Brief overview
- What is vaginismus? Cramp-like contraction of the vaginal and pelvic floor muscles, for example during sexual intercourse. In severe cases, the mere thought of sexual intercourse is enough to trigger a painful vaginal cramp.
- Treatment: Vaginal dilators, psycho- and sex therapy, relaxation techniques, pelvic floor training, in rare cases medication.
- Causes: Fear of pain or injury during intercourse, fear of pregnancy, traumatic experiences (abuse, birth trauma), partnership problems, emotional stress, depression
- Risk factors: General illnesses such as diabetes or high blood pressure, disturbed relationship with one’s own sexuality.
- Symptoms: Painful cramping of the vaginal and pelvic floor muscles, pain during sex, fear of pain and injury, penis cannot penetrate or can only penetrate with pain, feelings of guilt
- Diagnosis: Detailed medical consultation, exclusion of physical causes such as infections or inflammation in the genital area.
- Prevention: Healthy relationship with your own intimate area, coming to terms with traumatic experiences, well-trained pelvic floor, low-conflict partnership
What is vaginismus?
The onset of vaginal cramps usually triggers a spiral of fear and pain. For example, although the woman actually has a desire for sexual intercourse, she is overwhelmed by the fear of pain. This causes the muscles in the genital area to contract even more and cause or intensify the pain.
Typical for vaginismus is that there are no physical causes such as infections or inflammation. The cause of the spasm lies in the psyche.
Vaginismus is not a disease, but a painful sexual dysfunction. Sexual dysfunction is when you are unable to live out your sexuality satisfactorily. This includes difficulties with orgasm or erection as well as a lack of sexual interest. In vaginismus, the woman has a sexual desire, but penetration is not possible or only possible with pain.
Forms of vaginismus
A distinction is made between two forms of vaginismus, with the time at which the vaginal cramp occurs for the first time being decisive for the distinction. In primary vaginismus, the dysfunction is present from birth; in secondary vaginismus, the disorder develops during the course of life.
Secondary vaginismus: In secondary vaginismus, sexual intercourse or penetration of the vagina was previously possible without pain. Vaginismus is triggered by a traumatic event such as sexual abuse or birth trauma.
What is GPSPS?
GPSPS is the abbreviation for Genito-Pelvic Pain Penetration Disorder. This is a sexual dysfunction in which the symptoms of vaginismus (cramping of the vagina) and dyspareunia (pain during sexual intercourse) occur simultaneously.
How is vaginismus treated?
The aim of the treatment is to reduce the reflex-like contraction of the vaginal and pelvic floor muscles and to give the woman back control over her sexuality. The woman slowly and gradually learns that sexual intercourse is possible without pain.
Vaginal dilators
Vaginal dilators are special plastic pins that are available in different sizes. These are inserted into the vagina by the woman herself in increasing strengths. They cause the vagina to widen and the muscles to become accustomed to penetration. This creates a feeling for her own vagina and the woman experiences that insertion is possible without pain.
Psychotherapy and sex therapy
In many cases of vaginismus, accompanying psychotherapy is helpful, especially if traumatic events such as abuse or problems in the relationship are causing the vaginismus.
In sex therapy, the patient deals intensively with their relationship to their own body and with sexuality. Ideally, a sexual partner is included in the therapy.
Pelvic floor training
During pelvic floor training, the woman learns to specifically tense and relax the pelvic floor muscles. Some exercises can be easily incorporated into the daily routine at any time.
Tips for everyday life
- Tense the pelvic floor muscles in everyday life, for example when waiting at traffic lights or on the phone.
- Consciously tighten the pelvic floor during physical exertion (for example when carrying heavy loads).
- Avoid straining hard during bowel movements.
- Make sure you eat a balanced diet rich in fiber and drink enough!
- Being overweight puts pressure on the pelvic floor. Try to reach your normal weight!
Special exercises for the pelvic floor
Cat hump (standing on four feet): Kneel on the floor and support yourself on your hands, keeping your back straight. Inhale deeply and then exhale through your mouth. Form a cat hump (round your back and pull it upwards, head between your arms). Then inhale again and straighten your back.
Armchair walk (seated): Sit on an armchair and move to the front edge. Stand with your legs hip-width apart at a right angle. Now press your heels firmly against the floor. This activates the back of the pelvic floor. Hold the tension. To activate the front of the pelvic floor, press the tips of your toes firmly against the floor.
