Vaginismus, or vaginal spasm, is the sudden, uncontrollable and painful cramping of muscles in the pelvic floor and vaginal area. To break a negative cycle between pain and fear of another spasm, an early search for the causes is necessary. These are either physical, but in most cases psychological. Therapy is based on the particular causes, and in the case of psychological triggers, an individual combination of psychotherapy, relaxation exercises, pelvic floor training and the use of vaginal dilators is often used to treat vaginismus.
What is vaginismus?
Vaginismus (vaginal spasm) refers to the involuntary and extremely painful tightening of the muscles of the pelvic floor and parts of the vagina. Vaginismus (vaginal spasm) refers to the involuntary and extremely painful cramping of the muscles of the pelvic floor and parts of the vagina. The consequence of the suddenly occurring, extreme tension is a significant narrowing of the vagina with the consequence that gynecological examinations, sexual intercourse or the insertion of objects (tampon, fingers) are associated with severe pain or even impossible – even if the insertion is desired by the woman. As a rule, she herself cannot influence the reflex muscle spasm. Since recurring vaginal cramps also represent a psychological burden for the affected woman via the growing anticipatory anxiety, as well as a massive restriction in her sexuality and thus her quality of life, a prompt investigation of the cause or treatment of vaginismus should be initiated via a trusting visit to the doctor.
Causes
Vaginismus belongs to the painful sexual dysfunctions and can have both physical and psychological causes. In the physical area, for example, a hymen that is difficult to penetrate, the vagina narrowed by a septum, infections, hormonal causes or dysfunction of the pelvic floor muscles are among the classic triggers. Psychological causes include a traumatic sexual experience, a negative birth experience or an upbringing that devalued sexuality. In medicine, a distinction is also made between primary vaginismus – in which the woman was never able to insert anything into the vagina – and the defensive reaction of secondary vaginismus triggered by a negative event. The sudden onset of the cramp and the pronounced pain symptoms evoke an intense fear of expectation in most women with regard to the next attack, so that even with physical causes, the psychological component of vaginismus must always be taken into account.
Symptoms, complaints and signs
Vaginismus describes the involuntary, spasmodic tightening of a woman’s vagina. The extent of the cramping can vary widely. Some women experience cramping during an exam at the gynecologist’s office; in other women, the cramping rarely occurs. The cramping usually manifests in the outer third of the vagina during penile penetration. However, some sufferers also experience vaginal cramping and some may experience cramping of the pelvic floor muscles. The spasm is accompanied by a sharp, throbbing pain and a severe burning sensation. Because vaginismus most often occurs during sex, affected women suffer greatly and avoid sexual contact. Since in some cases vaginismus can also be caused by the insertion of a tampon, it can lead to secondary symptoms such as poor hygiene or inflammation. Vaginismus is not only accompanied by a panic fear of the pain it causes, but is often also a taboo subject. Many women are afraid to talk to their doctors about it. In some cases, gynecologists are also directly avoided because the examination can produce cramping. In some cases, vaginismus may indicate a psychological cause, such as abuse. Such psychological causes can be inquired about in careful discussions with the physician.
Diagnosis and course
An important component of the diagnosis of vaginismus is the patient’s description of the symptoms of vaginismus.Whether a gynecological examination of the affected person is possible at all – for example, to exclude birth injuries, strictures or infections – depends on the individual extent of the respective disorder. Psychological causes such as a traumatic experience (rape, abuse, painfully experienced gynecological examination) are discussed in careful conversations with the physician or psychologist. However, a prerequisite for diagnosis and treatment is that the woman approaches her doctor and, if necessary, her partner with the supposedly taboo subject of vaginismus. Only in this way is it possible to break the vicious circle of anticipatory anxiety and painful cramps and to avoid permanent sexual disorders and possible negative effects of vaginismus on the partnership.
Complications
Vaginismus almost always affects sexual relationships because penetration is impossible or painful. In some cases, a fear or aversion to sexual situations is added. Women who are in partnerships may put psychological pressure on themselves to “function.” However, this may actually increase vaginismus. In addition, if the sexual needs of the other partner remain unsatisfied or the partner does not have sufficient understanding of the discomfort, relationship conflicts are possible. Some women who suffer from vaginismus therefore avoid love relationships and withdraw. Often this withdrawal is not voluntary and is characterized by strong feelings such as loneliness. Affective disorders such as depression are thus favored. Shame and feelings of guilt are a frequent consequence of vaginismus. In addition, self-esteem often decreases. Post-traumatic stress disorder or other mental illnesses are possible if vaginismus is due to trauma or other stress factors. Medical complications arise from vaginismus almost exclusively indirectly. Vaginismus may be so severe that certain gynecological examinations are not possible. If an affected woman then avoids visiting the gynecologist, she may postpone treatment of other complaints. Further complications may develop as a result, such as infections that are not treated early because of the avoidant behavior.
When should you go to the doctor?
