What Causes Vaginismus?

Sexual intercourse is a natural physical experience shared between two people that can be wonderful and exhilarating. It is also necessary to have children. However, sex is not always enjoyable, or even possible, for some women. 

Women may have had previous unpleasant, painful, or traumatic sexual experiences. They may have anxiety about sexual activity. Women who have had these experiences or who experience anxiety about sex may have a lasting, residual fear of sexual penetration that leads to a condition called vaginismus. 

Vaginismus is a condition where your vaginal muscles involuntarily clench and prevent vaginal penetration during sex. The condition is psychological and stems from a fear of pain or memories you have of a previous traumatic experience. 

If you’re experiencing problems with vaginal penetration and sexual intercourse, it’s essential to understand the causes and signs of vaginismus so that you can help your doctor diagnose and treat it.

If you have vaginismus, you might avoid sexual activity altogether. You may be unable to insert a tampon or even tolerate a pelvic exam from your gynecologist. 

Other symptoms of vaginismus that you may experience are:

• Fear of and anxiety about sexual penetration
• Fear of any vaginal penetration
• Severe pain during sex
• Inability to use a tampon during your period (menstruation)
• Inability to remove a tampon (the tampon is stuck)
• Pain after sex

There are two types of vaginismus:

• Primary vaginismus — you have never been able to have sex that is not painful
• Secondary vaginismus — you have had pleasurable sex in the past but can no longer do so

Researchers have not fully determined the causes of vaginismus. They believe that the condition may be caused by psychological conditions that prevent you from being vaginally penetrated. Primary and secondary vaginismus have different causes. 

Primary vaginismus

If you have never had nonpainful sex or have never been able to have sex due to fear, anxiety, or other conditions, you are experiencing primary vaginismus. There have been many theories about what causes primary vaginismus, including:

• Myths about sexuality or religious beliefs that are central to many cultures and societies. These beliefs or ideas concerning what is or isn’t acceptable sexual behavior may cause you to experience involuntary pelvic muscle contractions when you attempt to have sex. 
• Family conflict may also contribute to vaginismus by causing anxiety and stress, which can affect your body. 
• Witnessing the sexual abuse of a family member or experiencing it as a child may also negatively impact you and prevent you from enjoying sex. 

Secondary vaginismus

If you have had positive sexual relationships in the past but cannot have one now, you are experiencing secondary vaginismus. Researchers believe that this condition occurs when you have recently experienced traumatic or painful events that create anxiety about sexual penetration. Examples of such incidents include:

• Forced sexual encounters
• Painful sex
• Changes in a woman’s life

If you experience depression, stress or anxiety, or changes in sexuality or preference, sex with your partner might become painful and cause you to lose the ability to control your vaginal muscles.

If you’ve experienced painful sex or are unable to have sex, consider seeing your doctor. If left untreated, vaginismus can lead to infertility (an inability to have children), relationship problems, and psychiatric conditions like depression. 

If you don’t receive treatment, you might blame and shame yourself for experiencing vaginismus when the condition is not your fault. A psychiatrist, a doctor who treats mental health issues, can help you address the problems you are having and prescribe treatments to help you have an enjoyable sex life.

First, your doctor will likely perform a pelvic exam to rule out any physical causes of vaginal pain. They may take samples for lab analysis and look for infections or other vaginal conditions. 

Your doctor will also talk with you about your medical and personal history to uncover any psychological disorders that might be causing your vaginismus. You might be referred to a psychiatrist, who will talk to you in detail about your condition, or be given a questionnaire to help assess your condition.

Some assessment questions might be very personal and ask about your sexual activity or techniques you might have tried to alleviate your condition. Your doctor will want to know about past sexual partners. They may also talk to your gynecologist to discuss your behavior during pelvic exams and determine how severe your vaginosis is.

If your doctor or psychiatrist diagnoses you with vaginismus, they will likely prescribe medication for anxiety and recommend treatments that promote a gentle introduction to sexual activity with your partner. 

Newer techniques are also being tested, such as intravaginal Botox injections. Botox keeps your muscles from contracting, which may allow them to relax when you want them to.

Follow-up sessions with your psychiatrist can help to treat your vaginismus. Your doctor may also evaluate other conditions that your vaginismus can cause, such as depression, distress, or anxiety.