Vaginismus

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

Vaginismus is a painful, spasmodic contraction of the vaginal and pelvic muscles, for example during sexual intercourse. Penetration into the vagina is then not possible or only possible with pain. Physical causes cannot be determined, the trigger lies in the psyche. Read here what causes a vaginal spasm and how it is treated!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. N94F52

Brief overview

• What is vaginismus? Spasmodic contraction of the vaginal and pelvic floor muscles, for example during sexual intercourse. In severe cases, the thought of sexual intercourse is enough to trigger a painful vaginal spasm.
• Treatment: vaginal dilators, psychotherapy and sex therapy, relaxation techniques, pelvic floor training, in rare cases medication.
• Causes: fear of pain or injury during sexual intercourse, fear of pregnancy, traumatic experiences (abuse, birth trauma), relationship problems, emotional stress, depression
• Risk factors: general diseases such as diabetes or high blood pressure, disturbed relationship to one's own sexuality.
• Symptoms: Painful cramping of the vaginal and pelvic floor muscles, pain during sex, fear of pain and injury, penis cannot penetrate or only with pain, feelings of guilt
• Diagnostics: detailed consultation with a doctor, exclusion of physical causes such as infections or inflammations in the genital area.
• Prevention: Healthy relationship with one's own intimate area, dealing with traumatic experiences, well-trained pelvic floor, low-conflict partnership

What is vaginismus?

Vaginismus (vaginal spasm, vaginal spasm) occurs when the vaginal and pelvic floor muscles contract like a spasm during sexual intercourse and penetration into the vagina (penetration), for example through a penis, is not possible or is associated with great pain. In many sufferers, the vagina also cramps when trying to insert a tampon or during a pelvic examination. In severe cases, the mere thought of manipulating the genital area is enough for the vagina and pelvic floor to contract like a spasm.

A vaginal cramp that occurs usually triggers a spiral of fear and pain. For example, although the woman actually has a desire to have intercourse, she is overwhelmed by the fear of pain. This causes the muscles in the genital area to contract even more, causing or exacerbating the pain.

It is typical of vaginismus that there are no physical causes such as infections or inflammation. The cause of the spasm lies in the psyche.

Vaginismus is not a disease, but a painful sexual dysfunction. One speaks of a sexual dysfunction when one's own sexuality cannot be lived out satisfactorily. These include orgasm or erectile dysfunction, as well as a lack of sexual interest. In vaginismus, the woman has a sexual desire, but penetration is not possible or only possible with pain.

Forms of vaginismus

There are two forms of vaginismus, the decisive factor for the distinction is the point in time at which the vaginal spasm occurs for the first time. In primary vaginismus, the functional disorder already exists from birth, in secondary vaginismus the disorder develops in the course of life.

Primary vaginismus: Primary vaginismus is innate. The dysfunction is usually recognized during the first sexual intercourse.

Secondary vaginismus: With secondary vaginismus, sexual intercourse or penetration into the vagina was previously possible painlessly. The vaginal spasm is triggered by a traumatic event such as sexual abuse or a birth trauma.

What is GPSPS?

GPSPS is the abbreviation for Genito-Pelvine Pain Penetration Disorder. This is a sexual dysfunction in which the clinical pictures vaginismus (cramping of the vagina) and dyspareunia (pain during sexual intercourse) occur at the same time.

How is vaginismus treated?

The aim of the treatment is to reduce the reflexive contraction of the vaginal and pelvic floor muscles and to give the woman back self-determination about her sexuality. The woman slowly and gradually learns that sexual intercourse is possible without pain.

Vaginal dilators

Vaginal dilators are special plastic sticks that are available in different sizes. These are increasingly inserted into the vagina by the woman herself. They cause the vagina to widen and the muscles to get used to penetration. This creates a feeling for her own vagina and the woman experiences that it can be inserted without pain.

In the further course, the sexual partner is sometimes included in the exercises. However, it is important that the patient maintains control over the exercise sequences, for example by inserting the penis herself.

Psychotherapy and Sex Therapy

In many cases of vaginismus, accompanying psychotherapy is helpful, especially if traumatic events such as abuse or problems in the relationship are causing the vaginismus.

During sex therapy, the patient deals intensively with her relationship with her own body and with sexuality. Ideally, a sexual partner is included in the therapy.

Pelvic floor training

During pelvic floor training, women learn to specifically tense and relax the pelvic floor muscles. Some exercises can be easily incorporated into the daily routine at any time.

Tips for everyday life

• Tense the pelvic floor muscles in everyday life, for example when waiting at the traffic lights or when making a phone call.
• Consciously tense the pelvic floor during physical exertion (e.g. when carrying heavy loads).
• Avoid strong pressure when defecating.
• Eat a balanced, high-fiber diet and drink enough!
• Being overweight puts pressure on the pelvic floor. Try to reach your normal weight!

Special exercises for the pelvic floor

Pelvic floor lift (standing): Stand hip-width apart with a straight upper body. Think of the pelvic floor as a lift that moves slowly upwards. Tense the pelvic floor muscles and pull the imaginary lift upward. Hold the tension for a moment. Then slowly lower the lift - stick by stick - back down.

