. It is by Linda Valins, and is called: "When a Woman's Body says 'No' to Sex: Understanding and Overcoming Vaginismus." This book deals with vaginismus that is due to emotional issues, so many women with emotional issues around sex find it very useful, while women with pain are less likely to relate to this book. It contains personal stories about dealing with vaginismus, as well as detailed treatment options.
Another highly recommended book, which is in print, is called "A Woman's Guide to Overcoming Sexual Fear and Pain," by Aurelie Jones Goodwin and Marc E. Agronin, MD. This book is in workbook form, with exercises and questions to work through.
Where can I find a therapist in my area?
Whether your vaginismus is due to emotional issues or not, many develop sexual issues as a result of having vaginismus. For many, support groups such as ours help a lot, and for some, professional therapy is useful. You can logon to www.bestco.info for information on finding a therapist.
Another option is to see if other women in your area have found good therapists who are knowledgeable in this area. A resource for Americans is the American Association of Sex Educators, Counselors, and Therapists, which has a searchable list of sex therapists throughout the country.
Rae Dolman, MASc
Wasser Pain Management Centre
416-586-4800 ext. 2760