Depending on the intensity, vaginismus symptoms range from minor burning sensations with tightness to total closure of the vaginal opening with impossible penetration.
Common symptoms of vaginismus
Burning or stinging with tightness during sex
Difficult or impossible penetration, entry pain, uncomfortable insertion of penis
Ongoing sexual discomfort or pain following childbirth, yeast/urinary infections, STDs, IC, hysterectomy, cancer and surgeries, rape, menopause, or other issues
Ongoing sexual pain of unknown origin, with no apparent cause
Difficulty inserting tampons or undergoing a pelvic/gynecological exam
Spasms in other body muscle groups (legs, lower back, etc.) and/or halted breathing during attempts at intercourse
Avoidance of sex due to pain and/or failure
Vaginismus is vaginal tightness causing discomfort, burning, pain, penetration problems, or complete inability to have intercourse. The vaginal tightness results from the involuntary tightening of the pelvic floor (especially the pubococcygeus (PC) muscle group), although the woman may not be aware that this is the cause of her penetration or pain difficulties.
Did You Know?
Vaginismus is a common cause of ongoing sexual pain and is also the primary female cause of sexless (unconsummated) marriages. Sexual pain can affect women in all stages of life; even women who have had years of comfortable sex. While temporarily experiencing discomfort during sexual intercourse is not unusual, ongoing problems should be diagnosed and treated.
Examples of the effects of vaginismusLeft diagram - As the man approaches the woman to attempt intercourse, her PC muscle group (darkly shaded) involuntarily tightens the vaginal entrance making intercourse painfully impossible ‘like bumping into a wall’. This type of vaginismus makes penetration impossible. Right diagram - In other cases of vaginismus, penetration may be possible, but the woman experiences periods of involuntary tightness causing burning, discomfort, or pain.
Variations in the experience of vaginismus
Vaginismus can be triggered in both younger and older women, in those with no sexual experience and those with years of experience. Not all women experience vaginismus the same way, and the extensiveness of vaginismus varies:
Some women are unable to insert anything at all.
Some women are able to insert a tampon and complete a gynecological exam, yet are unable to insert a penis.
Others are able to partially insert a penis, although the process is very painful.
Some are able to fully insert a penis, but tightness and discomfort interrupt the normal progression from arousal through to orgasm and bring pain instead.
Some women are able to tolerate years of uncomfortable intercourse with gradually increasing pain and discomfort that eventually interrupts the sexual experience.
Women may also experience years of intermittent difficulty with entry or movement and have to constantly be on their guard to control and relax their pelvic area when it suddenly ‘acts up’.
Vaginismus Symptom Severity Range
1. Minor discomfort or burning with tightness is experienced with vaginal entry or thrusting but may diminish.
2. More significant burning and tightness is experienced with vaginal entry or thrusting and tends to persist.
3. Involuntary tightness of the vaginal muscles makes entry and movement difficult and painful.
4. Partner is unable to penetrate due to tightly closed vaginal opening. If entry is forced significant pain results.
How does vaginismus cause problems?
With vaginismus, the mind and body have developed a conditioned response against penetration. The body has learned to expect or anticipate pain upon penetration, so that the powerful PC muscle ‘flinches’ or contracts to protect against the potential of intercourse pain. This can be equated to automatically blinking one’s eyes and wincing when an object is hurled toward us. It is not something a woman thinks about doing - it just happens (see Causes).
The tightened PC muscles may cause burning or pain with sex or may completely block entry. Instead of preventing pain, the tightening of the PC muscle group ultimately causes pain; although acting as a defense mechanism against pain, the opposite effect results.
Vaginismus has a wide range of manifestations, from impossible penetration, to intercourse with discomfort, pain or burning, all resulting from involuntary pelvic tightness. When a woman has never been able to have pain-free sexual intercourse due to penetration difficulties, it is generally classified as primary vaginismus. When a woman develops the vaginismus condition after having previously enjoyed problem-free sex, it is generally classified as secondary vaginismus. Depending upon the classification, there may be some minor differences in the way in which vaginismus is treated.
When a woman has never at any time been able to have pain-free intercourse due to vaginismus tightness, her condition is known as primary vaginismus.
Primary vaginismus refers to the experience of vaginismus with ‘first-time’ intercourse attempts. Typically, primary vaginismus will be discovered when a woman attempts to have sex for the very first time. The spouse/partner is unable to achieve penetration and it is like he just bumps into a ‘wall’ where there should be the opening to the vagina. Entry is impossible or extremely difficult. Primary vaginismus is the common cause of sexless, unconsummated marriages. Some women with primary vaginismus will also experience problems with tampon insertion or gynecological exams. The PC muscles constrict and tighten the vaginal opening making it uncomfortable or in many cases virtually impossible to have entry. When tightened, attempts to insert anything into the vagina produce pain or discomfort.
