What is Vaginismus (Contraction of the Vagina)? Symptoms and Causes

Vaginismus is a sexual disorder accompanied by dyspareunia, i.e. pain, burning during intercourse or when inserting a tampon and sometimes even when pressing on the genitals. 

Vaginismus is a spasmodic contraction, a spasm of the muscles of the vaginal entrance of the vagina that prevents the penetration of the penis, fingers, or objects through the vaginal entrance, even though the woman desires sexual intercourse. It is characterized by strong involuntary and uncontrolled contractions of the pelvic floor muscles. 

Any penetration is painful and causes discomfort, pain and burning. 

It is also characterized as a defensive reflex against the attempted intrusion of the penis, fingers, objects into the vagina. 

Classification of vaginismus. The following concepts are used: 

• primary 
• secondary  
• generalised
• precoital

Primary vaginismus is characterized by the fact that it lasts from the first attempts of sexual life. 

Sexual penetration is impossible, despite multiple attempts. Although partial penetration sometimes seems to occur, the tip of the penis usually only presses against the outside of the vulva and does not penetrate the vagina. It seems as if the vagina is too small, as if the hymen surrounds the entire entrance of the vagina, which when pinched is too small, or the opening seems to be almost absent. 

This type occurs in women who have been brought up in a restrictive way and led to false information about sex. Sex is bad, painful, can hurt. 

Secondary vaginismus is when sexual intercourse was initially possible and only subsequently vaginal spasm occurred. 

During sexual intercourse, inexplicably there is tension and discomfort. Often it is a consequence after a previous negative experience. In the past, sexual intercourse may have been uneventful and the negative experience caused persistent tension, pain, discomfort, leading to the interruption of sex. 

This condition is triggered by a temporary medical condition, trauma or pelvic pain. With various urinary tract infections or pelvic inflammatory disease, decreased moisturization of the vagina, rape or after a long break from sex. The woman is confused, scared and worried about how things will progress, whether she will still be able to have intercourse and whether the problem will be corrected. 

Some women are able to tolerate the problem for years until it escalates to the stage of a sexless relationship or marriage. 

Generalized vaginismus arises reflexively when attempting sexual intercourse, as well as during a gynecological examination, which is impossible to perform. 

Precoital vaginismus: contraction of the vagina occurs, only during intercourse and gynecological examination is partially possible. 

Cases can range from mild to severe. 

Table: division into 4 stages 

What is the difference in organic and inorganic vaginismus? 

Organic vaginismus is characterized by painful intercourse with symptoms similar to bodily illnesses, diseases, or anomalies, and deviations from the normal state that make it difficult to penetrate the vagina, such as inflammation in the vagina, various obstacles in the shape and structure of the vagina, or too much stiffness of the hymen. 

Inorganic vaginismus is one of the most common sexual dysfunction disorders. Strong involuntary contractions of the vaginal entrance are typical occurrences. Each dilation is very painful. The woman may refuse intercourse, and the mere touch of the genitals makes her uncomfortable. 

The cause of occurrence varies. It can occur in younger, but also in older women, in women without sexual experience, but also with years of experience. In each woman, it can manifest itself differently, and their extent may vary. 

The disorder is mostly psychogenic. It can occur after a traumatic experience, on a psychological or somatic basis. 

It is often associated with fear of intercourse, involuntary clenching of the pelvic muscles, fear of pain, most often it is of psychogenic origin. 

This may be due to lack of stimulation, lack of foreplay, various psychological conditions, disturbing factors, past traumatic or painful attempts at sexual intercourse, the family environment in which the woman grew up, religious orientation, as well as past partner relationships. 

Women often do not know how to express their needs, desires or even voice their disapproval. 

Personality disorder, personality traits, anxiety tendencies can also have a big impact. Women with this disorder have a great need for self-control and a fear of losing it, of losing their honesty, their integrity. Most often, however, it arises from a combination of several factors. 

In vaginismus, the woman's body and mind trigger withdrawal based on anticipated pain automatically, without the woman realizing it. 

It's not that he wishes it, but it just happens, we can also attribute it to the automatic blinking of the eyes. It just happens. It is not voluntary or intentional. 

The cause can be divided into two types.

Due to non-physical causes:

• Fear or anticipated pain from sexual intercourse  
• Fear of first sexual intercourse and subsequent violation 
• Due to tissue rupture  
• Fear of getting pregnant 
• Anxiety and stress from previous unpleasant experiences 
• Relationship issues
• Lack of trust
• Fear of commitment 
• Loss of control 
• Traumatic events such as sexual abuse and repressed memories 
• Childhood experiences of being led too much into religion and then teaching children that sex is wrong 
• Lack of sex education 
• Sometimes there is no cause 

Due physical causes: 

• Urinary tract infections 
• Yeast infections 
• Sexual diseases 
• Endometriosis 
• Tumours 
• Cysts 
• Eczema 
• Vaginal prolapse 
• Childbirth, pain after childbirth, Caesarean (C-section/caesarean delivery)
• After a spontaneous abortion 
• Menopause and hormonal changes 
• Vaginal dryness 
• Lack of foreplay 
• After surgical interventions in the pelvic area 
• Bullying, abuse  
• Rape 
• Physical assault 
• Taking medicines and their side effects causing pelvic pain 

Vaginismus can manifest itself in a variety of symptoms. For each woman, the situation may be different. While one has only one distinct symptom, the other experiences multiple symptoms at the same time. 

