Vaginismus

Vaginismus is a condition in which the muscles around the vagina tighten on their own whenever penetration is attempted, during sex, when inserting a tampon or during a medical examination, making it painful or impossible. It is not something a woman chooses, and she can’t simply relax her way out of it. It is common, and it is treatable.

Also called: sexual pain-penetration disorder (WHO’s ICD-11); genito-pelvic pain/penetration disorder (the American manual, DSM-5, which groups it with other pain during sex); penetration disorder. Lifelong (primary) vaginismus has been there from the first attempt; acquired (secondary) vaginismus starts after a period without problems.

Signs and symptoms

the vaginal muscles clamp shut when something is about to be inserted, with a burning or stinging pain, or no way in at all
it happens with a tampon, a finger, a smear test or sex, not only with a partner
fear or dread beforehand, and tensing of the whole body
avoiding sex, examinations or screening because of the fear
desire and arousal may be perfectly normal; the problem is the reflex

For a diagnosis the pattern has usually lasted six months or more. It is most common from the late teens to the early thirties, often showing up at a first attempt at sex or a first smear test.

Causes

The reasons aren’t always clear, and several usually combine:

anxiety or fear about sex, or fear of pain itself
a painful first experience, a rough examination or a difficult birth
sexual assault or abuse, now or in childhood
being raised to believe sex is shameful or wrong, with little or no sex education
a painful condition such as thrush, which teaches the body to brace

Once pain has happened, a cycle sets in: expecting pain makes the muscles tense, tensing causes pain, and the pain confirms the fear. How a partner responds matters; pressure or anger tightens the cycle, patience loosens it.

Treatment

Treatment works on two fronts at once: the feelings around penetration, and the reflex itself.

Talking therapy to understand and change feelings about the body, sex or a past experience, including trauma-focused therapy where abuse is part of the story.
Relaxation, breathing and gentle touch exercises to learn what the pelvic muscles feel like when they let go.
Pelvic floor physiotherapy: squeezing and releasing exercises that give conscious control over the muscles.
Graded desensitisation: a set of smooth trainers in increasing sizes, used slowly at home after guidance, so the body learns that penetration can happen without pain.

Treatment starts with specialised therapists, then continues at home, and a partner can be involved. Where anxiety is severe, a doctor may prescribe for it, but no medicine treats vaginismus on its own. In a small Indian series of five women treated by gynaecology and mental health teams together, all were able to have penetrative sex within three to eight months; a Nigerian medical journal has reported the same combined approach succeeding here.

In Nigeria

Vaginismus is rarely named here, and the pressure around it is heavy. A marriage that can’t be consummated draws questions from both families within months, and the questions usually land on the wife. Because infertility is public and painful in Nigeria, a couple may face pressure to conceive while still unable to have sex at all, and may be sent for prayer or herbs rather than to a clinic. Clinicians in conservative societies note that stigma delays help for years. We found only a single published Nigerian case report, so there is no local figure for how common it is; the NHS calls it common.

Vaginismus vs other painful sex

Pain during sex (dyspareunia) has many causes: thrush, sexually transmitted infections, pelvic inflammatory disease, endometriosis, menopause, or a reaction to condoms or soap. Those need medical treatment, and they can start the vaginismus cycle. Low desire is different again; many women with vaginismus want sex and enjoy closeness. A gynaecologist’s examination, which can be very brief and done at your pace, is how these are told apart.

When to get help

See a gynaecologist or sexual health clinic first, to rule out infection or another physical cause. You can ask for a female doctor, bring someone you trust, and agree beforehand how the examination will go. Then, or alongside, you can book a licensed therapist on Mytherapist.ng, alone or as a couple, through relationship and marriage counselling; ask whether they work with sexual difficulties. If sexual assault or abuse is part of your history, a therapist who works with trauma can help.