Some women also experience related spasms in other body muscle groups or even halted breathing. Generally, when the attempt to put something in the vagina has ended, the muscles relax and return to normal. For this reason, medical examinations often fail to reveal any apparent problems unless the tightness occurs and is noted during the pelvic exam.
Vaginismus Risk Factors
Vaginismus can strike any woman at any time at any age. Contributing factors could include:
Pelvic pain due to a medical condition, infection, physical trauma or assault, age-related changes, or painful physical events such as childbirth.
Emotional distress, anxiety, fear, relational difficulties, or other similar emotions that relate to sex, intimacy, past trauma, or relationships.
The anticipation pelvic pain due to some past or present condition or situation.
Secondary vaginismus sexual pain can affect women in all stages of life – even women who have had many years of pain-free intercourse.
Secondary vaginismus refers to the experience of tightness pain or penetration difficulties later in life, after previously being able to have normal, pain-free intercourse. It typically follows or is triggered by temporary pelvic pain or other related problems. It can be triggered by medical conditions, traumatic events, relationship issues, surgery, life-changes (e.g. menopause), or for no apparent reason (see Causes for more examples). Secondary vaginismus is the common culprit where there is continued, ongoing sexual pain or penetration tightness where there had been no problem before.
Most commonly, secondary vaginismus strikes women experiencing temporary pelvic pain problems such as urinary or yeast infections, pain from delivering babies, menopause, or surgery. The initial pain problems are addressed medically, healed, and/or managed, yet women continue to experience ongoing sexual pain or penetration difficulties due to vaginismus. While the initial temporary pain was experienced, their bodies developed a conditioned response resulting in ongoing, involuntary vaginal tightness with attempts at intercourse.
Left untreated, vaginismus often worsens, because the experience of ongoing sexual pain further increases the duration and intensity of the involuntary PC muscle contraction. The severity of secondary vaginismus may escalate so that sex or even penetration is no longer possible without great difficulty. Some women will also experience difficulty with gynecological exams or tampon insertion. Vaginismus can also impede a woman’s ability to experience orgasm during intercourse, as any sudden pangs of pain will abruptly terminate the arousal buildup toward orgasm.
Vaginismus is involuntary - not intentional
It is important to note that vaginismus is not triggered deliberately or intentionally by women. It happens involuntarily without their intentional control and often without any awareness on their part. Vaginismus has a variety of causes, often in response to a combination of physical or emotional factors. The mystery of the problem can be very frustrating and distressing for both women and their partners. Despite the fact that vaginismus is involuntary and can strike any woman, many women feel intense shame from being unable to have intercourse and keep their pain private, feeling uncomfortable sharing their secret with anyone.
“It always felt tight and uncomfortable. I never realized it was vaginismus.”
“I experience burning pain upon penetration attempts.”
“I’m still a virgin even though we’ve tried many times - it’s like he hits a wall.”
“Sex used to be great, but now I close up - it burns and stings.”
“Sex was fine until after thebaby - now it always hurts.”
“We can’t consummate our marriage - it’s impossible.”
“The doctor says there’s nothing wrong with me. So why does it still hurt?”
“When he starts to move, it feels uncomfortable and we have to stop.”
“Ever since the operation I feel burning pain when I try to get him in.”
“After menopause I began to feel soreness and now I tighten up.”
“I don’t wear tampons because itis too hard to get them in.”
“I seem to ‘tighten’ up down there even when I really want to have sex.”
“There’s no way I’m doing a pelvicexam again - it’s unbearable.”
“Sex has never been comfortable for me.”
Unconsummated Marriages & Impossible Penetration
With severe cases of vaginismus where there has never been penetration, is it really possible to overcome? Is there hope for unconsummated couples?
Yes. Fortunately vaginismus is highly treatable with full restoration of sexual intercourse. Couples completing treatment fully consummate and enjoy normal penetrative sex. See Feedback for many user contributed stories of overcoming penetration difficulties.Unconsummated Couple“My husband and I waited for each other for marriage, and ended up waiting a lot longer than we ever dreamed! Two years of marriage later, we still had been unable to consummate our marriage and enjoy that wedding night we’d looked forward to…” More »
Vaginismus is by far the most common cause of unconsummated marriages (where the problem is due to female issues). Couples often describe their attempts at intercourse as there being a “wall” where the vaginal opening should be. It is baffling to some women as to how this condition originated in them if they had no prior sexual contact or pelvic problems. Intercourse is impossible and painful insertion attempts reinforce the vaginismus response. The conditioned reflex continues to happen every time there is potential for vaginal penetration. The muscles act rebelliously, refusing to allow entry even though the woman may truly want to consummate and receive her spouse vaginally. This is extremely frustrating. For the aroused man, it is like running into a brick wall. For the woman, it is like her body is no longer under her control.
