Vaginismus

Breaking the cycle of pain and fear: Understanding Vaginismus

Written by Dr. Fiona Callender, ND

Vaginismus is the persistent (has lasted longer than 6 months) tension at the vaginal opening that prevents - or makes really difficult/painful!-  any sort of insertion in the vagina, whether thats for sexual activity, a speculum for a vaginal exam, or a tampon. For some, this has been a lifelong experience, for others this comes on later, for various reasons that are sometimes hard to pinpoint.

Vaginismus is one cause of painful sex, but not the only cause

Vaginismus falls under the umbrella of “dyspareunia” - which is essentially a more general term for pain with sex. Vaginismus can be distinguished from vulvodynia , which may also involve dyspareunia, but more specifically involves pain in the vulva. Vulvodynia can involve burning, itching, throbbing - with no medical cause. Vulvodynia and vaginismus can occur at the same time - and even contribute to the onset of the other. Although vaginismus is relatively common - it’s something that many people don’t know about, even health professionals aren’t often well versed in how to support it. It can be one of those conditions that we cope with in silence either because we don’t know there are supports available, or because it feels awkward/uncomfortable to seek care for.

A Fear-Avoidance Cycle

When we assess, we find that those with vaginismus have varying degrees of increased tone or tension in the pelvic floor muscles. When pain is experienced, this results in fear and avoidance around activities that will trigger it. This often leads to anticipatory fear and anxiety, contributing to a cycle of tension and pain. Either there is an avoidance around those activities, or there is hypervigilance around the pain and increased guarding in the pelvic floor muscles - leading to even more pain. This then further contributes to negative thoughts and experiences around those activities.

Treatment for vaginismus often involves various practitioners and an approach that is multifactorial. To approach breaking the cycle of pain and avoidance/hypervigilance, therapy can be really helpful. From a naturopathic and pelvic floor perspective, I often focus on helping you send signals of safety to your body and work on reducing fear with relaxation exercises. We talk about pain and where this comes from - we aim to understand our bodies and the science of pain. Part of treatment often involves working on connecting with your pelvic floor muscles to allow them to relax. That can be easier said than done for muscles you can’t see! Many of us have never learned or thought much about those muscles. We work together to help build body awareness and down regulate some of the nervous system signals involved in maintaining that tension. This is a slow and gradual process and you are always in the driver’s seat according to your comfort level. We work together on a plan that feels right for you.

But why did we get vaginismus in the first place?

The reasons behind vaginismus are not fully understood and, again, likely involve a number of factors - biological, psychological and sociocultural. Negative and/or painful experiences with a pelvic exam in a doctor’s office or a sexual trauma have been shown to impact how our muscles respond in the future. But not everyone who experiences vaginismus has had a negative experience in this way. A range of ways we think about sex and sexuality may also impact vaginismus. For some, the context in which we grew up may contribute. Did we grow up in a household or culture where there were negative or shameful views around sex? Did we grow up thinking sex was taboo or female sexuality should be repressed? Societies where those views are more largely held tend to have a higher prevalence of vaginismus. Some of these cognitions actually directly impact the pelvic floor muscles too! In studies on vaginismus, those with vaginismus tend to have a greater level of pelvic muscle contraction in response to sex-related images and videos than those who didn’t. That said, that’s not the case for everyone. Vaginismus can also be triggered by other pelvic pain or other conditions. It’s complicated!

It’s not normal to have vaginal pain, but thankfully there are often ways we can support you. Offering a space for you to bring up your concerns is the first step. If you are curious if our space is the right fit for you, you can book a meet & greet with Dr. Fiona.