Why is having sex and inserting tampons painful for some? Vaginismus explained

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Vaginismus is a medical condition that can make penetration painful and even impossible. (Photo: Getty Images)

Vaginismus is the involuntary tightening of the vaginal muscles that makes wanted penetration very painful or even impossible. If this sounds familiar, you should know that, nevertheless, there is nothing inherently wrong down there.

Although the medical condition was identified about 150 years ago, Sheryl A. Kingsberg, a professor at Case Western Reserve University School of Medicine and division chief of ob-gyn behavioral medicine at University Hospitals Cleveland Medical Center, tells Yahoo Life, vaginismus often goes unreported, underdiagnosed and untreated.

There are multiple physical and mental health factors involved in vaginismus, but with the right care, it is treatable.

What are the symptoms of vaginismus?

The most noticeable symptom of vaginismus is discomfort or muscle spasms when you try to insert an object into the vagina, whether it’s from sex, a tampon or during a pelvic exam. “The pain occurs directly at the opening of the vagina,” Heather Jeffcoat, a physical therapist and author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve, tells Yahoo Life. Jeffcoat explains that vaginismus can be misdiagnosed for another condition called vestibulodynia, “which is also painful, but not so much a burning pain, right at the vaginal opening,” she says.

Other symptoms of vaginismus may include anxiety over sexual intercourse, unsuccessful attempts at vaginal penetration and burning or stinging pain.

A women’s health provider or a gynecologist may perform a clinical exam to rule out any physical causes that could explain pain felt during penetration. Kingsberg says one of the diagnostic tests may involve carefully moving a Q-tip around the entrance of the vagina to identify any tissue sensitive to pain. Other internal exams may look for inflamed tissue or infection, such as a gynecological condition that would cause pain rather than the anticipation of pain.

Kingsberg warns that ‌while the underlying pain disorder can be treated, the anticipation of pain may remain because it has become a conditioned response. “Even if you want to insert a tampon or have intercourse with a partner, the vagina is acting as a reflexive response, just like your hand heading to a hot stove,” Kingsberg explains. “The reflex pulls your hand away before you consciously move it, to avoid third-degree burns. The vagina works in the same way and tenses up to protect from the exploitation of pain.”

What causes it?

There are two categories of vaginismus: primary and secondary vaginismus. Primary vaginismus occurs in people who have never had sex and often arises from the anxiety or anticipation of pain during penetration, whether it comes from a finger, a tampon or sexual activity. As a result, your muscles tense up to avoid any possible pain.

People who have successfully had sex in the past but are now experiencing pain during sex have secondary vaginismus. Many potential causes explain why some people develop vaginismus later in life, including:

  • Disease or medical conditions that cause pain

  • Sexual trauma or sexual abuse

  • Vaginal tears or lesions

  • Falls on their tailbone

  • Trauma from surgery

  • Scarring

  • Endometriosis or infections

  • Menopause

  • Negative feelings about sex

An infection, for example bladder infections, yeast infections or a urinary tract infections (UTI) can worsen vaginismus pain.

Are certain women more likely to get it?

Vaginismus affects about 1% to 6% of women, according to an American College of Obstetricians and Gynecologists report. However, Kingsberg says U.S. and European studies estimate the number to be higher — around 5% to 15%.

Women with religious or cultural beliefs are more likely to experience vaginismus, because they’ve grown up anxious about the perceived “sinful” act of sex. “In my practice, many women come from rigid cultural or religious backgrounds where they’re raised with the expectation that anything to do with their vagina is off-limits,” says Kingsberg. “Then they get married, and now they’re supposed to have frequent intercourse in order to reproduce.”

Jeffcoat adds: “Some women can’t just flip a switch, because they’re told their entire life that sex is bad.”

Women who were sexually abused also have an increased risk of developing vaginismus. A 2021 review of studies on vaginismus suggests that those who endured sexual and emotional abuse had a higher chance of reporting pain during intercourse. Another study, published in 2018, found that women with genitopelvic pain also reported more instances of childhood sexual abuse, emotional abuse and emotional neglect.

How does vaginismus affect women’s lives and relationships?

Kingsberg says vaginismus often causes relationship problems, especially in heterosexual relationships where the partner has an expectation of achieving penetrative sex. While some partners may be very supportive, others may grow frustrated over the lack of sexual intercourse.

For the woman, vaginismus can create a sense of distress from a lack of control over her body. As a result, a woman with vaginismus may avoid any sexual activity with her partner because she is fearful that it will lead to penetrative sex. For this reason, Jeffcoat encourages partners to attend couples’ therapy to establish boundaries and to explore alternative forms of non-penetrative sexual contact.

What are the treatment options?

Jeffcoat says that vaginismus is “100% curable” and not something that anyone should have to live with permanently. Your doctor can develop a plan to tackle both the anxiety associated with pain and getting the body used to penetration. Treatment options include:

  • Cognitive behavioral therapy (CBT): If there is no physical pain, a psychologist may offer CBT to address and treat negative feelings toward sexual intercourse and anxiety.

  • Vaginal dilator therapy: Doctors may use a set of static medical dilators that range in size from small to large, which allow for gradual relaxation of the vaginal muscles and exposure to penetration. The approach keeps the woman in control and going at a pace she is comfortable with, and allows backing down to a smaller size if there is any discomfort. “Using the dilators helps decrease the expectation of pain” and provides “that confidence to know that when they get to a larger size, they can look back to their progress,” says Jeffcoat.

  • Pelvic floor physical therapy: A physical therapist can help women relax the muscles that have become tight over time from involuntary tightening.

  • Vibration therapy: Jeffcoat says vibration helps reduce muscle tension and is helpful as an initial therapy because it can be used externally before penetration.

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