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Vaginismus. Perhaps you have heard of it, or perhaps...

Are you reading this because you think you or your partner may be dealing with it? It is estimated that approximately 5% of Dutch women experience vaginismus. That is quite a large number of women. Vaginismus can be incredibly frustrating. Not being able to have intercourse with your partner, have a gynaecological examination, or insert a tampon. It can cause sadness, anger and frustration. The good news: the vast majority of women are able to overcome their vaginismus. With the right help and perseverance.

Definition: what is vaginismus?

Do your front vaginal muscles involuntarily tighten when an object approaches (such as a finger, a penis, a tampon or a medical instrument)? This is called a vaginistic reaction. This involuntary tightening of the vaginal muscles can make penetration painful or completely impossible. But vaginismus is much more than just a physical reaction - it is often accompanied by fear, tension and avoidance behaviour.

When we speak of vaginismus, we mean a condition in which this happens regularly, creating a pattern of involuntary muscle spasms that make penetration difficult or impossible.

Vaginismus & dyspareunia

Vaginismus is different from dyspareunia (pain during sex). Dyspareunia and vaginismus are very similar. With dyspareunia, penetration is possible but painful. With vaginismus, the vaginal muscles tighten so much that penetration becomes difficult or impossible. Sometimes a woman suffers from both conditions. Having one does not exclude the other. Both conditions can also reinforce each other.

Recognising vaginismus

  • "I feel no pain when the penis enters, but when he starts to move I experience a burning sensation that gets progressively worse, until he has to stop."
  • "I can insert a tampon, but when my partner tries to penetrate me, everything tightens up."
  • "At the gynaecologist, I tense up so much that examination is impossible."
  • "It feels as if there is a wall. My partner simply cannot get in."
  • "The first time sex worked fine, but after a painful experience it became impossible."

Types of vaginismus & symptoms

Primary vaginismus

Often the limit is reached when an unpleasant or uncomfortable feeling occurs. If the other person continues at that point, it gets worse. Then it is time to communicate this clearly. Continuing is absolutely not an option. This can feel frustrating and lead to a sense of failure. But it is important to respect your own boundaries and to communicate them.

Secondary vaginismus

Often the limit is reached when an unpleasant or uncomfortable feeling occurs. If the other person continues at that point, it gets worse. Then it is time to communicate this clearly. Continuing is absolutely not an option. This can feel frustrating and lead to a sense of failure. But it is important to respect your own boundaries and to communicate them.

Complete vaginismus

This means that nothing can be inserted into the vagina - no body part or object whatsoever. No tampon, no finger and certainly no erect penis. Absolutely impossible.

Partial vaginismus

Often the limit is reached when an unpleasant or uncomfortable feeling occurs. If the other person continues at that point, it gets worse. Then it is time to communicate this clearly. Continuing is absolutely not an option. This can feel frustrating and lead to a sense of failure. But it is important to respect your own boundaries and to communicate them.

Situational vaginismus

Often the limit is reached when an unpleasant or uncomfortable feeling occurs. If the other person continues at that point, it gets worse. Then it is time to communicate this clearly. Continuing is absolutely not an option. This can feel frustrating and lead to a sense of failure. But it is important to respect your own boundaries and to communicate them.

Psychogenic or organic

Often the limit is reached when an unpleasant or uncomfortable feeling occurs. If the other person continues at that point, it gets worse. Then it is time to communicate this clearly. Continuing is absolutely not an option. This can feel frustrating and lead to a sense of failure. But it is important to respect your own boundaries and to communicate them.

What causes vaginismus?

Vaginismus can develop in many different ways. It almost always has a psychological cause - a fear. Often related to a negative experience, belief or thought.

Below, we discuss the most common causes of vaginismus.

Scientific research into possible causes

  • Research has been conducted into other possible causes of vaginismus. For instance, studies have examined whether women with vaginismus have a higher baseline tension in their pelvic floor muscles. However, research has not found clear evidence for this.
  • There has also been investigation into whether women with vaginismus have a lower pain threshold. Again, no clear differences were found compared to women without vaginismus.
  • What has been established is that women with vaginismus often have a stronger fear response to pain-related stimuli. This supports the theory that vaginismus is primarily a fear-driven condition.

Other causes of vaginismus

Fear as a cause of vaginismus and the vicious circle

As mentioned, fear is the primary cause of vaginismus. This fear is different for everyone. There are, however, a few fears that are reported more frequently.

  • Fear of pain. The most frequently mentioned cause. Having experienced pain during or after sex makes you afraid it will happen again. This fear causes the muscles to tense up, which in turn causes pain. A vicious circle.
  • Fear of the unknown. Not knowing what to expect can cause tension. This is especially common with women who have not yet had sexual intercourse.
  • Fear of losing control. The feeling of not being in control of your own body can be frightening and cause the muscles to tighten.
  • Fear of pregnancy. For some women, the fear of becoming pregnant (or not wanting to become pregnant) can be so strong that the body responds with a vaginistic reaction.

