Painful sex is unfortunately quite common, even if it isn’t regularly discussed. The American College of Obstetricians and Gynecologists estimate that, at some point in their lives, 3 in 4 women will experience painful sex1. One cause is a genito-pelvic pain/penetration disorder called vaginismus. Vaginismus is characterized by the uncontrolled tightening of the muscles at the opening of the vagina when trying to insert something (think: penis, tampon, finger, or medical instrument). These muscles are generally under our control, but similar to getting a side stitch or a leg cramp from exercising, these muscles can tighten involuntarily and cause pain. If you’ve ever watched the popular Netflix series Sex Education, a character describes vaginismus by saying, “It’s like my vagina has lockjaw!”
It is essential to recognize that there are many causes of sexual pain. Vaginismus is described as the cause of sexual pain when a woman has recurrent vaginal spasms and pain with penetration that interferes with sexual intercourse/penetration.
What does the pain during sex feel like?
Pain associated with vaginismus can vary significantly between individuals. It may feel like burning, it may be sharp, or it may be mild discomfort. This pain can be anywhere from mildly to extremely painful and possibly even emotionally painful, given that women often have no control over it. The pain may be so bad that nothing can be put in the vagina. While vaginismus does not affect the ability to get sexually aroused or orgasm, the pain can lead to 1) an inability to tolerate sex, 2) a decrease in or no sexual desire, 3) avoidance of sexual activity, and/or 4) intense fear of pain.
What causes pain during sex?
Vaginismus can affect women of all ages. Some individuals discover they are affected the first time they try to achieve penetration. When they are unable to achieve penetration due to pain and/or tightness of the vaginal opening, they may mistakenly believe that they have a structural abnormality, such as a vagina that is “too small” or that something is blocking the opening, such as an unbroken hymen. For other individuals, vaginismus is acquired later in life. The causes of vaginismus are not clearly understood, although contributing factors may include both physical and non-physical causes. Sometimes there is no identifiable cause.
Possible physical causes:
- Urinary tract infections
- Sexually transmitted infections
- Vaginal tears (e.g., from childbirth)
- Vaginal dryness (e.g., from postmenopausal hormone changes or insufficient foreplay)
- Prior surgeries
- Pelvic trauma
- Pelvic pain due to conditions like endometriosis or fibroids
- Post-cancer radiation2
Possible non-physical causes:
- Anxiety (e.g., general anxiety, negative attitude toward sex, fear of intercourse or pregnancy)
- History of sexual abuse or trauma
- Partner issues (e.g., distrust, commitment struggles, relationship stress)
Can you have vaginismus only sometimes?
Pain from vaginismus does not always occur consistently, and different people have different triggers. For example, it is possible to experience vaginismus from penetration with a penis but not from a tampon.
How to avoid painful sex. Can Vaginismus be treated?
Yes, vaginismus can be treated. It is often treated using a combination of approaches, and it’s different for different people. A gynecologist or primary care provider can provide a treatment plan. If there are underlying medical conditions causing the pain, a clinician can help address these issues. Pelvic floor therapy and home exercises can help loosen the tight muscles around the vagina. In certain cases, injections or medications may be warranted. Mental health support, such as cognitive behavioral therapy or counseling, may also be helpful. Dilators, such as the Milli Vaginal Dilator, can help relieve the symptoms of vaginismus by helping the body slowly get accustomed to having something in the vagina. Use of vaginal dilators may reduce your fear and anxiety of vaginal penetration by repeated, gradual, self-controlled exposure. Dilators can also promote stretching of the vaginal tissues and relaxation of the pelvic floor during wanted penetration.
2. Bergeron, S., Corsini-Munt, S., Aerts, L. et al. Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment. Curr Sex Health Rep 7, 159–169 (2015).