An involuntary spasm of the musculature surrounding the vagina so that it closes, causing penetration to be difficult and painful, or impossible.

Causes, incidence, and risk factors

This is considered a sexual dysfunction. It is a complex condition with several possible causes. It may result from past sexual trauma or abuse, other psychological factors, or a long history of discomfort with sexual intercourse related to another disorder. Sometimes no cause can be determined. Vaginismus is an uncommon condition, occurring in less than 2% of women. Women with varying degrees of vaginismus often develop anxiety regarding coitus and penetration, and intercourse is usually painful. However, this does not mean that they cannot achieve or sustain sexual arousal. Many are very sexually responsive and may have orgasms through clitoral stimulation. Women with vaginismus may seek sexual contact and sexual play as long as vaginal penetration is avoided.

Signs and tests

A gynecological examination can confirm the diagnosis of vaginismus. The health care provider will note whether there is an involuntary muscle contraction when fingers are inserted into the vagina , and this usually reproduces the pain the woman feels with intercourse. A medical history and complete exam is important to rule out other causes of dyspareunia (pain with sexual intercourse).

Treatment

The treatment of choice with vaginismus is an extensive therapy program that combines education and counseling with behavioral exercises. Exercises include pelvic floor muscle contraction and relaxation (Kegel exercises) to improve voluntary control. Vaginal dilation exercises are recommended using plastic dilators. This should be done under the direction of a sex therapist or other health care provider and treatment should involve the partner. This treatment should include gradually more intimate contact culminating in intercourse. Educational treatment including information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex should be provided as well.

Expectations (prognosis)

When treated by a specialist in sex therapy, success rates are generally very high.

Complications

Vaginismus is one common cause of female sexual dysfunction, which may lead to serious dissatisfaction and discord in intimate relationships. It is one cause of unconsummated marriages. This problem can lead to male erectile dysfunction after repeated unsuccessful attempts at intercourse.

Calling your health care provider

If you have pain associated with intercourse or difficulties with successful vaginal penetration, you should discuss this with your health care provider.

Prevention

If a woman finds intercourse painful, she should seek medical evaluation early. When pain continues to be endured as part of sex, it increases the risk of conditioning a vaginismus response.