Unhappy in the relationship

Another cause of vaginistic reactions during sex may be that you simply do not feel happy in your relationship. You may not actually want to go to bed with your partner (at that moment). Your body can respond to this by tensing the vaginal muscles. This is an unconscious protective mechanism.

Sexual trauma

Sexual trauma can also be the cause of vaginismus. When there has been sexual abuse, touching of the genitals may trigger a reliving of the trauma, causing the vaginal muscles to tighten as a protective mechanism. Professional help is essential in such cases.

Insufficient knowledge of sexuality

If your upbringing was strict and sexuality was never discussed, it can happen that there is little knowledge about the sexual functioning of your own body and that of your partner. This can create uncertainty and tension, which can contribute to vaginismus. Also, a strict religious or cultural upbringing in which sex is considered sinful or dirty can play a role.

Physical causes

Many women initially think there is something physically wrong with them when they notice that penetration does not work. Understandably so, because you notice it physically. However, the cause is often not physical but psychological. The involuntary muscle spasm is in most cases a response to an underlying fear. Fear of pain, fear of the unknown, fear of losing control.

More causes

Difficult childbirth, vaginal infections, surgery, certain medications.

All in all, there are many possible causes for having or developing vaginismus. These causes can be very different from woman to woman. What they all have in common is that the body responds to an underlying fear or negative experience by tightening the vaginal muscles.

Vaginismus & menopause

Women going through menopause can develop vaginismus. The cause is quite clear in this case. During menopause, the skin of the vagina becomes thinner (atrophy). Because the cells are less well nourished and the skin becomes drier, penetration can become painful. This pain can then lead to fear of the next time, causing the vaginal muscles to tighten involuntarily. And so a vicious circle is created.

Treatment

If you suffer from vaginistic complaints related to menopause, the treatment is relatively straightforward. The fear and tension are directly linked to pain during sex, which is caused by the thinner and drier vaginal skin. A good lubricant, vaginal moisturiser or local oestrogen cream (prescribed by your GP) can help make the vaginal skin more supple again. Once the pain diminishes, the fear often decreases as well.

Childbirth & pregnancy with vaginismus

Childbirth

Pregnant women with vaginismus often dread childbirth enormously. But do not worry too much about this. Childbirth is already exciting enough. For most women with vaginismus, the delivery goes well. The body produces hormones during labour that help relax the muscles. A caesarean section is always an option if vaginal delivery is not possible or desired.

Pregnancy

Despite vaginismus, you can still become pregnant. The vaginistic complaints do not need to be resolved for this. However, it is beneficial if the complaints have decreased so that examinations during pregnancy are easier. Artificial insemination or IVF are options if natural conception is not possible due to vaginismus.

Treating vaginismus

For women, it can be difficult to talk about vaginismus. Even with their own partner. Vaginismus can put enormous pressure on a relationship. Yet it is a good idea to be open about it. To try to explain what is happening and how it makes you feel. Your partner can then better understand the situation and support you in finding a solution.

Visiting your GP

Remember that your GP really is accustomed to these situations, has medical confidentiality, and has encountered many women with vaginismus before. You can certainly trust your GP.

The doctor may examine you to rule out physical causes. They can then refer you to a sex therapist, psychologist or pelvic floor physiotherapist. These specialists have extensive experience with vaginismus and can guide you through a treatment programme.

Standard components of vaginismus treatment

Most treatments include a number of standard components: 1) relaxation, 2) getting to know yourself better, 3) learning to relax the pelvic floor, 4) dilation or penetration training (without and with partner), 5) communication with partner. The duration of treatment varies per person and depends on the underlying cause and the severity of the complaints.

Vaginismus surgery

Surgery is a controversial topic. Many women who have undergone surgery report that it did not provide relief for them. For many women, the problem is not physical but psychological, and surgery does not address the underlying cause. Surgery should therefore only be considered when there is a demonstrable physical abnormality that prevents penetration.

Vaginal botox

In recent years, botox has also been used for vaginismus. Some women have achieved success with this approach. There is some scientific literature that looks promising. It can help reduce the involuntary muscle spasms, making it easier to practice with penetration. However, botox alone is usually not sufficient - it works best in combination with therapy and exercises.

What can I do at home? Practical vaginismus exercises and tips

Do you suffer from vaginismus and want to see if you can overcome it without outside help? Then there are a number of things you can do yourself.

