What Is Vaginismus–and Could It Be Making Sex Painful?
The condition can make it difficult even just to insert a tampon.
Nearly three-quarters of women experience pain during sex at some point–but for a small number of women, the reason is a little-known condition that causes the muscles at the opening of the vagina to involuntarily squeeze. Called vaginismus, this can cause pain during sex or gynecological exams, as well as discomfort and difficulty inserting a tampon.
“In women, when something is inserted into the vagina, the muscles around the vaginal opening have to relax a bit in order for the opening to stretch,” explains Nazema Y. Siddiqui, MD, associate professor of obstetrics and gynecology at Duke University Medical Center. “For women with vaginismus, this relaxation doesn’t happen, and instead, the muscles reflexively tighten up, thus narrowing the vaginal opening and making it more difficult to insert anything into the vagina.”
There are several types of vaginismus. Primary vaginismus is when the pain and muscle contractions have always been present.
“With primary vaginismus, you have women who have never tolerated any kind of vaginal penetration,” says Kristin Rooney, MD, a urogynecologist with the University of Nebraska Medical Center.
Secondary vaginismus is when a woman has had pain-free penetration at some point before symptoms start. Experts think that childbirth, a traumatic event (like sexual assault), or an infection may be triggers.
Global, general, or total vaginismus means a woman feels pain whenever anything enters her vagina. Situational vaginismus is when the pain happens only during certain types of penetration, for example, during sex, but not during a pelvic exam.
No one knows the exact cause of vaginismus, and there are likely many different factors that contribute.
“Sometimes you see it after you give birth and have stitches, or after a really bad, long yeast infection. [That may] do something to the pain sensors,” says Jennifer Wu, MD, an obstetrician and gynecologist at Lenox Hill Hospital in New York City. “It could be due to trauma, infection, nerve damage–so it’s hard to know.”
Vaginismus can also happen to women experiencing generalized anxiety. “This is the person who just tends to hold their body tight in that area,” says Dr. Rooney. Or, it can be due to more specific anxiety, like from a prior negative sexual experience.
It’s also possible that vaginismus is a response to pain on the vulva, the external parts of a woman’s genitalia. External irritation and discomfort, like vulvodynia, may make women tense up and have a hard time tolerating penetration, Dr. Rooney adds.
Menopause may also play a role. Sex can become painful as declining estrogen levels make the vagina less pliable. When this happens, muscles may involuntarily contract.