If inserting a tampon, having penetrative sex or undergoing a vaginal examination feels painful, extremely difficult or sometimes impossible, there can be a number of reasons why.
Vaginismus involves involuntary tightening or guarding of the muscles around the vaginal opening when penetration is attempted or anticipated. This response isn't something you're simply choosing to do, and trying harder to “relax” isn't always enough to change it.
Vaginismus can look different for everyone. Some people are unable to tolerate any penetration, while others can experience penetration but with pain, fear, muscle guarding or significant discomfort.
Understanding what's happening can be an important first step towards finding an approach that feels appropriate for you.
Vaginismus: Why Does Penetration Feel Painful or Impossible?
People describe vaginismus in many different ways.
You may experience:
Pain or burning with attempted penetration
A feeling that the vaginal opening is “blocked”
Difficulty inserting a tampon
Difficulty with penetrative sex
Pain or difficulty during cervical screening or vaginal examinations
Involuntary tightening when penetration is attempted
Fear or anxiety around penetration
Anticipating pain before penetration occurs
Being able to tolerate some forms of penetration but not others
Avoiding penetration because of previous painful experiences
Symptoms can vary depending on the situation and may also change over time.
What Does Vaginismus Feel Like?
Why Does My Body Tighten When I Try to Have Sex?
The pelvic floor muscles surround the vaginal opening and need to be able to appropriately relax and lengthen for comfortable penetration.
With vaginismus, the pelvic floor may tighten or guard automatically when penetration is attempted or anticipated.
For some people, this can become part of a pain–tension–fear cycle. If penetration has previously been painful, the body may begin anticipating discomfort and respond with protective muscle guarding, which can then make penetration more uncomfortable.
This doesn't mean the pain is “all in your head”. Pain involves interactions between the tissues, pelvic floor muscles, nervous system, previous experiences and the brain's protective responses.
What Causes Vaginismus?
There isn't always one identifiable cause.
Vaginismus may be influenced by a combination of physical, psychological and social factors, including:
Previous painful penetration
Pelvic floor muscle overactivity
Vulval or vaginal pain
Fear or anticipation of pain
Previous difficult medical examinations
Trauma or unwanted sexual experiences
Changes following childbirth
Menopause and hormonal changes
Other pelvic pain conditions
Beliefs or experiences surrounding sex and penetration
For some people, symptoms develop despite having no obvious triggering event.
The important thing is that your individual experience is understood rather than assuming there is one cause for everyone.
Can You Suddenly Develop Vaginismus?
Yes. Some people have experienced difficulty with penetration for as long as they can remember, while others develop symptoms after previously having comfortable penetration.
When vaginismus develops later, it may follow an episode of painful sex, childbirth, pelvic pain, infection, surgery, menopause, trauma or another change.
Sometimes there isn't an obvious reason.
A change in your ability to tolerate penetration is worth discussing with an appropriate healthcare professional, particularly if there are other new symptoms.
Why Can I Use a Tampon but Sex Still Hurts?
Being able to tolerate one form of penetration doesn't necessarily mean every type of penetration will feel comfortable.
The size, depth, movement, position, level of arousal, lubrication and context are different with a tampon, vaginal examination and penetrative sex.
Pelvic floor muscle activity can also change depending on what your body is anticipating.
This means someone can comfortably use a tampon but experience pain during sex — or experience the opposite.
It can.
If your pelvic floor involuntarily tightens around the vaginal opening, inserting a speculum for cervical screening may be uncomfortable or difficult.
If you know vaginal examinations are challenging for you, tell your healthcare practitioner before the examination begins.
There may be options to make the experience more manageable, and you should be involved in decisions about how an examination proceeds.
You can also ask questions, request modifications or withdraw consent at any stage.
Can Vaginismus Make Pap Smears or Cervical Screening Difficult?
Does Vaginismus Mean My Pelvic Floor Is Too Tight?
