Unveiling Vaginismus: A Compassionate Guide

Introduction

Human sexuality can sometimes be an intricate web, whereby the ability to access pleasure intertwines with our emotions, or relationships, our past, and our bodies. Certain conditions can play out across all these regions in life and cast shadows over moments that would otherwise be intimate and pleasurable, resulting in distress and discomfort. Vaginismus is one of these conditions. While it may be one of the most common female psychosexual presentations, it still often remains unspoken about. There is still so much misunderstanding about what it is and the best way to treat it. Within this discussion lies a complex interplay of the psychological, relational, and emotional factors that can contribute to the development of, and are influenced by, vaginismus.

Let’s learn a bit more about this condition together. If you are reading this and you, or a loved one, is experiencing this, please know that support is available. Whether that be with myself, or a different sexologist in your area, we frequently support clients towards pleasurable and connective sex lives once more, or for the very first time.

First, the what.

Vaginismus is an involuntary contraction of the muscles surrounding the vagina, making penetration painful or even impossible. Some people with vaginismus also experience vulvar pain. While it is primarily a physical experience, its origins often trace back to psychological and emotional roots, making it a prime candidate for psychosexual therapy. In fact, under 5% of vaginismus cases were found to be caused by abnormalities in the hymen or vagina (Ter Kuile & Reissing, 2020). Empirical research in this area has been limited, but has found that a number of significant contributors. Today we will focus on a few that present themselves frequently to my clinic: relationship stress, shame, body image, trauma, and fear of losing control and fear of intimacy or pain itself.

Relationships & vaginismus.

Intimate sexual relationships can be both sources of comfort and joy, but may also harbour tensions that reverberate into sexual intimacy. Sex requires desire, and desire between two people can sometimes be complicated, especially in a long term relationship. Communication breakdowns, unresolved conflicts, and emotional distance can create barriers to intimacy, triggering vaginismus as a subconscious defence mechanism. Addressing these relational dynamics is crucial in unraveling the knots of sexual pain and fostering a space of trust and vulnerability as well as excitement and desire.

Previous sexual relationships or dynamics that have since ended may also have triggered the vaginismus, leading to a cycle of negative associations and fear that can still play out in the present and preventing true healing.

Sexual pain and distress can also cause tension within the relationship when there is a break down of communication, or a misunderstanding on the causes, or confusion around approaching the presence of sexual pain in a supportive way. Research has also shown that the presence of one partner’s sexual concern can sometimes trigger another, this is no ones fault and can be explored in therapy to see resolution.

The role of expecting pain.

The biggest cause of prolonged vaginismus is fear. It can stem from a range of places, and getting to the heart of each individuals fear is often the best way to show self-compassion and gently ease into re-coding the meaning of sex, pleasure, and the vulvar-vaginal region as a whole. Fear perpetuates. When pain and fear becomes expected in sex and triggers a range of protective responses in the body prior to engaging in penetrative activities, then each sexual experience subsequently is more likely to result in pain. It is a self-fulfilling prophecy. Sex can often become a traumatic experience, even with a loved one and the presence of consent.

Thoughts and beliefs such as: “I won’t be able to have sex and it will result in my partner leaving me”, “I’m broken and this is the proof”, “I don’t deserve to feel good”, “I’m a sinner for doing this”, “I’m going to be in excruciating pain”, “I’m not safe when having sex”, “I don’t want to have sex, but I owe it to my partner”, “My vagina will never be the same after I gave birth”, “I was always taught sex was meant to be easy and magical and I have so much shame that it’s not for me, I can’t stand the shame”. These are the underlying beliefs that can be ever so gently found and held with compassionate understanding. Finding alternative narratives where fear and pain are not present allows the pattern to break. The self-fulfilling prophesy dies.

The expectation of pain doesn’t even need to emerge out of a painful experience. We are taught from a young age to expect pain during sex! It is so normalised in our culture that it became the butt of the joke in media we consumed before ever being sexually active. Narratives about what penetrative sex involves include blood, deep breathing, the slow easing of pain, and of course, we can’t forget how attractive and pleasurable having a tight vagina is made out to be for male partners! It’s the perfect storm.

Some narratives can also relate to body and genital image and the idea of what is and is not attractive. Some may become fearful of their own body being perceived due to their vulva looking different to mainstream perceptions, or their body being marginalised in sexual media. Unpacking the narratives that impact vaginismus can lead to genuine breakthroughs.

Others may have had a poor physical experience. Sexual assault is far too common. Unsurprisingly a range of sexual concerns can emerge afterwards. Being trauma-informed in the approach to treatment is essential. The common treatment for vaginismus is increasing dilator sets to stretch the tight pelvic-floor muscles and breathing through the pain. Sound familiar? This can be re-traumatising for many. Trauma-informed sex therapy is the gold standard treatment and can be used in adjunct with other approaches to protect against the risk of re-traumatising and not treating the underlying cause of fear.

What to do next?

Booking in a fifteen minute call with me is a great place to start. During that call we can discuss your specific case and you can have a chance to ask some more questions. I work in an integrative and multi-disciplinary way, especially with my sex therapy clients. Therapy may involve a series of sessions with myself, sometimes we also involve a client’s sexual partner, and a trip to a pelvic-floor physiotherapist. If there is more emotional or traumatic complexity we may collaboratively decide a longer course of therapy is the right choice to you. We will look after you.