What is Vaginismus?
Vaginismus is a sexual dysfunction in which the muscles of the pelvic floor involuntarily spasm shut when insertion is attempted.This can make penetrative sex, gynecological examinations, and the use of certain menstrual products extremely painful, or even physically impossible (often described as feeling like hitting a wall).Anyone with a vagina -- cisgender women, nonbinary people with vaginas, transgender men who have not had bottom surgery, and transgender women who have had bottom surgery-- can get vaginismus.Vaginismus is NOT rare, but it is under-researched. It is estimated anywhere from 1 to 20% of people who have a vagina will experience vaginismus.
What causes vaginismus?
Vaginismus can be considered "primary" or "lifelong" (meaning the person has never had penetrative sex before showing symptoms of vaginismus) or "secondary" or "acquired" (meaning the person has had penetrative sex without vaginismus before but has vaginismus now).Vaginismus can also be "global" (occurring in all situations, no matter what is attempting to be inserted) or "situational" (only occurring in a particular situation, such as only during sex or only during medical exams).From this variation of presentation, it makes sense that there are numerous possible causes of vaginismus.Some possible causes include:
A strict religious or otherwise conservative upbringing which teaches that premarital sex is "dirty" or "wrong" (possibly even deserving of shunning or punishment) and may engage in fearmongering (such as claiming "sex always hurts the first time" or threatening those who are "not dressed modestly enough") -- this can be both/either familial and/or on a societal level
Sexual abuse (in adulthood or childhood)
Previous experience with consensual but painful sex (see vaginismus pain cycle below)
A frightening and/or painful gynecological exam or procedure
Childbirth (including injuries such as tearing and medical interventions such as episiotomy and/or forceps)
Fear of pregnancy
Hormonal birth control side effect
Radiation therapy side effect
As a response to other painful health conditions (vaginal and beyond), such as vulvodynia, vaginal atrophy, internal cystitis, endometriosis, lichen sclerosis, and/or fibromyalgia. It is especially worth noting that vaginismus and vulvodynia are sometimes comorbid, since either one can lead to developing the other.
Gender dysphoria
Hormonal changes, such as menopause or Testosterone Therapy
In response to painful infections, such as reoccurring yeast infections, UTIs, or an STD
After surgery, such as vaginoplasty (ironically, vaginismus may be discovered while trying to keep up with the post-vaginoplasty dilator regimen)
Some have vaginismus for no discernable reason at all!
Many sources like to claim vaginismus is inherently caused by a reaction to the fear of penetration, which some with vaginismus find dismissive. While fear of penetration can be a causative factor, it is also worth noting that some did not feel any anxiety around penetration until they experienced how painful it is with vaginismus, or another painful vaginal condition which lead to developing vaginismus. This means in many cases, the fear of penetration is an effect of the pain instead of a cause!Whether it was originally a cause or an effect, once acquired, the fear and anticipation of pain leads to a response cycle that keeps vaginismus going (see image below from Origin, a growing Pelvic Floor Physical Therapy startup offering care in 8 states and virtual care nationwide).
While vaginismus can have psychological causes which may require psychological treatment, the physical pain is real and typically requires physical treatment.Vaginismus does NOT indicate a lack of sexual arousal.The video below by Dr. Alicia Jeffrey-Thomas, DPT (thepelvicdancefloor on tiktok) is to reiterate how a strict religious upbringing is a common cause of vaginismus.
How is vaginismus treated?
Often, the first recommended treatment involves an at-home regimen of using vaginal dilators (pictured below).
Starting from the smallest dilator, the person with vaginismus moves up to the next sized dilator only once the size they're on becomes comfortable. The new dilator could be uncomfortable, but should not be painful-- painful insertion will worsen the problem. Some simply wait with the dilator in for a few minutes a day until they feel used to it, others masturbate with them to associate penetration with pleasure.A vital misconception commonly on the internet, even on reputable medical websites, is that kegel exercises are recommended while using dilators, or to be done on their own during the day. Normal kegels are NOT typically recommended when beginning to treat vaginismus. Instead, reverse kegels, or pelvic floor drops, are recommended. (If a regular kegel feels like holding in pee, a reverse kegel/pelvic floor drop feels like farting or pooping.) Kegels tighten, reverse kegels release.The video below by Dr. Alicia Jeffrey-Thomas, DPT (thepelvicdancefloor on tiktok) is to reiterate how kegels can be counterproductive when treating vaginismus!
Pelvic wands are also recommended. They are used to target specific muscles within the pelvic floor from inside the vagina and gently release the tension. It is much easier to describe how to use them with a visual, so below are photos of a pelvic wand, a "pelvic clock" visual, and my pelvic physical therapist's directions on how to use the wand with the pelvic clock in mind.