Pelvic floor muscle overactivity or guarding may form part of the presentation, but simply describing the pelvic floor as “tight” doesn't tell us the whole story.
Pelvic floor function includes the ability to contract, relax, lengthen and coordinate appropriately.
Pain, sensitivity, nervous system responses and anticipation can also influence how the pelvic floor behaves.
This is why management isn't necessarily about simply stretching the muscles or telling someone to relax.
No. An internal examination is not something you have to do to begin pelvic health care.
Your first appointment can include discussion of your symptoms, history, goals and concerns. Your practitioner can explain the different assessment options available and why they may or may not be useful.
If an internal pelvic floor examination is considered appropriate, it should only occur with your informed consent.
You can decline an examination, ask to stop or change your mind at any point.
For someone experiencing pain, fear, vaginismus or a history of trauma, having choice and control throughout the assessment process is particularly important.
Do I Need an Internal Pelvic Floor Examination?
How Is Vaginismus Managed?
Management depends on what's contributing to your symptoms and what you would like to achieve.
It may involve a combination of:
Pelvic floor education
Pelvic floor relaxation and coordination strategies
Breathing techniques
Gradual exposure to penetration where appropriate
Vaginal trainers/dilators where appropriate
Education around pain and the nervous system
Strategies around comfortable sexual activity
Psychological or sex therapy support
Management of other contributing pelvic or vulval conditions
Collaboration with your GP, gynaecologist or other healthcare professionals
There isn't one treatment pathway that is appropriate for everyone.
What Are Vaginal Dilators and Do I Have to Use Them?
Vaginal dilators — also called vaginal trainers — are graduated devices that can sometimes be used as part of management for vaginismus or painful penetration.
The aim isn't to force or stretch the vagina open.
When appropriate, they may be used gradually to build familiarity and comfort with penetration while practising pelvic floor relaxation and reducing protective responses.
Not everyone with vaginismus needs or wants to use vaginal trainers, and they should not be presented as something you simply have to push through.
Can Vaginismus Get Better?
Vaginismus can be managed, and many people experience meaningful changes in their symptoms and ability to tolerate penetration with appropriate care.
However, everyone's presentation and goals are different, so there isn't a single timeframe or approach that applies to everyone.
Importantly, the goal also doesn't have to be penetrative sex.
Your goals might involve comfortably using a tampon, undergoing a medical examination, reducing pelvic pain, understanding your pelvic floor or feeling more comfortable and confident in your body.
Your goals should guide your care.
How Can Pelvic Health Care Support Vaginismus?
Pelvic health care can help identify factors that may be contributing to painful or difficult penetration and provide an individualised management plan.
Depending on your presentation and preferences, this may include:
Education about the pelvic floor
Pelvic floor relaxation and coordination
Breathing strategies
Pain education
Movement and exercise
Vaginal trainer guidance where appropriate
Internal pelvic floor assessment or treatment only with your consent
Self-management strategies
Collaboration with psychology, sex therapy, gynaecology or other healthcare professionals where appropriate
Assessment and management should progress at a pace that feels appropriate for you.
If pain, involuntary muscle tightening or fear around penetration is preventing you from using tampons, having cervical screening, participating in sexual activity you want to participate in or otherwise affecting your wellbeing, it's worth seeking support.
You don't need to wait until penetration becomes impossible before asking for help.
New vaginal or vulval pain, unexplained bleeding, unusual discharge, skin changes, recurrent infections or other new symptoms should also be medically assessed.
When Should I Seek Help for Painful or Difficult Penetration?
Vaginismus & Pelvic Health Care in Healesville
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised assessment and management for vaginismus, painful penetration, pelvic floor muscle overactivity and associated pelvic health concerns.
We understand that discussing these symptoms or having a pelvic health assessment can feel vulnerable. Our aim is to provide education, choice and knowledge, allowing you to remain involved and in control of decisions about your care.
