According to the American College of Obstetricians and Gynecologists, three-quarters of people with vaginas will experience painful sex at some point. While the reasons vary — ovarian cysts, endometriosis, or not be sufficiently aroused can all cause painful sex — vaginismus is one little-talked-about condition that affects two out of every 1,000 people with a vagina in their lifetime. So why don't more people know about it?
"Vaginismus is the involuntary contracture of the muscles surrounding the vagina essentially constricting the vaginal orifice, making it extremely difficult and painful to experience sexual intercourse," Dr. Felice Gersh, M.D., an OB/GYN, founder and director of the Integrative Medical Group of Irvine, and author of PCOS SOS: A Gynecologist's Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness, tells Bustle. Vaginismus doesn't just prevent intercourse — it can prevent the insertion of anything into the vagina, like a tampon or suppository.
Although vaginismus is treatable, embarrassment and stigma often keeps people from talking to their doctor about it. And that can have major repercussions.
"Some patients are unable to get pap smears because doctors cannot get the speculum into their vaginas," Dr. Jennifer Caudle, a family physician and assistant professor at Rowan University School of Osteopathic Medicine, tells Bustle. It's important to treat the underlying causes behind vaginismus in order to access care — but it's hard to seek out treatment if you don't know what you're treating in the first place.
Here's what no one tells you about vaginismus.
1Vaginismus Isn't Just Physical
Although it may seem like vaginismus is mostly physical and biological, it's more complicated than that.
"Most people don’t realize that vaginismus has biological [and] psychological aspects," Dr. Anna Yam, PhD, a clinical psychologist who specializes in pelvic pain including vaginismus, and owner of Bloom Psychology, tells Bustle.
As Dr. Yam explains, vaginismus is similar to an eye blink in that the contraction of the muscles in the vagina are involuntary and usually triggered by "perception of a threat." That threat being the fear of pain during intercourse, or when another object is inserted in the vagina.
"Biological muscle contraction is reinforced by the psychological fear, and vice-versa," Dr. Yam says, creating a vicious cycle.
The factors that lead to vaginismus are a combination of biological, physical, psychological, and others that need more study.
2It's Common In People With Little Sexual Experience
For people who have either never had penetrative sex or have only had it a few times, fear of having painful sex can be amplified, leading to vaginismus. While there aren't solid statistics around this association, Dr. Laurence Gerlis, a UK-based general practitioner, tells Bustle that the anxiety that comes with having little to no experience can set off the vaginismus, and in severe cases can prevent intercourse of any kind. It's important to treat vaginismus by managing this underlying anxiety, the Mayo Clinic says.
3It Can Interfere With One's Social Life
Whenever someone has a deep fear of anything — whether that's a fear of spiders or of something more dangerous — it can keep them from living their life.
"Women with vaginismus might avoid dating and those who date often feel (internally or externally) pressured to resolve the issue in order to have penetrative sex," Dr. Yam says. But while dating with vaginismus might be tricky, it's not impossible.
As Dr. Yam explains, this fear can be the result of this pressure, especially in a society that puts so much emphasis on sex. In turn, it can lead to even more fear and anxiety.
"Social and emotional pressure is also perceived as a threat and can similarly interfere with treatment," Dr. Yam says. That's why it's important to address it as soon as possible, before the pressure becomes too intense.
4It Can Be Caused By Sexual Trauma
While for some people vaginismus is brought on by general anxiety that brings on the tightening of the muscles, for others, the contractions can be brought on as a result of sexual trauma.
"Many, but certainly not all, [people] with this condition have experienced sexual trauma at sometime during their lives," Dr. Gersh says. Dr. Gerlis adds that emotional abuse, in addition to sexual abuse, can also play a role in developing vaginismus. Seeking out a therapist can help manage a person's response to trauma.
5It Can Interfere With Pregnancy
Because of the stigma surrounding vaginismus, not enough people seek treatment. This causes not only living with pain, but in severe cases, according to Dr. Gerlis, it can make conception difficult. It can also create an unsafe pregnancy, as a 2019 study found. Of the 20 pregnant people with vaginismus in the study, only 50% reported going to follow-up visits during the duration of their pregnancy. Although regular doctor's visits are necessary during pregnancy, what kept these people from visiting the doctor regularly was feelings of shame. The same study also found that 40% of these people had never consulted a doctor about their vaginismus.
If sex hurts, for any reason, it's important to be open with your doctor so that you can treat the underlying issues.
6It's Very Treatable
Although having vaginismus may be hard to talk about for some, it's absolutely treatable. According to Dr. Gersh, working with physical therapist who specializes in pelvic floor musculoskeletal issues is a good place to start.
"Often just working with vaginal dilators and practicing relaxation techniques will easily resolve this condition," Dr. Gersh says. "Sometimes anti-inflammatory vaginal suppositories or muscle relaxants are helpful."
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As is the case with any pain during sex, vaginismus can't be diagnosed and treated without a doctor's input. Fear of what might be "wrong" just stands in the way of people living a life without pain. And everyone deserves to live without pain.
If you or someone you know has been sexually assaulted, you can call the National Sexual Assault Telephone Hotline at 800-656-HOPE (4673) or visit online.rainn.org.