Relaxation exercises
Emotional stress and inner tension can sometimes exacerbate existing problems. Relaxation exercises help to achieve greater inner calm. Breathing exercises or “progressive muscle relaxation” are particularly recommended. Ask your doctor about therapists who can guide you through these exercises.
Medication
In rare cases, the doctor will use medication to prevent further cramping. Injections of so-called “muscle relaxants” – active substances that relax the muscles – improve the symptoms, at least temporarily.
Talk to your partner about it as soon as you feel pain when the penis enters the vagina, for example. Do not try to force penetration. This creates a vicious circle that only increases the discomfort. Try to relax and see a doctor soon. He or she will help you to find out the cause of the vaginismus and find an appropriate therapy.
The treatment of vaginismus requires a lot of patience – also from your partner, but in most cases leads to good results!
What are the causes of vaginismus?
Causes
The cause of vaginismus lies in the psyche. Physical causes such as infections or inflammation in the genital area (such as endometriosis), which also cause cramp-like pain, are not usually present. The cramping in the lower third of the vagina is a strong unconscious defense reflex of the woman, triggered by fear of pain or injury.
Possible causes are
- Affected women believe that the vagina is too tight (e.g. for their sexual partner’s penis) and are afraid of pain during penetration.
- Fear of injury to the genital area, for example by the partner’s penis
- Fear of pregnancy
- Rejection of the sexual partner
- Partnership problems
- Traumatic experiences such as sexual abuse, birth trauma or painful gynecological examinations
- Emotional stress, depression
Symptoms
The symptoms of vaginismus vary from woman to woman. In milder forms, the cramping only occurs in certain situations, such as under stress. With “total vaginismus”, the vagina always cramps as soon as it is touched. For affected women, both sexual intercourse and the insertion of tampons are impossible. Gynaecological examinations with a speculum can also cause major problems.
Symptoms:
- Painful cramps of the pelvic floor and vaginal muscles.
- The cramping cannot be controlled voluntarily.
- Insertion of the penis, fingers, a dildo or a tampon is not possible or only possible with severe pain.
- Avoidance of sexual activity.
- Avoidance or fear of an examination by a gynecologist.
- In some cases, the mere thought of penetration can trigger a vaginal cramp.
If you have sexual problems, contact your trusted gynecologist. They will work with you to find out the cause of the problem and initiate appropriate treatment. Treatment is usually very successful, especially for vaginismus!
Risk factors
Studies show that sexual disorders are generally associated with risk factors such as diabetes, high blood pressure, lipometabolic disorders and depression. Girls and women who view sexuality as something shameful or who grew up in a family where the topic was taboo are also more susceptible to vaginismus.
Examination and diagnosis
The first point of contact if vaginismus is suspected is the gynecologist. In a detailed initial consultation (anamnesis), the doctor will ask about the existing problems. He or she will also ask questions about previous illnesses and sexual history, for example whether there have been experiences of abuse or problems in the partnership. It is also important for the doctor to know whether the patient experiences vaginal cramps with every type of penetration and how long the problem has existed. The doctor will also ask about past pregnancies and births.
If it is possible – and the woman concerned tolerates the examination – the doctor will examine the genital tract for changes that also cause pain and vaginal cramps. These include vaginal infections, injuries, scars or diseases such as endometriosis.
If a gynecological examination is not (yet) possible, the doctor will advise the woman on how to proceed. The examination only takes place when the woman is ready for it.
To prepare for the examination, it helps to familiarize yourself with your own intimate region beforehand. This can be done, for example, by looking at the vagina in front of a mirror or lightly touching it with your fingers. If this can be done without pain, the woman begins insertion exercises: Under relaxed conditions, she tries to insert her fingers or so-called vaginal dilators into the vagina. These are special rods that are available in different sizes. The patient learns that she may still feel discomfort, but no pain, and that the negative feelings will subside over time.
Prevention
Course of the disease and prognosis
If left untreated, vaginismus rarely disappears on its own. If the woman receives treatment, the prognosis is very favorable, even if the vaginismus has been present for many years. The success rate is around 90 percent.
Author & source information
This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical professionals.
