Any woman can be affected by vaginismus. Even women who have previously been able to have pain-free penetrative intercourse or who have given birth before can develop vaginismus.

Primary vaginismus is when a woman has never been able to have pain free intercourse.

Secondary vaginismus occurs in women who were previously able to have comfortable penetrative sex and may be triggered by events such as childbirth, surgeries, infections, or menopause.

Women with vaginismus may experience pain or a burning discomfort during attempted intercourse. Depending on the severity of vaginismus, penetrative intercourse may even be unachievable.

Beyond discomfort during sexual intimacy, vaginismus may manifest in other ways, such as the inability to insert a tampon, or difficulty with pelvic examinations in the medical setting e.g. undergoing a PAP smear, during which the use of a vaginal speculum to open up the vaginal canal is necessary.

Vaginismus is a spectrum and can range from mild to severe.

No, painful intercourse (medically knowns as “dyspareunia”) can be caused by many different reasons and vaginismus is only one. Other causes such as skin conditions, infections, vaginal atrophy or lack of lubrication can all cause painful intercourse.

Learn more about the 10 Causes of Dyspareunia in Women

The diagnosis of vaginismus is largely clinical, which means your doctor will talk to you and ask you to describe your symptoms in detail and then perform a thorough physical examination. This is also to ascertain that there are no other underlying medical condition contributing to the pain you experience. Other similar medical conditions may also masquerade as vaginismus but treatment may be very different.

In some cases, if your doctor has reason to think your symptoms could be due to another condition, additional investigations such as an ultrasound scan of the pelvis may be warranted.

There is no quick-fix or magic pill to cure vaginismus.

Treatment for vaginismus is complex and must address not just the physical aspect but also any associated emotional or psychosexual and relational aspects. This is why treatment is multi-pronged and should involve both the woman and her partner (if there is one).

Treatment of the physical aspect of vaginismus is aimed at releasing the tension in the pelvic floor muscles. Desensitisation techniques are used in retraining of the pelvic floor muscles to teach them to relax, and to allow a woman to take conscious control and override the involuntary muscle spasms.

This is done through the use of vaginal dilators and pelvic floor exercises. These may be used together with medications to help one relax, and creams or gels to numb the vaginal area.

Botox injections administered through the vagina to the surrounding muscles is an experimental treatment which appears to have some good results but no real large-scale research to support it. This has to be done under sedation or general anaesthesia and is not routinely offered as initial treatment.

Some women and their partners may also find psychosexual and relationship counselling helpful during this journey.

Vaginal dilators are used to help with desensitisation. A set of vaginal dilators comes in gradually increasing sizes. These dilators are not meant to enlarge or stretch the vaginal opening, but rather, to desensitise the pelvic floor muscles.

The dilators are inserted either by yourself or together with the help of your partner, in the familiar environment of your own home, or in the clinic, starting with the smallest sized dilator in the set. As your pelvic floor muscles learn to relax more over time, you will be able to progress through using the various sized dilators in the set.

These dilators are often used in conjunction with a topical numbing cream or anaesthetic cream to make insertion more comfortable.

There is no set duration of time for treatment. Different women will take different amounts of time to get through the dilator set. It is important to remember not to push or compare oneself and feel discouraged- your journey to overcoming vaginismus is your own.

Vaginismus is treatable and pain-free sexual intercourse is achievable.