In medicine, vaginismus is a condition where the muscles at the entrance to vagina contract, preventing successful sexual intercourse. It is most commonly caused by psychological problems but it may sometimes be due to vaginal inflammation.

Psychological causes of vaginismus can usually be treated effectively by a sex therapist.

Vaginismus is a painful or spastic contraction of a woman's pelvic floor muscles that occurs with attempted penetration of the vagina. Young women may be unable to begin having intercourse without pain.

Some women with vaginismus shun sexual contact for fear that it may lead to attempted penetration. Other affected women have otherwise normal sexual response, and can reach orgasm through forms of masturbation and outercourse.

Primary vaginismus

Vaginismus is commonly seen in the gynecological examining room among young women who appear afraid of their first pelvic examination. Rather than being uncooperative, such young women are actually suffering from a reflex they have not yet learned to control.

Secondary vaginismus

Vaginismus is sometimes a secondary process. A woman who had severe dyspareunia from some physical cause, such as the structural changes caused by female circumcision, may develop secondary vaginismus as a reflex. Women who have been raped, sexually abused, or examined by a rough clinician also may develop secondary vaginismus.

Treatment

In general, women who have vaginismus are strongly motivated to change. Many of them can learn to break their cycle of spastic contractions even with one limited pelvic exam performed with extreme gentleness (including a one-fingered vaginal exam and omission of the rectal exam). Allow the woman to be in charge of the exam; do nothing without her knowledge and permission, and explain all parts of the examination in detail in advance. As the exam progresses, reassure the woman that her pelvic findings are normal (if they are normal). A partner can be counseled to show the woman the same degree of gentleness and communication.

Some women may require vaginal dilation as part of the treatment of vaginismus. The best vaginal dilator is the woman's own finger, which she can insert with the aid of a little lubricant. Artificial dilators are also available.

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