Buy a book with a step-by-step or action plan

  • Overwin je vaginisme
    Overwin je vaginisme is a practical and accessible self-help book. The book was written by an experienced sex therapist and provides a clear step-by-step plan for overcoming vaginismus at your own pace.

Breathing exercise for relaxation

A good and easy-to-perform breathing exercise for relaxation is the 4-7-8 technique. You can find an explanation with video on our relaxation page.

Tensing & relaxing muscles

  • Lie down on the floor or in bed.
  • Tense the muscles of your feet and hold for 5 seconds.
  • Relax your feet again.
  • Now do the same with your calves, thighs, buttocks, abdomen, hands, arms, shoulders, face.
  • Work your way through your entire body from bottom to top.
  • Finally, tense your entire body at once and hold for 5 seconds. Then relax everything.

Self-massage

Self-massage teaches you to make your pelvic area supple and relaxed. You learn to massage away tension in your vulva and vagina, which can help reduce your vaginismus. Self-massage also helps you become more aware of your own body and discover what feels pleasant and what does not.

Lubricant

Having lubricant at home is a good idea. Using lubricant makes it much easier to insert objects into your vagina. You can use it, for example, during pelotte therapy or when practising with dilators. A good water-based lubricant is recommended as it is safe to use with all materials.

Gradually getting used to penetration

This is a part of every treatment. Regardless of the cause, it is of great importance to (re)slowly become familiar with penetration. The pelvic floor muscles must learn to stay relaxed during penetration. This is done step by step, at your own pace, with objects that gradually increase in size. Vaginal dilators are ideal for this purpose.

Tools for gradually getting used to penetration

Put an end to negative thoughts and get started

It is incredibly frustrating to suffer from vaginismus and sometimes it can feel as if 'sex just isn't for you'. Try not to fall into these negative thoughts because precisely these thoughts can maintain or worsen the vaginismus. Vaginismus is treatable and the vast majority of women overcome it. It takes time, patience and perseverance - but it is possible.

Success factors for overcoming vaginismus

  • Take small steps - this prevents disappointment and keeps you motivated.
  • Do not continue if it hurts; take a step back instead.
  • Ensure strong motivation. Write down why you want to overcome your vaginismus.
  • Involve your partner in the process.
  • Seek professional help if you are not making progress on your own.
  • Be patient with yourself. Recovery takes time.

Peer support

It can be helpful to share experiences and tips and to discover that you are not the only one with this problem. Unfortunately, most peer support groups in the Netherlands do not get off the ground well. Fortunately, there are good online communities and forums where women share their experiences with vaginismus.

References / sources / research

Videos about vaginismus

My Fucking Problem, documentary trailer

My Fucking Problem, documentary trailer 2

Anne van Campenhout on Humberto

Jacqueline van de Bilt on vaginismus

Veelgestelde vragen

Wat is vaginisme precies?+

Vaginisme is een onwillekeurige samentrekking van de bekkenbodemspieren rond de vagina, waardoor penetratie pijnlijk of onmogelijk wordt. Het is een veelvoorkomende aandoening die zowel fysieke als psychische oorzaken kan hebben.

Wat zijn de symptomen van vaginisme?+

De belangrijkste symptomen zijn pijn of een brandend gevoel bij penetratie, het gevoel dat de vagina te nauw is, onvermogen om een tampon in te brengen, en angst of spanning bij de gedachte aan penetratie.

Wat zijn de oorzaken van vaginisme?+

Vaginisme kan veroorzaakt worden door angst voor pijn, eerdere negatieve seksuele ervaringen, stress, relatieproblemen, infecties, hormonale veranderingen of een te strakke bekkenbodem.

Is vaginisme te genezen?+

Ja, vaginisme is in de meeste gevallen goed behandelbaar. Met de juiste combinatie van bekkenbodemtherapie, dilatortraining, ontspanningsoefeningen en eventueel psychologische begeleiding herstellen de meeste vrouwen volledig.

Hoe werkt de behandeling met dilators?+

Bij dilatortraining wordt een reeks oplopende dilators gebruikt om de vaginale spieren geleidelijk te laten wennen aan penetratie. U begint met de kleinste maat en werkt langzaam op naar grotere maten, op uw eigen tempo.

Hoe lang duurt de behandeling van vaginisme?+

De duur verschilt per persoon. Sommige vrouwen merken binnen enkele weken verbetering, terwijl anderen maanden nodig hebben. Gemiddeld duurt een behandeltraject drie tot zes maanden bij regelmatig oefenen.

Wanneer moet ik naar een arts met vaginisme?+

Raadpleeg een arts of bekkenfysiotherapeut als penetratie structureel pijnlijk is, u geen tampon kunt inbrengen, of als de klachten uw relatie of welzijn beïnvloeden. Vroegtijdige hulp versnelt het herstel.

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