(Click photos to enlarge.)
While lube alone cannot cure vaginismus, high quality lubricant can definitely help during the process of using dilators, using a pelvic wand, and attempting sexual penetration once the largest dilator is comfortably useable.CBD (or THC!) lubricant can also be very helpful. It acts as a topical muscle relaxant, soothing irritated skin and nerves. This can help someone who has made major treatment progress but just needs a touch of something to make it work, but this is not a cure on it's own-- it won't make someone whom is unable to insert a finger suddenly become able to have penetrative sex.Below are links to several varieties of the tools I've mentioned.
That said, many require further treatment than a DIY-at-home regimen.Pelvic floor physical therapy is highly recommended to whom it is accessible, and depending on the cause of the person's vaginismus, there may be a need for mental health therapy as well.When vaginismus is related to a painful experience (be it sexual abuse, a medical procedure, or something else), therapy can be highly beneficial, especially if the person is also experiencing PTSD, a dissociative disorder, or another trauma-related disorder from their experience(s).Pelvic Physical Therapy can be extremely helpful, and for those that don't pursue it as their first step in treatment, it is the best next step to take if symptoms persist after DIY physical treatment and mental health therapy. However, it can be expensive and is often not covered by health insurance. If you research the pelvic floor physical therapists in your area, you can see if they have any sort of specials running, if they have a payment plan, or if your insurance covers them.Many pelvic PTs, knowing how cost prohibitive PT can be, often post advice related to vaginismus online. For example, many post the yoga poses and stretches that can be helpful (diaphragmic breathing, happy baby, child's pose, frog pose, cat-cow, deep squat stretch, calf stretches, among others-- this is general advice, not every stretch is for everyone. A pelvic PT can recommend yoga poses and stretches that are specific to your needs, including and beyond vaginismus).Below is a link to Origin, a Pelvic Floor Physical Therapy startup which accepts some insurance and has lower cost care than average. They offer nationwide virtual care and in-person care in multiple locations in California and Texas, as well as in Miami, Florida; Atlanta, Georgia; Raleigh, North Carolina; Portland, Oregon; Memphis, Tennessee; and Salt Lake, Utah. My personal experience with pelvic physical therapy was not through Origin, so while I cannot speak to what care from them is like, I am optimistic about their mission to make Pelvic PT more accessible.
Botox injections for the purpose of relaxing the pelvic floor muscles are also an option, but the insurance and cost issue again applies. After the botox injections, a dilator regimen begins, possibly as well as a pelvic physical therapy regimen. Some who started out unable to insert the smallest dilator say that botox was what truly started treatment progression for them.Those who are experiencing vaginismus due to hormonal reasons (such as menopause or testosterone hormone therapy) can benefit from the use of topical vaginal estrogen creams. This will not interfere with the effectiveness of Hormone Replacement Therapy.Some find that with treatment, vaginismus is able to be cured in a matter of weeks or months. For some others, it takes years.For some (such as the one making this webpage), even after achieving successful pleasurable penetration, vaginismus remains as a chronic condition that requires occasional re-treatment with dilators to maintain the ability to be pleasurably penetrated.A recent study has said that regardless of what treatment method was used, 79-80% of people with vaginismus can expect to achieve painless penetrative sex. Other sources say that this is a low estimate, that the percentage is actually higher. Either way, it is regarded as one of the most treatable sexual dysfunctions.It is also worth noting that when penetration is possible, many with vaginismus find non-latex condoms significantly more pleasant than latex condoms. And, to reiterate the lube point, many find that low-quality lubricants (such as ones available at convenience stores) are unpleasant, ranging from causing a burning sensation to simply being inefficient. Always remember to make sure your condoms and your lubricants are compatible before use!
I am a doctor, nurse, gynecologist, OBGYN, or other medical healthcare professional
Make friends with your local Pelvic Floor Physical Therapist, learn from them, and know when to recommend their services to your patients.
DO NOT SAY PAIN DURING SEX IS NORMAL! Vaginismus can be excruciating, as can several other vaginal health conditions. Pain during sex may be common, but it is not normal.
DO NOT SHRUG, SAY YOU CAN'T SEE A PROBLEM, RECCOMEND KEGELS, AND LEAVE YOUR PATIENTS STRANDED TO FIGURE IT OUT ON THEIR OWN!