Typical symptoms are: 

• Burning, stinging sensation during sex 
• Difficult, even impossible penetration of the penis 
• Pain 
• Vaginal dryness
• Persistent sexual discomfort due to infection, rape, cancer, surgery, menopause, other problems 
• During intercourse, pain of unknown origin and without cause arises 
• Difficult or impossible to introduce a tampon 
• Impossible to perform a gynaecology examination 
• Avoidance of sex
• During attempted sexual intercourse, convulsions or even cessation of breathing may occur 

Women often do not know that they are suffering from different degrees of vaginismus, so they try to explain and define it as follows: 

• I'm a virgin and we've tried multiple times to have intercourse, but it's like he's always hit a wall 
• I feel a burning pain during penetration 
• Sex used to be great, but now it's already burning and painful 
• After childbirth, sex isn't what it used to be, it hurts and stings 
• After my ob/gyn checkup, the doctor assured me that everything was fine so why was I still bothered? 
• When he's inside me and starts to move, it's uncomfortable and painful to the point that we have to stop 
• After menopause I started to feel pain and just the thought of intercourse makes me cringe 
• I can't insert a tampon because it's so hard to put it in, I just can't get it in 
• I've never liked sex, it's just not pleasurable to me

Men may notice excessive tightness of the vagina, which is also uncomfortable to painful for them. 

Women seek an oby/gyn because they do not know exactly what is happening to them. Some of the reasons may be: 

• Penetration is difficult or impossible 
• There is pain and tension during intercourse 
• After childbirth, persistent pain during sex, often caused by secondary vaginismus 
• Pain during intercourse appeared without apparent cause, especially when attempting intercourse 
• Avoidance of intercourse due to anticipated pain and subsequent failure 

Women turn to a gynaecologist with their problems because they know that something is wrong and it is limiting them in their sex life. 

The basis of diagnosis is to perform a gynecological examination, and obtain anamnestic data. The gynecologist asks about sex life, from its beginning to the present, with a description of the partner relationship. 

Some women are uncomfortable talking about their sexual problems, but unless you talk to your doctor about it, the chances of a cure are minimal.  

As part of the diagnosis, it is necessary to distinguish whether the disorder is vertebrogenic, i.e. a problem originating from a spinal disorder, urological - of the urinary organs, or gastrointestinal - of the gastrointestinal tract. 

It is important to correctly diagnose what the problem is. Whether it is simply a simple fear, up to phobic avoidance of sexual intercourse, or a specific disease, such as an aberrant in the shape of the vagina, inflammatory processes. Such a diagnosis belongs in the hands of a gynecologist, who will examine you and exclude other pelvic diseases. 

The following is examined: blood, blood count, biochemical examination of the blood, inflammatory markers, levels of sex hormones and thyroid. 

The doctor will have you fill out a questionnaire of the woman's sexual function, which also helps with the diagnosis. 

Vulvoplethysmography is a special type of examination: the blood supply to the genitals of a woman is measured, and the changes are recorded by a device.  

The course of the disease is varied. 

The contraction may be triggered during a direct intrusion attempt, or before an expected or imagined attempt. 

Sometimes the spasm appears later, during intercourse, when pain, burning or stinging starts to appear. 

This unpleasantness in the vagina ends when intercourse stops, which frequently has to be terminated earlier because of the woman's discomfort and pain. 

In some cases, penetration can be difficult, even impossible. The tightness of the vagina can be so restrictive that the opening to the vagina becomes completely constricted. In this case, there is no chance to have intercourse. 

Penetration can be partial, and women feel involuntary clenching and then burning, pain and discomfort from the subsequent clenching and dryness of the vagina, even impossible penetration, or when a man approaches, her muscles tighten, preventing penetration. Any attempt at penetration, or even the insertion of a finger, is painful or burning. The muscles are completely clenched, and there is probably a complete lack of vaginal lubrication. 

Some women with vaginismus are eager to have sex and are even able to have orgasms, despite pain and poor access to the clitoris. 

The difference between them is that some have a desire for intercourse and are able to have sexual experiences ranging from arousal to satisfaction. For them, it is important to work towards the ability to have sexual intercourse. Women who have a primarily disturbed desire for sexual intercourse and are unable to have sexual experience, so for them the need is low and the motivation is low. 

Later, reluctance to have sexual intercourse or revulsion from touching the genitals may be added. 

Failure to treat such a condition leads to relationship conflicts and mismatched sexuality.