Vaginismus is painful and can make a normal sex life nearly impossible for affected women. It is not expected that vaginismus will get better on its own or that the woman will be able to develop mechanisms to deal with it without help. Therefore, when the first cases occur, the gynecologist should be consulted immediately. Since vaginismus can occur in connection with traumatic experiences, a woman can also turn to a treating psychologist when she notices the symptoms. The visit to the doctor should not be made dependent on the age of the affected woman or her sexual experience. It may be that vaginismus occurs in a young girl and she notices it during her first sexual experiences – in the same way, it may be that a woman suddenly suffers from vaginismus after childbirth because she has not processed the experience of childbirth. In some cases, discomfort during sexual intercourse occurs seemingly without any apparent cause, but this does not mean that it cannot still be vaginismus. Only a gynecologist can detect it, but the earlier vaginismus can be detected, the sooner it can be treated. The treatment period will take some time, but the more unpleasant experiences a patient with vaginismus has before her first doctor’s appointment, the more time it will take.
Treatment and therapy
Effective treatment of vaginismus depends on the particular trigger of the vaginal cramps. If the cause is physical, this may include surgical splitting of a tight hymen or removal of a congenital septum in the vagina. If a psychologically based condition is suspected, a combination of effective therapeutic measures is often used to gradually reduce the frequency of attacks and the patient’s anxiety. Often, the step of confiding in a doctor and partner already brings initial relief for those affected when they experience understanding for their situation. In the field of vaginal cramp therapy, good results are achieved particularly with vaginal dilators.These are smooth, conical rods in various sizes, with the help of which the woman can gently dilate her vagina. This treatment can be supported by classical relaxation methods or biofeedback, but also by targeted pelvic floor training, in which the woman can rediscover the experience of control over her own body by tensing and relaxing the relevant muscles. In the case of massive psychological triggers, an accompanying psychotherapy is advisable, which serves to process experienced traumas. If the effects on the partnership are severe, special couple or sex therapies can be helpful against vaginismus.
Outlook and prognosis
Vaginismus prevents a fulfilling sex life for affected individuals. Unfortunately, painful vaginal cramps are a condition that will not get better on its own. Since the most common cause of vaginismus is psychological triggers, the condition may not improve until the cause is identified and treated. Depending on what triggers the vaginal cramps, it may take several sessions with a sex psychologist before a woman notices any noticeable improvement. Even if there is a purely physical cause or the psychological triggers can be improved through exercises and training with dilators, it takes time. In this method, the woman gradually inserts wider and wider objects into the vagina and works on consciously relaxing. As a result, over time, a normal and fulfilling sex life becomes possible for her. What can prevent the success of the treatment is pressure from the partner or even from oneself. It is only understandable, but absolutely counterproductive, if the partner or the patient herself becomes impatient and thus puts herself under even more pressure. In the worst case, this can aggravate the already existing vaginismus and reverse treatment successes that have already been achieved. Involving the partner in the diagnosis and treatment, on the other hand, ensures that he or she can develop understanding and contribute to improvement through patience.
Prevention
Because of the variety of causes and its sudden onset, vaginismus is a disorder that is difficult to prevent. In the physical sphere, regular gynecological examinations as well as good hygiene are ways to detect or prevent diseases that promote vaginismus at an early stage. In the psychological sphere, particular emphasis should be placed on consistently working through negative events surrounding sexuality or childbirth in order to counteract the development of vaginismus as a consequence of trauma.
Aftercare
After vaginismus (vaginal cramping), individualized aftercare is often helpful. The reason for the cramping is important in designing personalized aftercare. Physical causes are cared for by the gynecologist, while psychological causes often require the trusting cooperation of the doctor, psychologist, the affected person herself, and her partner. The fear of a renewed vaginal fight can significantly limit a woman in her sexual life and even be a reason for renewed vaginismus. Therefore, it is good to know the cause of individual vaginismus and work on it. If it is certain positions during sexual intercourse that obviously trigger the vaginismus, simply refrain from them in the aftercare. If the fear of penetration has become too great, the woman can gradually approach this situation again with a finger or a vibrator. Often it is psychological reasons that are responsible for the vaginal cramp. This is where aftercare should start very gently. Talks with psychologists help to cope with problems. Self-help groups offer an exchange with like-minded people. Discussions with the partner contribute to better mutual understanding and reduce fears. The woman’s ability to relax should also be promoted during aftercare. This is well possible with progressive muscle relaxation or even yoga.
What you can do yourself
In many cases, vaginismus is due to a psychological trigger. Internalizing this and assuming that there is no organic disorder is a good first step. In the case of vaginismus that is physically caused by, for example, a narrowed vagina or inflamed tissue, treatment of the cause is necessary.A good way to strengthen intimate body awareness and gain further anatomical knowledge of the sexual organs is to practice a good pelvic floor muscle training program. There are group and home courses for this, which can be done with or without a partner. In so far as vaginismus is not based on trauma of a psychological or physical nature, a suitable means of relaxation can be applied, in which the affected person concentrates fully on herself and her body. In the case of situational vaginismus – i.e. vaginal cramps that always occur in the same situation – it can help to take a closer look at the supposed trigger. Furthermore, masturbation exercises, in which the movement originates from the vagina by moving the pelvis, are said to have good results in overcoming vaginismus. Here it is important that the control comes from the sexual organ and not from fingers or the like. This helps to learn how the vagina behaves during attempted penetration. These can also, taking into account one’s own physical limitations, lead to a certain desensitization and stretching of the tissue if the vagina is too narrow. However, the effect is limited if the vagina is too small.
