Information From Your Health Care Provider

VAGINISMUS

Basic information

Vaginismus involves spasms (clenching up) of the pelvic muscles before sexual intercourse. The problem can affect females of all ages. Types are:
- Primary vaginismus—a woman has never been able to have sexual intercourse.
- Secondary vaginismus—a woman has had intercourse previously, but is no longer able to because of the spasms.

Muscle spasms around the vagina and rectum. They may be quite painful.
The vagina closes so tightly that the penis cannot penetrate for sexual intercourse. It also prevents inserting any object into the vagina, such as a tampon, diaphragm, or speculum (used for pelvic exam).

It may be caused by physical or mental (emotional) factors, or a combination of the two.

An unconscious desire to prevent penile penetration. This may be due to fear of pain, anxiety, hostility, anger, or a distaste for sex.
Being brought up to think that sex is a sin or dirty.
Previous sexual trauma (incest, rape, sexual abuse).
The first sexual experience for a woman.
A sexual partner who is not sensitive; insufficient or unskillful foreplay.
Emotional stress.
Infections, allergic reactions, or a rigid, intact hymen.
Surgical or postdelivery scarring.
Endometriosis (a gynecological condition).

Pelvic exam by a health care provider and counseling prior to beginning of sexual activity.

Medical treatment and counseling can help. Treating the underlying cause may clear up the condition.

Emotional problems caused by guilt, anxiety, loss of self-esteem, and feeling inadequate. Relationship problems with your sexual partner.

Your health care provider will do a physical exam and a pelvic exam if possible. Sedation may be needed for a complete exam. A sexual history is important. This will include early childhood experiences, family attitudes toward sex, previous and current sexual responses. Contraceptive practices, reproductive goals, feelings about your sexual partner, and specifics about the pain you experience will be discussed.
Treatment will be given for any medical problems. This is often followed by therapy to help with emotional problems, and to reduce the muscle spasms.
One therapy involves dilating (widening) the vaginal opening gently and gradually. This is done with rubber or glass dilators. Treatments may be started at the medical office and then continued at home.
Prior to dilation therapy or attempted intercourse, sit in a tub of warm water for 10 to 15 minutes. Baths often relax muscles and relieve discomfort.
Kegel exercises to control the pelvic muscles may be helpful. You will be instructed on how to do them.
Counseling is helpful for many patients and their partners. It can help resolve any conflicts and concerns in your life, and improve communication with your partner.
You and your partner may try other sexual activities. This can include massage, oral sex, or masturbation.

Anti-anxiety drugs or muscle relaxants may be prescribed for a short period of time.
Before attempting intercourse, you and your partner should use a vaginal lubricant.

No limits.

No special diet.

You or a family member has symptoms of vaginismus.
Symptoms don't improve after 3 weeks, despite treatment. Symptoms recur after treatment.