Vaginismus is a sexual dysfunction with psychological origins, frequently observed in society. Presenting itself as a fear reaction and a panic attack–like condition, vaginismus occurs in one out of every ten women. Although the prevalence of vaginismus varies across cultural structures, the most significant reason for its emergence is lack of knowledge about sexuality. Insufficient understanding of sexuality leads to fear reactions, which then develop into panic-like responses, resulting in vaginismus.
Vaginismus is not directly related to social events. However, societal perceptions of sexuality and virginity, inadequate sexual education, lack of experience, persistent false beliefs, taboos, and myths form a cultural basis for the emergence of vaginismus. Therefore, examining the definition of vaginismus in detail will also help us better understand and address its treatment.
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What Is Vaginismus?
Painful, fearful, and tense situations caused by the involuntary contraction of the muscles around the vaginal entrance, which make sexual intercourse difficult or impossible, are referred to as vaginismus.
Vaginismus may present during sexual intercourse as an involuntary vaginal reflex, but it may also be triggered by tampon insertion, medical examinations, or even finger contact. Due to the involuntary vaginal reflexes and resulting spasms, the vaginal entrance closes, making intercourse impossible. If the spasm persists, pain emerges.
Vaginismus does not only cause spasms in the vaginal area — it can also cause muscle spasms in other parts of the body, and in some cases even lead to difficulty breathing. When the stimulus triggering the vaginal muscle contraction ends, the muscles relax and return to their normal state.
Vaginismus, defined as the involuntary contraction of the pelvic floor muscles, prevents sexual intercourse and makes treatment essential. It is a contraction that occurs outside the woman’s conscious control. In vaginismus, penetration rarely occurs, and if it does, it is painful or uncomfortable because the contractions persist. Although vaginismus is primarily a psychological sexual dysfunction, it may rarely develop due to trauma or recurrent vaginal infections.
What Are the Causes of Vaginismus?
Vaginismus is more common in cultures with restrictive views on sexuality than in societies with open sexual education. We may list the causes of vaginismus as follows:
- Lack of sexual education; this is the most fundamental cause of vaginismus. The unknown often creates fear. Therefore, one should not remain uninformed about sexuality, which is an essential part of life. Not knowing the structure and location of the sexual organs alone can lead to vaginismus.
- Fear of pain; one of the most common causes. A woman may avoid sexual intercourse for various reasons, which can lead to vaginismus. Forced marriage, fear of pregnancy, fear of sexually transmitted infections, or perfectionistic tendencies (fear of losing control) may all contribute.
- Societal structure; in a restrictive cultural environment, women may not develop a healthy understanding of sexuality due to taboos, myths, false beliefs, or prohibitions. Overemphasis on virginity may prevent gradual sexual experience, causing fear to increase or persist.
- Physical causes; ovarian cysts, urinary tract infections, vaginal atrophy, vaginal dryness, thick or rigid hymen, childbirth trauma, vulvar cancer, vaginal infections, dermatological diseases, and rheumatic conditions affecting joints can also play a role.
The treatment of vaginismus is among the most successful types of sexual therapy. Although treatment steps may seem standardized, the approach must be personalized.
How Is Vaginismus Diagnosed?
Vaginismus is defined as the involuntary contraction of the pelvic muscles during sexual intercourse, preventing penetration. When vaginismus arises due to trauma or surgery, it is called secondary vaginismus; when pelvic muscle spasms prevent even gynecological examination, it is considered primary vaginismus. The condition is usually psychological in nature.
Especially in cases involving inadequate sexual education, family and societal pressure, first-night anxiety, or physical/psychological violence, vaginismus treatment can be applied comfortably and often yields quick results.
How Is Vaginismus Treated?
The first thing to know about treatment is that vaginismus is temporary and treatable. There is no need for surgery or invasive procedures. If the woman has no additional medical condition, medication is not required. As with all sexual problems, vaginismus involves sexual incompatibility. Even though the problem seems to belong to the woman, relational cycles apply to sexual relationships as well. Therefore, the ideal approach is for the couple to seek treatment together. Another key factor is finding a sexual therapist who can guide them appropriately. The therapist must evaluate the couple thoroughly, take a detailed sexual history, and create a personalized treatment plan.
Exercises given under the name of “sensate focus” (love games) are explained clearly and practiced gradually. Before these exercises, the woman’s emotional readiness for sexuality is essential. Therefore, vaginismus treatment is a step-by-step process. Rapid solutions do not suit everyone. Personalized therapy is crucial. After masturbation, relaxation, breathing exercises, and finger exercises are completed, intercourse practice begins. Treatment concludes when the woman learns to experience pleasure from sexual intercourse (not only penis–vagina penetration).
Incorrect or harmful interventions in vaginismus treatment include: hymen removal surgery, sexual intercourse under general anesthesia, Botox injections, applying topical creams inside the vagina, taking muscle relaxants or sedatives before intercourse, and single-session treatments. These do not constitute valid or scientific treatments.
Vaginismus Treatment
Vaginismus can occur in women who have never had intercourse as well as in those who previously had normal sexual experiences.
If a woman has never experienced painless intercourse due to muscle contractions, the condition is called primary vaginismus. It appears during first intercourse attempts or during gynecological examinations.
If the woman previously had normal, painless sexual intercourse but later developed vaginismus, it is classified as secondary vaginismus.
In some cases, even after trauma has been addressed and surgical procedures completed, difficulty with intercourse may continue. Involuntary muscle contractions may occur unexpectedly despite sexual desire. The root of this reaction lies in unhealthy sexual messages embedded in the subconscious.
To determine the correct treatment, physical and medical causes behind painful intercourse must be examined thoroughly. Methods used in vaginismus treatment include:
- Hymen removal; considered a solution by many women with vaginismus, but unless the hymen is unusually thick or rigid, removal does not solve vaginismus and may worsen it.
- Psychotherapy; teaches relaxation skills. Without relaxation, fear of failure increases anxiety. Psychotherapy is not sufficient on its own; it must be supported with structured exercises.
- Exercises; including Kegel exercises, breathing exercises, relaxation techniques, Botox in some cases, and the use of vaginal dilators to teach muscle control and relaxation.
