Vaginismus is when the muscles around the vagina tighten on their own whenever penetration is attempted, whether during sex, when inserting a tampon or during a medical examination. It isn’t deliberate, it isn’t “all in your head”, and it isn’t your fault. Doctors sometimes group it with other kinds of painful sex under the name genito-pelvic pain/penetration disorder. The NHS describes vaginismus as treatable, usually with specialist guidance followed by practice at home.
Signs of vaginismus
- penetration feels impossible, or like hitting a wall;
- burning or stinging pain when penetration is tried;
- fear or panic at the thought of sex or a vaginal examination;
- being unable to use tampons or have a Pap smear;
- wanting closeness, but tensing up as soon as penetration is near.
Some women have had vaginismus since their first attempt at sex. Others develop it later, for example after childbirth, an infection, a painful experience or menopause.
What causes it?
The cause isn’t always clear (NHS). Possible causes include:
- fear of pain, or of sex in general;
- having been taught that sex is shameful or wrong;
- a painful first experience, or an unpleasant medical examination;
- sexual abuse or assault;
- a painful physical condition, such as an infection;
- anxiety and pressure, for example in the first months of marriage or when family keeps asking about a baby.
Treatment works best as a team
Vaginismus involves both the body and the mind, so care can involve three kinds of professional. You may not need all three, but each covers a different part.
A gynaecologist
A gynaecologist checks for physical causes of pain, such as infections or skin conditions, and treats them. You can ask for a woman doctor, ask for the examination to go slowly, and ask to stop at any point. Tell the doctor beforehand that you find examinations hard. If an examination isn’t possible yet, say so; it can wait until you are ready.
A pelvic floor physiotherapist
A women’s health or pelvic floor physiotherapist teaches you to notice and relax the pelvic floor muscles, using breathing and relaxation exercises. They may introduce vaginal trainers, smooth tampon-shaped devices in graded sizes, to use privately at home, one step at a time. Some of this work needs in-person visits, so ask what can be done online.
A therapist
A therapist works on the fear and anxiety that keep the muscles tense. This can include:
- understanding how fear and muscle tension feed each other;
- cognitive behavioural therapy (CBT) for frightening thoughts about pain;
- a gradual, step-by-step plan that you control, at your own pace;
- sensate focus, a set of touch exercises for couples that takes penetration off the table while comfort grows;
- trauma-focused support if past abuse is part of the picture;
- couple sessions, so your partner understands and can support you without pressure.
Therapy sessions are conversations only. You will never be asked to undress or show anything on camera.
Your first therapy session
The therapist will ask, gently, what happens when penetration is attempted, how long it has been going on, whether you have seen a gynaecologist, and how it is affecting you and your relationship. You don’t need to describe anything in detail, and you can stop or skip a question at any time. Simply being believed can be a relief. Together you will agree a plan that moves at your pace, and decide whether a doctor’s check should come first.
How partners can help
- Learn about vaginismus, so you understand that it isn’t a choice or a rejection.
- Take penetration off the table while treatment is going on, and keep closeness and affection in other ways.
- Never pressure or push, even with good intentions; pressure makes the muscles tighten more.
- Come to a couple session if your partner would like you to, and ask how you can support home practice.
- Look after yourself too. It is normal for partners to feel frustrated or worried, and talking to a counsellor can help.
How long does treatment take?
It varies from person to person. Many people work through a gradual plan over several weeks or a few months, practising between sessions. Progress is rarely a straight line, and setbacks are a normal part of it. Going at your own pace matters more than going fast.
Online or in person?
Therapy for vaginismus works well online, and many women find it easier to talk from their own room. Physical examinations, and some physiotherapy, need a clinic. On Mindara, physiotherapists and doctors may be listed on this page alongside therapists.
For newly married women and couples
Vaginismus can first come to light after marriage, when expectations from a partner or family can be intense. You are not alone, and a marriage that hasn’t been consummated yet can be helped. It helps partners to understand that pressure makes the muscles tighten more, not less. A couple session can help you both talk about it kindly. If you are getting ready for marriage and worried about sex, premarital counselling is a good place to raise it.
Choosing a provider on Mindara
You can choose a woman therapist who speaks your language; profiles show both, along with fees. Therapists who list sexual health send proof of training, which our team checks. Receipts say “Counselling session”, and these services are for adults only. Read more about who to see on our sexual health page and in our guide to sexologist vs sex therapist.
When to get urgent help
See a doctor promptly for bleeding, fever, unusual discharge or severe pain. If memories of past abuse are coming up and you feel unsafe or overwhelmed, call Tele-MANAS on 14416 (free, at any time), or 112 in an emergency. Our trauma therapy page explains trauma-focused support.