Sex is an activity involving many complex conditioned responses. Bodies do not start out as skilled reactors to sexual stimulus. Successful intercourse is learned through experience and interaction. The nervous system and musculature discover and remember what feels good, works, and what isn’t comfortable. Normally, the transition to intercourse becomes more pleasurable after the first few experiences. The mind and body allow entry and learn to anticipate intercourse positively. Healthy messages result and they generate arousal in anticipation of intercourse. In a woman with primary vaginismus, the mind and body never get the chance to be trained through positive intercourse experiences. The process of learning how to have successful intercourse is cut short when the vaginal muscles spasm as a protective device against pain. With the absence of any direct conscious control on the woman’s part, nerves controlling the vaginal muscles react to the anticipation of intercourse as a call to tightly constrict, brace, protect, and guard against the onset of potential penetration pain.
Will vaginismus go away on its own?
Vaginismus is a self-perpetuating condition that requires treatment to break the 'cycle of pain' and fully resolve.
Since vaginismus is an involuntary, self-perpetuating condition, it will not normally 'go away' unless properly addressed. The 'cycle of pain' that is triggered with vaginismus usually continues indefinitely (and typically worsens) until the woman learns how to control and override the pelvic floor muscle triggers that tighten the vaginal opening. As much as she may like to do so, a woman cannot simply 'will' vaginismus away, and it will not go away on its own.
Fortunately, vaginismus treatment has high success rates. A full recovery from vaginismus is the normal outcome of treatment, with pain-free intercourse restored.
Vaginismus is considered one of the most successfully treatable female sexual disorder. Many studies have shown treatment success rates approaching nearly 100%. Treatment resolution follows a manageable, step-by-step process.
Vaginismus is highly treatable. Successful vaginismus treatment does not require drugs, surgery, hypnosis, nor any other complex invasive technique. Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps, and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.
The sexual pain, tightness and penetration difficulties from vaginismus are fully treatable and can be completely overcome with no remaining pain or discomfort.
Women experiencing sexual tightness/pain, penetration problems, or unconsummated relationships can expect remarkable resolution of their vaginismus, allowing full, pain-free intercourse.
Treatment steps can usually be completed at home using a self-help approach, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider or specialist.
Vaginismus treatment exercises follow a manageable, step-by-step process (see Steps below).
Vaginismus is Highly Treatable
The sexual pain, tightness, burning or penetration difficulties caused by vaginismus are completely treatable, with high success rates for treatment. Couples are often amazed by the sudden life-changing effects of treatment. Those with penetration difficulties, or pain during intercourse, normally transition to pain-free and pleasurable intercourse following a step-by-step approach.
Is vaginismus really treatable; and if so, how long does it take to resolve?
Vaginismus is considered one of the most successfully resolved female sexual disorders. High treatment success rates are typical within reasonable time frames.
A Treatment Program is Important
Many of the steps to treat vaginismus are counter-intuitive and not immediately obvious. As failure at any point inhibits recovery (experiencing discomfort tends to intensify vaginismus - see ‘cycle of pain‘) and can cause avoidance or abandonment of progress, it is best to approach vaginismus with an educated understanding to ensure success in dealing with it.
What is involved in the successful treatment of vaginismus?
Outline of 10 step vaginismus resolution process
To aid women in getting proper treatment direction, we have assembled a comprehensive program in book/kit form as outlined below. The self-help program is a straight-forward, step-by-step approach used by many treatment professionals to successfully guide women through the complete process of overcoming vaginismus.
Complete vaginismus kits with 10 step treatment program books, dilators, video »
Vaginal Dilator Set
Medical-grade vaginal dilators with smooth, comfortable design & handle »
Comprehensive self-help program recommended by specialists »
Treatment steps can usually be completed at home using a self-help approach, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider or specialist. Easy-to-follow instructions, supplemented with descriptive illustrations and helpful strategies, make the process a positive, successful experience. At the completion of the steps, pain and penetration problems due to vaginismus are typically fully resolved.
Step 1 - Understanding vaginismus
Step 1 provides an overview of vaginismus and how sexual pain, tightness, burning sensations or penetration difficulties may result from it. This approach helps women to get started by being proactive about their sexual health as understanding vaginismus is fundamental to the process of overcoming it. Topics also include how to obtain a solid diagnosis, treatment methods, relationship issues, pelvic/relaxation techniques, conditioned responses and muscle memories.
Step 2 - Sexual history review & treatment strategies
A balanced approach is taken to help women review and analyze their history. Exercises help identify and evaluate any events, emotions, or triggers contributing to vaginismus sexual pain or penetration problems. Checklists and detailed exercises map out a woman’s sexual history and pelvic pain events, working toward appropriate treatment strategies. Emotional reviews help detail any negative events, feelings, or memories that may collectively contribute to involuntary pelvic responses. Topics also include blocked or hidden memories and how to move forward when there have been traumatic events in a woman’s past.