DO NOT TELL YOUR PATIENTS WHO EXPERIENCE PAIN DURING SEX TO "JUST RELAX" AND/OR "HAVE A GLASS OF WINE" OR ANYTHING SIMILAIRLY DISMISSIVE! You cannot simply relax away vaginismus. And advising to "have a glass of wine before sex" has lead to some with vaginismus becoming involved with alcoholism in pursuit of pain relief (which the alcohol isn't capable of providing)!
DO NOT TELL YOUR PATIENTS THAT IT'S ALL IN THEIR HEAD, OR THAT VAGINISMUS IS PURELY PSYCHOLOGICAL! This is highly dismissive and untrue. While vaginismus can have a psychological component, the physical pain is real and will require some kind of physical treatment plan, such as dilators or pelvic floor physical therapy. While mental health treatment is necessary for some, patients who resolve their vaginismus without physical treatment are in the vast minority. Additionally, this attitude dismisses the prevalence of traumatic experiences and mental distress caused by vaginismus.
DO NOT RECCOMEND GIVING BIRTH TO CURE VAGINISMUS! While this may have helped some, not only is this not a guaranteed fix, it has the potential to worsen it, and/or for vaginismus to cause complications during birth (vaginismus patients are known to be at an elevated risk for needing C-sections). For some, childbirth is even the cause of it!
If you wouldn't say it to someone experiencing pain in their penis, don't say it to someone experiencing pain in their vagina.
Vaginismus patients typically do better with smaller speculums.
Do not continue painful vaginal examinations or procedures once your patient has told you to stop or if they are clearly experiencing severe pain from something that doesn't normally cause it. (For example, if the patient is screaming, crying, shaking, and/or passing out during a pap smear or a cervical check during labor.)
When performing a gynecological procedure known to be painful, offer pain relief. This goes for iud insertions, biopsies, LEEP procedures, etc. Do this not just for your patients who have vaginismus, but for all of your patients so that you do not cause vaginismus via a traumatizing painful medical experience.
If/when you have a child patient with labial adhesion, NEVER "TREAT" IT BY MANUALLY TEARING THE LABIA APART! Some have developed vaginismus due to the painful, traumatic childhood experience of having their fused labia manually torn apart, which is improper treatment of the issue. If treating it with estrogen cream fails, separation of the labia is a surgical procedure done under general anesthesia, not something which should be done while the patient is awake!
Talk about vaginismus and other vaginal pain conditions with your doctor and nurse colleagues to raise awareness so that all of you are prepared for any patient you might meet.
Hold your colleagues accountable if they do not take their patient's pain seriously.
Encourage colleagues on the research end of things to look further into vaginismus and other vaginal pain disorders.
Challenge insurance companies to begin covering more treatments for vaginal pain disorders, including pelvic physical therapy. (I realize what insurance companies decide is largely outside of your control, but as frustrating as it may be, any effort towards representing the needs of your patients is worth it.)
So we can't have sex? (I do not have vaginismus)
Not with that fucking attitude. That depends on your perspective.If penis-in-vagina sex is the only type of sex you have any interest in and you are not willing to wait for your potential partner to become able to have it painlessly, you may want to consider not dating someone with vaginismus. This is not the fault of the person with vaginismus for having a medical condition.If you are willing to be patient and supportive, penis-in-vagina sex may become an option in the future. That said, there are more sex acts than penis-in-vagina-- just ask the queer and the kinky!Alternatively, your partner may find that they do not want penis-in-vagina sex. It may not even be a treatment goal for them (instead focusing on the need for comfortable medical exams).They might exclusively enjoy non-penetrative sex. If you enjoy non-penetrative sex as much or more than penetrative sex, you can mutually enjoy yourselves and feel relieved without the pressure of pursuing penetrative sex.Or, they may be asexual. If you are asexual too, neither of you are obligated to pursue sex! If you aren't asexual, this person is not obligated to have sex with you or to pursue vaginismus treatment with sex in mind!Like any relationship, you should talk about what works for you both and if your desires are compatible-- Vaginismus effects sexual ability, not sexual compatibility!Some non-PIV sex options include:
Touching
Mutual Masturbation
Frottage
Using non-penetrative sex toys
Exploring BDSM, which can include spanking (with hands or with implements such as floggers, whips, and paddles), bondage, roleplay, and much more.