Hunchback (in a quadruped position): Kneel on the floor and support yourself on your hands, your back straight. Inhale deeply, then exhale through your mouth. Form a cat's hump (pull your back rounded up, head between your arms). Then inhale again and straighten your back.

Armchair march (while seated): Sit on an armchair and move to the front edge. The legs are hip-width apart at a right angle. Now press firmly against the floor with your heels. This activates the back of the pelvic floor. Hold the tension. To activate the front pelvic floor, press the tips of your toes firmly against the floor.

Relaxation exercises

Emotional stress and inner tension sometimes exacerbate existing problems. Relaxation exercises help to achieve more inner calm. Breathing exercises or "progressive muscle relaxation" are particularly recommended. Ask your doctor about therapists to guide you.

Medication

In rare cases, the doctor may use medication to prevent further cramping. By injecting so-called "muscle relaxants" - active ingredients that relax the muscles - the symptoms improve, at least temporarily.

Solve vaginal spasm yourself?

Discuss it with your partner as soon as you feel pain penetrating e.g. the penis into the vagina. Do not try to “force” penetration. This creates a vicious circle that only exacerbates the complaints. Try to relax and see a doctor soon. He will help you to find out the cause of the vaginismus and to find an appropriate therapy.

The therapy of vaginismus requires a lot of patience - also from your partner, but in most cases it leads to good results!

What are the causes of vaginismus?

causes

The cause of vaginismus lies in the psyche. Physical causes such as infections or inflammation in the genital area (such as endometriosis), which also cause cramp-like pain, are usually not present. The cramping in the lower third of the vagina is a strong unconscious defense reflex of the woman, the trigger for this is fear of pain or injury.

Possible causes are:

• Affected women believe, for example, that the vagina is too narrow (for example for the penis of the sexual partner) and fear the pain of penetration.
• Fear of damage to the genital area, for example by the partner's penis
• Fear of pregnancy
• Rejection of penetration in general
• Rejection of the sexual partner
• Partnership problems
• Traumatic experiences such as sexual abuse, birth trauma or painful examinations at the gynecologist
• Emotional stress, depression

Symptoms

The symptoms of vaginismus vary from woman to woman. In lighter forms, the cramp only occurs in certain situations, such as under stress. In "total vaginismus" the vagina always cramps as soon as it is touched. Both sexual intercourse and the insertion of tampons are impossible for affected women. The gynecological examination with the speculum can also cause major problems.

Symptoms:

• Painful cramps of the pelvic floor and vaginal muscles.
• The cramp cannot be deliberately controlled.
• Inserting the penis, fingers, a dildo or a tampon is not possible or only possible with severe pain.
• Avoiding sexual activity.
• Avoidance or fear of an examination at the gynecologist.
• In some cases the thought of penetration alone can trigger a vaginal spasm.
• Affected women often suffer from great emotional stress. This can go so far that you do not feel like a fully-fledged woman, feel guilty about your partner and suffer from feelings of inferiority.

If you have sex problems, contact your trusted gynecologist. He will find out the cause of the problem with you and initiate appropriate therapy. The success of the treatment is usually very good, especially in the case of vaginismus!

Risk factors

Studies show that sex disorders are generally linked to risk factors such as diabetes, high blood pressure, lipid metabolism disorders, and depression. Girls and women who regard sexuality as something shameful or who grew up in families in which the subject was taboo are also more prone to vaginismus.

Investigation and diagnosis

The first point of contact for suspected vaginismus is the gynecologist. In a detailed initial consultation (anamnesis), the doctor asks about the existing problems. He will also ask questions about previous illnesses and sexual history, for example whether there is any experience of abuse or problems in the relationship. It is also important for the doctor to know whether the patient is experiencing a vaginal spasm with any type of penetration, and how long has the problem existed. The doctor also asks about past pregnancies and births.

Even if the inhibition threshold to talk about one's own sexuality is often high, it is important to speak openly about it with the doctor. This is the only way to find out the cause of the disorder and how you can counteract it!

If possible - and the affected woman tolerates the examination - the doctor examines the genital tract for changes that also cause pain and vaginal cramps. These include vaginal infections, injuries, scars or diseases such as endometriosis.

If a gynecological examination is not (yet) possible, the doctor will advise the woman on how to proceed. The examination only takes place when the woman is ready.

In order to prepare for the examination, it helps to familiarize yourself with your own genital area on your own beforehand. This can be, for example, looking at the vagina in front of the mirror or lightly touching it with your fingers. If this succeeds painlessly, the woman begins with introductory exercises: Under relaxed conditions, she tries to insert her fingers or so-called vaginal dilators into the vagina. These are special sticks that are available in different sizes. The patient learns that she may still feel discomfort, but not pain, and that the negative feelings diminish over time.

prevention

A vaginal spasm cannot be completely prevented because it is not controlled deliberately. A healthy relationship with your own intimate area and a well-trained pelvic floor reduce the likelihood of developing vaginismus. The processing of traumatic events (abuse, difficult birth) and the support of confidants are just as important.

Course of the disease and prognosis

If left untreated, vaginismus rarely goes away on its own. If the woman can be treated, the prognosis is very favorable, even if the vaginismus has existed for many years. The success is around 90 percent.

Tags:  home remedies medicinal herbal home remedies drugs