Did You Know?
Vaginismus can be overcome without drugs, surgery, self-hypnosis, nor any other complex invasive technique.
Step 3 - Sexual pain anatomy
Women often lack complete information about their body’s sexual anatomy, function, and the causes of pelvic pain and penetration problems. Confusion regarding problems with inner vaginal areas and vaginal muscles frequently lead to misdiagnosis and frustration. Step 3 educates about these sexual body parts with emphasis on their role in sexual pain and penetration issues. Topics include how to distinguish what kind of pain or discomfort is normal with first-time or ongoing sex and what physical changes take place during arousal to orgasm cycles in the context of sexual pain or penetration problems. Anatomy areas such as the hymen and inner vulva are explained and demystified (for example there are six diagrams of hymen varieties to help distinguish hymen problems).
Differences in treatment
Note that treatment for those who have never been able to have pain-free intercourse (primary vaginismus) usually requires all ten steps, while those with secondary vaginismus may be able to shorten or bypass some steps (see also Is there a difference between the treatment for primary and secondary vaginismus?).
Step 4 - Vaginal tightness & the role of pelvic floor muscles
Female sexual pain and penetration difficulties typically involve some degree of involuntary tightening of the pelvic floor. This step focuses on the role of pelvic floor muscles, especially the pubococcygeus (PC) muscle group, explaining in great detail how once they are triggered they continue to cause involuntary tightness with attempts at intercourse. Effective vaginismus treatment focuses on retraining the pelvic floor to eliminate involuntary muscle reactions that produce tightness or pain. Learning how to identify, selectively control, exercise and retrain the pelvic muscles to reduce pain and alleviate penetration tightness and difficulties is an important step in vaginismus treatment.
Step 5 - Insertion techniques
For women with penetration difficulties or pain, techniques must be learned to allow initial entry without pain. In this step, women practice pubococcygeus (PC) muscle control techniques as they allow the entry of a small object (cotton swab, tampon, or finger) into their vagina, working completely under their control and pace. Any involuntary muscle contractions that had previously closed the entrance to the vagina and prevented penetration are overridden. Women begin to take full control over their pelvic floor and learn how to flex and relax the pelvic floor at will, eliminating unwanted tightness and allowing entry.
Using dilators without a program?
Note that vaginal dilators are typically not effective when used without guidance. They should not be used without proper physical instruction, exercises, transitional steps, etc. Dilators are simply one aspect of the vaginismus treatment process, and if used without pelvic control techniques they will likely be very ineffective. Involuntary muscle reactions are what produces the tightness and pain of vaginismus. The main focus of proper dilator use is in retraining the pelvic floor, not on stretching the vaginal opening.
See the FAQ - Using dilators without a program? for more information.
Step 6 - Graduated vaginal insertions
When used properly, vaginal dilators are effective tools to further help eliminate pelvic tightness due to vaginismus. Dilators provide a substitute means to trigger pelvic muscle reactions. The effective dilator exercises in Step 6 teach women how to override involuntary contractions, relaxing the pelvic floor so it responds correctly to sexual penetration. Graduated vaginal insertion exercises allow women to comfortably transition to the stage where they are ready for intercourse without pain or discomfort.
Step 7 - Sensate focus & techniques for couples to reduce pelvic floor tension
Helping with the transition to pain-free intercourse, this step explains sensate focus techniques for couples to use to reduce pelvic floor tension and increase intimacy. Couples begin to work together during this step as exercises teach how to successfully practice sensate focus (controlled sensual touch) and prepare for pain-free intercourse using techniques from earlier steps. The exercises are designed to build trust and understanding and assist in the process to adjust to controlled intercourse without pain.
Step 8 - Pre-intercourse readiness exercises
Finalizing preparations for couples to transition to fully pain-free intercourse, this step completes pre-intercourse readiness. Couples review and practice techniques that eliminate pelvic floor tension and prepare to transition to full intercourse. Preparing ahead of time to be able to manage, control and eliminate pain or penetration difficulties, the exercises assist with the final transition to pain-free intercourse.
Step 9 - Making the transition to intercourse
Step 9 explains the techniques used to eliminate pain and penetration difficulties while transitioning to normal intercourse. Many troubleshooting topics are covered (with supporting diagrams) such as positions to use to maximize control and minimize pain, tips to ensure more comfortable intercourse, etc.
Step 10 - Full pain-free intercourse & pleasure restoration
The final step toward overcoming vaginismus includes penis entry with movement and freedom from any pain or tightness. Step 10 exercises are designed to educate, build sexual trust and intimacy, and complete the transition to full sexual intercourse free of pain. Couples can begin to enjoy pleasure with intercourse, initiate family planning, and move forward to live life free from vaginismus.
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