Oral sex*
Anal sex*
* It is worth noting that for some (not all) who have vaginismus, giving oral and/or receiving anal may also not be options.This is because the anus, like the vagina, is part of the pelvic floor, so the same muscles are involved. Some may even need to dilate anally. This may indicate that it is hypertonic pelvic floor muscle dysfunction instead of vaginismus. They are similar-- typically with vaginismus, tension happens when insertion occurs, while hypertonic pelvic floor muscle dysfunction is constant tension (additional symptoms include: pain in the lower back, hips, and thighs; frequent urination, painful urination and defecation, hemorrhoids, rectal fissures, pain in the clitoris, and of course, vulvar/vaginal burning and pain during sex). Treatment methods are the same with both conditions. However, while some sources differentiate the two, other sources claim that the two conditions are one in the same. (Frustrating, isn't it?) At this point, I'll remind you that vaginismus is under-researched.As for the jaw: The vagus nerve, muscles, and fascial tissues link the jaw and the pelvic floor. Additionally, some with tense muscles related to stress or poor posture may have tension in both places. So, some with vaginismus also have TMJ dysfunction.This is worth being aware of, but don't assume that all with vaginismus also have these issues. You should ask your partner what they are willing and able to do, and then go from there.
Can I have more information?
Yes!
Below is a short educational video about vaginismus from Dr. Alicia Jeffrey-Thomas, DPT (tiktok user thepelvicdancefloor).
The YouTube video below is "Tightly Wound" by Shelby Hadden and Sebastian Bisbal. It's a 10-minute animated short film about Shelby's experiences with vaginismus. It was the first time I saw vaginismus mentioned on film (it's spread a bit since) so it means a lot to me personally, and it's intensely relatable for many with the condition.
Linked below is a mixture of medical information, personal stories, and organizations involving vaginismus.
Below are links provided on other sections of the webpage, for your convenience.
Who made this webpage?
I'm Zoe Jazz, I'm an author, and I have vaginismus.I was diagnosed with vaginismus in 2013. Back then, attempting penetration felt like being stabbed with a flaming knife. I finally became able to have pleasurable penetrative sex in 2020, but I still occasionally have to do physical therapy exercises to remain able to have pleasurable penetrative sex.My initial intention with this was to make a small webpage that someone with vaginismus could put a link to on a dating profile. Instead, I hope to have shared enough information for this to be useful for anyone who's new to vaginismus, whether they have it or not.The information on this webpage comes from a mixture of research, over a decade of personal experience, the experiences of others in online vaginismus support groups, and the experiences of others willing to speak or make art about having and/or treating the condition.
You are under no obligation whatsoever to tip me. However, any tips are absolutely appreciated.
What can I do to help?
That depends. Who are you?(You can read the tabs for who you're not if you want to know more info, if you like. Content warning for talk of medical malpractice in the doctor tab and of sexual abuse in the partner tab.)
I have (or think I have) vaginismus
Be prepared to advocate for yourself in medical situations. Don't be afraid to refuse exams you find painful, to ask for anesthesia, to ask for smaller speculums, to ask to insert the speculum or transvaginal ultrasound probe yourself, or to ask for any other need you may have.
If you feel that your gynecologist is not taking your pain seriously and is dismissive of your concerns, or if they do not know what vaginismus is and they aren't willing to learn about it, switch doctors. You may need to do this more than once (hopefully you won't need to, but many have had to switch several times).
Do not force yourself to treat vaginismus faster than you are comfortable with.
If you are comfortable with it, try non-penetrative sex methods.
Only attempt sex--penetrative or not-- if and when you really want to, not because you think you "need" to do it in order to gain or keep someone's interest.
Even though you want to insert a person or toy, if it is still causing you pain, it is better to continue treatment before attempting to insert anything for fun again.
If you are new to vaginismus, be sure to read the other sections of this webpage.
Consider joining vaginismus support groups online-- there's one on Facebook as well as reddit.
I am the romantic and/or sexual partner of someone with vaginismus
Be supportive of your partner in the process of achieving penetrative sex.
If your partner is comfortable, be with them while they use their dilators, and assist in whatever way you're both comfortable with.
Use high quality lubricant when penetration is involved.
Be aware of how attempting penetrative sex too early in treatment may be negatively effecting your well-being, too -- Seeing a person you care about in pain and feeling like your body is causing it may lead to you developing negative associations with sex. This could lower your libido, and if you have a penis, can lead to you developing erectile dysfunction or premature ejaculation. It is an absolutely wonderful thing for a person with vaginismus to have a partner that cares. That said, if you feel that attempting penetrative sex is effecting you negatively but your partner with vaginismus still wants to keep trying, you can request to put a pause on it and be honest about how you feel that attempting penetration while it's painful is hurting both of you. Finding non-penetrative sexual activities you both like can be a relief for both of you.
Know that both of you can feel pleasure and achieve orgasm without penetration, however, do not pressure your partner into non-penetrative sex acts that they are uncomfortable with.
Do not blame your partner if dilation/therapy/physical therapy takes a while or if they need to take a break from it. Don't pressure them to go through treatment faster.
