Vaginismus

Vaginismus is a sexual pain disorder characterized by involuntary contraction of the pelvic floor muscles around the vagina, which can make vaginal penetration difficult or impossible. It is often described as primary when penetration has never been possible and secondary when penetration becomes painful after a period of normal sexual function. In modern clinical guidance, it is included within the broader category of genito-pemoral pain/penetration disorders.

Symptoms commonly include involuntary vaginal muscle spasms on attempted penetration, sharp or burning pain, and a sense of fear or anxiety about penetration. Many individuals also avoid intercourse, tampon use, or gynecological exams, and may experience distress or relationship problems as a result. Some people have normal sexual desire and arousal, but penetration remains problematic.

Causes are multifactorial. Physical factors such as infections, scarring, hormonal changes, or pelvic floor injuries can contribute, but many cases involve a combination of psychological factors (anxiety about sex, trauma, negative beliefs about intercourse) and pelvic floor muscle hypertonicity, leading to a conditioned protective response.

Diagnosis typically involves medical history, a gynecological examination when appropriate, and the exclusion of other causes of pain. In DSM-5 terms, the disorder includes difficulties with penetration, fear or anxiety about penetration, and significant distress or interpersonal problems.

Treatment is multidisciplinary. Options include pelvic floor physical therapy with gradual desensitization and dilator exercises, biofeedback, and liberal use of lubricants; psychological therapies such as cognitive-behavioral therapy and sex therapy; and partner involvement. In refractory cases, less common interventions like botulinum toxin injections may be used. With appropriate care, many people improve over time. Prevalence estimates vary, but vaginismus is a relatively common cause of sexual pain in women.