Gynecologists’ Top Advice on Treating the Down-There Pain Few Women Discuss
Vaginismus affects nearly 1 in 5 women, yet many have never heard of it. Read on for must-know info
Pain during sex is common for women of a certain age. Often, the problem is the result of menopause: Shifting hormones and lower levels of estrogen can lead to vaginal dryness, triggering pain with intercourse. But when lubricants and vaginal moisturizers don’t help or if this pain happens before menopause, during gynecological exams or even when you’re trying to insert a tampon, a condition called vaginismus could be to blame. We asked gynecologists for more details on the little-known condition. Read on for their advice on how to get over vaginismus.
What is vaginismus?
The condition involves unconscious tightening or contracting of the muscles in and around the vagina, preventing penetration and causing pain that can be severe when you try, explains integrative gynecologist Felice Gersh, MD.
“This is a condition nobody talks about and that people think is really, really rare,” says sex therapist Bat Sheva Marcus, PhD, author of Satisfaction Guaranteed: How to Have the Sex You’ve Always Wanted. Dr. Marcus spent more than 20 years as the clinical director of Maze Women’s Sexual Health in New York, a practice that specializes in helping women with the condition.
But that’s not the case: Data suggests vaginismus affects up to 17% of women. But experts say many cases aren’t reported, mostly because women are embarrassed about it, so the incidence is likely higher. “Women who have vaginismus start to feel like they’re crazy, like they have a terrible black secret or black cloud hanging over their head,” says Dr. Marcus. “They think they’re the only ones and they can’t talk about it. They feel like something is wrong with them.”
What causes vaginismus?
There are many underlying causes of vaginismus, says Dr. Gersh. These can include:
- trauma/physical damage during childbirth
- medical conditions like recurrent urinary tract infections (UTIs), yeast infections, chronic pain syndromes or endometriosis
- a painful past gynecological exam
- unpleasant sexual intercourse or past sexual trauma
- anxiety disorders
- fear of penetration or pain
- fear of getting pregnant
“There is definitely an association of vaginismus with a prior traumatic experience, including emotional and physical traumas,” Dr. Gersh explains, adding that there are many cases in which no clear cause is discovered. And if the cause is physical (recurrent UTIs, yeast infections or vaginal injury during childbirth), addressing and fixing that cause can help. What’s more, vaginismus is generally the result of some sort of stimulus, she says. “This could be a tampon insertion or any vaginal penetration, whether that’s part of a pelvic examination or with sexual activity.”
Related: Ob/Gyns: Don’t Ever Use a Tampon With Damaged Packaging — Here’s Why
Why treating vaginismus is key
Barbara DePree, MD, a certified menopause practitioner and founder of MiddlesexMD.com, an educational resource on sexual health for women in perimenopause and beyond, says the resulting tightness can be so severe that many women describe any attempted penetration as ‘hitting a wall.’ She recommends discussing this type of pain as soon as possible with your doctor. “Sex should never hurt and early intervention can prevent a bad situation from getting worse.”
In fact, avoiding treatment for vaginismus can set off cascading effects. “Women who have it stop dating,” says Dr. Marcus. “Some women who get married and realize they have vaginismus stop being sexual at all with their partners. Women put off treatment because they feel so bad about themselves or because they’re so ashamed or don’t realize there’s help. They go through years and years without being treated.” Yet the experts we spoke to all agree that vaginismus is highly treatable.
How to get over vaginismus
Because vaginismus generally has physical and psychological components, it’s important both are addressed in treatment. “It lives on a spectrum,” Dr. Marcus says. She describes it in terms of an X and a Y axis: The X axis is the tight muscles that prevent penetration and the Y axis is fear. Some women have very tight muscles and others are less tight, while some women have huge amounts of fear and other have just a little. For the best treatment, Dr. Marcus says it’s key to understand how much of the condition is related to tight muscles and how much is related to fear. “Your brain and vulva have to start learning to communicate with each other and you have to be sure that they know and trust each other,” Dr. Marcus says. A few strategies that can help treat the condition:
1. Dilators
These tube-shaped devices, generally made from silicone or plastic, come in a set that includes various sizes (the smallest around the size of your pinky finger). Women can use them to progressively retrain vaginal muscles to relax with penetration, says Dr. DePree. A set to try: QoQui 5-Pack Silicone Dilators (Buy on Amazon, $25).
Dr. DePree advises starting with the smallest dilator, adding a lubricant and setting a timer for 10 minutes. “Aim to take deep breaths, relaxing the pelvic muscles as you slowly insert the dilator,” she says. If you feel resistance or if your discomfort reaches a 3 out of 10, stop and take deep breaths, gently contracting then relaxing the muscles around the dilator to see if you can insert it farther. Continue this 10-minute practice every other day until you can comfortably insert the dilator as far as a tampon, then start over with the next size.
2. Botox
For some women, the idea of putting a dilator in the vagina is so frightening that they can’t comprehend it, says Dr. Marcus. For those women, Botox is a good option. Women are sedated for the 15-minute procedure. A tech then injects Botox (a toxin that can paralyze muscles to prevent their contraction) into the muscles surrounding the vaginal opening so that a dilator can be inserted. When the patient wakes, it’s a life-changer, Dr. Marcus says. “Their reaction is ‘Oh my God, I can really put something in there!’ But Botox is just the beginning of the process. You still have to get your brain and vulva and vagina speaking to each other, but the Botox can jump you over those first few steps of introducing the first dilator.”
3. Anesthetics and muscle relaxants
Doctors can prescribe a local anesthetic to numb the vaginal opening, a strategy Dr. Gersh says has a high level of success. Note: Because these creams can also cause penile numbness, experts advise applying them at least 30 minutes before having sex. Oral muscle relaxants are another option, as is using the prescription muscle relaxant Baclofen in a vaginal suppository, Dr. Gersh adds. “These medications can relax and calm the vaginal muscles and improve the chance of successful intercourse.”
4. Stress-reduction techniques
Not only can stress cause vaginismus, it can be a result of the condition that prevents recovery and makes vaginismus worse, Dr. Gersh says. But modalities such as meditation, guided imagery, hypnosis, progressive relaxation and cognitive behavioral therapy can all help reduce stress and anxiety to prevent vaginismus. Says Dr. Gersh: “Optimizing a relaxed state of mind will set you up for a better and healthier physical state as well.”
5. Pelvic floor physical therapy
Dr. Gersh says anyone suffering from vaginismus can benefit from this type of therapy, which involves visits to a physical therapist trained specifically to help you learn to relax and train vaginal muscles. Therapists with this training will have the initials WCS (Women’s Clinical Specialist) or PRPC (Pelvic Rehabilitation Practitioner Certification) after their names. To find a therapist, visit APTAPelvicHealth.org and plug the initials WCS or PRPC into the search.
The keys to success
- Don’t wait: Vaginismus is treatable and you can be pain-free in eight to 12 weeks, assures Dr. Marcus, who says she’s seen women avoid sex or endure painful sex for decades because they don’t ask for help.
- Go slowly: Once you have a plan for treating your vaginismus, remember that reversing it comes with time, practice and patience, Dr. DePree says. “You need to start slowly and work within your comfort zone. Pushing too hard and going too fast can hurt you. Practice and time are worth taking when the result is the kind of sexual intimacy you want.”
For more on women’s health, keep reading:
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