Do not be offended or take it personally if/when vaginismus makes penetrative sex too painful to continue, or if it makes it impossible to start, even if treatment has been progressing for a while.
It is understandable if your partner's vaginismus effects you emotionally, however, do not make your partner's medical condition about you.
Do not continue penetrative sex when your partner is in pain and has expressed (verbally or nonverbally) that they want to stop. If you continue, you are raping them.
I am the friend or family member of someone with vaginismus
Be empathetic and open to discussing how treatment is going if your friend wants to vent or celebrate. Having a friend who cares means a lot to most people with vaginismus.
When trying to offer encouragement, do not say dismissive statements such as "sex isn't everything" or "be thankful that it'll drive away everyone who isn't serious about you." If you wouldn't say it to someone experiencing pain in their penis, don't say it to someone experiencing pain in their vagina.
Do not suggest that they "just date an asexual person!" Having vaginismus is not an indicator of sexual preference or level of desire. Depending on the individual who's asexual (some have sex, some do not-- did you assume all asexual people don't?), a person with vaginismus who desires sex could be a real mismatch with an asexual person. Vaginismus effects sexual ability, not sexual compatibility!
If your friend or family member with vaginismus is a transgender man, don't suggest that his vaginismus would cure easier if he "embraced his femininity." You cannot simply decide to stop having gender dysphoria. And if vaginismus or another vaginal pain condition is a side effect of testosterone therapy, regardless of what he chooses to do about it, respect his decision to do what he wants with his own body.
So we can't have sex?
Is the person asking this question the person who has vaginismus or not?
(If it's both of you, you can read both sections, though some information is repeated between the two.)
So we can't have sex? (I have vaginismus)
If you've known that you have vaginismus for a while, I'll bet you already know about your non-penetrative sex options and have done with that information what you will. That said, for those just finding out--I understand very personally how frustrating it is to not be able to insert anyone or anything into yourself when you very much want to. I also understand how dismissive it feels when treating vaginismus is framed as being "in order to fulfill your partner's needs" while talking about non-penetrative sex is framed around how "you wouldn't be as upset about your vaginismus if you realized that your vagina doesn't need penetration for pleasure," but it seems like neither narrative asked you what your needs or wants are. It's perfectly rational to be upset about that. Your pleasure and the ways in which you want it (or don't want it!) should be the main concern when vaginismus, sex, and treatment are brought up-- not what someone else wants or thinks that you should want.Sexual pleasure without penetration exists and it is wonderful, but even if you already enjoy that kind of pleasure, wanting a type of sexual pleasure you aren't physically capable of having is brutal. You deserve to pursue pleasure in whatever way you want to. Whether you want to have penetrative sex or you don't and your treatment is purely for medical purposes, you deserve to have it known that you're pursuing treatment at your own pace to fulfill your own needs.That having been said, if you are interested in some non-penetrative sex suggestions, the possibilities include:
Touching
Mutual Masturbation
Frottage
Using non-penetrative sex toys
Exploring BDSM, which can include spanking (with hands or with implements such as floggers, whips, and paddles), bondage, roleplay, and much more.
Oral sex*
Anal sex*
* It is worth noting that for some (not all) who have vaginismus, giving oral and/or receiving anal may also not be options.This is because the anus, like the vagina, is part of the pelvic floor, so the same muscles are involved. Some may even need to dilate anally. This may indicate that it is hypertonic pelvic floor muscle dysfunction instead of vaginismus. They are similar-- typically with vaginismus, tension happens when insertion occurs, while hypertonic pelvic floor muscle dysfunction is constant tension (additional symptoms include: pain in the lower back, hips, and thighs; frequent urination, painful urination and defecation, hemorrhoids, rectal fissures, pain in the clitoris, and of course, vulvar/vaginal burning and pain during sex). Treatment methods are the same with both conditions. However, while some sources differentiate the two, other sources claim that the two conditions are one in the same. This is both frustrating and a sign that more medical research should be done.As for the jaw: The vagus nerve, muscles, and fascial tissues link the jaw and the pelvic floor. Additionally, some with tense muscles related to stress or poor posture may have tension in both places. So, some with vaginismus also have TMJ dysfunction.This is worth being aware of, whether either of these additional possibilities effect you or not.Regardless of what kind of sex you want to have, what kind you want but are not currently able to do, and what kind of sex you don't want to have, YOU ARE NEVER OBLIGATED TO DO ANY KIND OF SEX ACT THAT YOU DO NOT WANT TO DO "FOR THE SAKE OF YOUR PARTNER!"