Pain During Sex? It Could Be Vaginismus

Sex is great, and good sex is even better. But for some people with vaginas, things aren’t so black and white when it comes to feeling pleasure.

As many as six percent of women experience excruciating pain during penetrative sex due to an underlying condition called vaginismus. In some cases, the condition can also lead to self-esteem issues stemming from fears about sexual performance and internalized shame and guilt.

We spoke to two women’s health experts about vaginismus and how those with the condition can still live their best, most liberated sex lives.

What is vaginismus?

Vaginismus is one of a variety of sexual pain conditions that results from an involuntary contraction of the vaginal muscles. This is often in response to a fear of insertion or penetration into the vagina.

From hormone-related problems with lubrication and endometriosis to sexual trauma and genital mutilation, the vagina’s involuntary reaction could be caused by a variety of factors. “It often presents in folks unable to accommodate an item, or very fearful of that happening,” says Dr. Shauna Correia, sexual medicine physician and medical manager at the BC Centre for Sexual Medicine. If you feel a sharp, stinging pain upon the insertion of anything into the vagina—or if you are fearful in anticipation of pain—the muscles will reflexively respond by contracting themselves, Correia explains.

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“The first thing we need to do is make sure we have a proper diagnosis,” she says. “[Vaginismus] often occurs co-morbidly with other conditions, and if we just think about it as related to the muscles and we don’t diagnose the other conditions, it’s going to be very difficult for those muscles to learn how to relax.” She points to provoked vestibulodynia, an undertreated and common painful condition that affects the vulva, as an example of a condition that often exists alongside vaginismus.

Correia says a differential diagnosis—the process during which a medical expert considers all potential causes for your symptoms, and then narrows them down via a series of tests—is vital to ensuring that other nerve-related, hormonal or dermatological pain conditions are treated before focusing in on vaginismus. Once the vaginismus is isolated, treatment might become easier.

What are some of the mental health impacts of vaginismus?

“Because of the difficulties with vaginal insertion, a lot of people with vaginas who experience vaginismus are also experiencing sexual dissatisfaction and self-esteem, and diminished sexual desire,” says Dr. Kaitlyn Goldsmith, sessional instructor of human sexuality at the University of British Columbia and registered clinical psychologist.

The fear response that underlies the vaginal contraction typical of vaginismus might trigger a larger avoidant response in general, she says. “This could lead to an avoidance of anything sexual; some people even experience a pulling away from their partners of any sort of physical touch because of the anxiety,” adds Goldsmith. “This can become a self-perpetuating cycle because as you engage less with your partner physically, you become more anxious and reluctant to attempt insertion.”

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Are there treatment options for vaginismus or alternatives to penetrative sex that are worth trying out?

From treatments that target mental health to muscle relaxation techniques, there are a number of ways to address vaginismus.

Goldsmith emphasizes the importance of creating a personalized treatment plan. “It can involve a multidisciplinary approach—some people benefit from doing pelvic floor physiotherapy. For [others] it’s important to remove any skin irritants that could be causing harm or more sensitivity in the vulvar-vaginal area,” she says. That’s why, Goldsmith adds, it’s important to talk to your doctor about your individual symptoms.

“It’s possible with treatment to significantly improve the individual’s ability to accommodate things within the vaginal space,” says Correia. “There’s evidence-based strategies such as mindfulness-based cognitive behavioural therapy (MBCT).” MBCT can be used in combination with vaginal accommodators and kegel exercises to essentially coach the vaginal muscles into relaxing.

Both Correia and Goldsmith highlight the crucial role that education plays, both for individuals experiencing the condition as well as their partners. That includes insights into pelvic floor anatomy, learning more about vaginismus itself (to ease anxieties about the unknown) and sexual health in general.

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“Understanding sexual arousal, desire and how to engage with a partner in a way that doesn’t just involve insertion—exploring different types of activities such as kissing, mutual masturbation, outercourse [such] and other techniques can be really positive and pleasurable for the individual and their partner,” says Goldsmith.

Correia notes that for many living with the condition, getting the necessary support and treatment takes time. With education, it’s possible to navigate the condition with less difficulty. “It can take up to seven years for patients to access a [sexual] clinic where they can get an appropriate diagnosis and treatment,” she says. “Often that’s many years of silence and not understanding what’s happening to their bodies, and why it’s happening.”

What is the current state of vaginismus research and healthcare support?

Goldsmith notes how underfunded women’s health education and research have historically been.

“[Sexual] is so often dismissed by healthcare providers by saying things like, ‘That’s just how it is, you need to get over it,’ or ‘Just have a glass of wine and relax,’” says Goldsmith. She highlights that even within the healthcare system, there’s still a lack of education related to vulvar and vaginal health. This begins with primary healthcare providers, who are often not equipped to provide the right kinds of support, which can lead to a lack of specialized care.

When discussing how to study the condition, Correia suggests reframing how we conceptualize sexual pain conditions more broadly within diagnosis and research, since the other issues that vaginismus is co-morbid with often go under the radar.

“Partly it’s because it’s the easiest term to say (the other diagnoses are long and complicated) folks get labeled with just vaginismus, and don’t get appropriate treatment. We’re missing a lot when we’re looking at this without a proper diagnosis,” she says—and this means that other conditions that cause sexual pain, such as provoked vestibulodynia, remain under-researched.