Vaginismus: Causes, Myths, Treatment Options, and Sex Therapy

What is Vaginismus?

To read my overview of sexual pain including vaginismus, read this blog.

Vaginismus is the involuntary spasm of the vagina that interferes with or entirely prevents sexual intercourse. It is often highly distressing, with significant negative impacts on an individual’s self-esteem, sexual pleasure, sexual intimacy, and the relationship.

Vaginismus has been included in most recent clinical guidelines (DSM-5) under Genito-Pelvic Pain/Penetration Disorder (GPPD). This inclusion recognises the significant pain, fear, anxiety, and pelvic floor tensing during attempted penetration.

What Causes Vaginismus?

Vaginismus rarely has one cause, and it is often a combination of psychological, relational, societal, and biological factors that contributes to vaginismus.

Psychological: Anticipating pain and the fear involved with this leads to hypervigilance, muscle tensing, and extreme avoidance of penetration. This is a perpetuating cycle where when one engages in sexual activity with a fear response, this leads to pain and more tensing, leading to more fear, more avoidance, and more pain.

Individuals with anxiety disorders are at higher risk of vaginismus. Individuals with vaginismus are often afraid of intimacy, fear losing control during intimacy, and are impaired in their ability to cope with vulnerability.

Sexual abuse can also be a risk factor which results in a disgust-induced protective bodily response to sexual stimuli. Not all individuals with vaginismus have experienced abuse.

Relational: The relationship may inadvertently sustain and perpetuate vaginismus. Partners who are kind and with good intentions deliberately choose not to address the issue, may feed into sexually avoidant behaviour. The alternative is that both partners work as a team to actively address their sexual intimacy. On the other hand, shame and fear can morph into resentment or frustration in which both feel helpless and hopeless regarding sex. These negative emotions then perpetuate the negative emotion that can fuel vaginismus.

Social factors: Individuals who grew up in religious or cultural environments where sexuality is negatively spoken about or silenced are at high risk of vaginismus. The body internalises these negative messages, and responds to the perceived threat of sexual activity. This can also occur when mothers communicate strongly negative or frightening messages about sexuality.

Biological and Medical Factors: Sexual pain can be brought upon by conditions such as endometriosis, vaginal atrophy, pelvic infections, hymen anomalies which in turn can condition the muscles to reflexively spasm.

Common Myths About Vaginismus

It’s all in your head: while vaginismus is deeply psychological, the pain and physical “block” that occurs is very real. This very real physical component can then also amplify the psychological in a vicious, perpetuating cycle. Treating vaginismus is not only navigating and understanding the psychological, it also involves treating the physical pain and physical dysfunction involved.

Success equals penetration: the successful treatment of vaginismus is not penetration. The successful treatment of vaginismus is sexual pleasure and sexual wellbeing, the outcome of which may be penetration. Focusing in on penetration does not automatically mean that sex will then be pleasurable or pain free. It is essential to prioritise sexual satisfaction over penetration, as the alternative can cause further harm.

Vaginismus means I am broken: Vaginismus is often the body’s highly advanced, but overactive way of protecting itself. When the underlying factors are understood, vaginismus often makes sense. It is out of a place on understanding, empathy, and support that change is possible, while shame only perpetuates pain further.

Can Vaginismus be Treated?

Vaginismus is treated by a range of therapies, and given the holistic nature of sexuality, it is important to also take a holistic approach to treatment.

Pelvic Floor Physiotherapy: a specialist physical therapist examines the pelvic floor to identify pain and tension points. Treatment involves biofeedback, manually releasing muscles, and practicing skills to allow the pelvic floor muscles to relax. It will also likely involve the use of vaginal dilators to slowly expose the vagina to penetration, to practice this in a state of relaxation to counter the fear response.

Pros:

-              Safe and effective

-              First-line treatment for vaginismus

-              Does not rely on medication

-              81-100% success rate with dilator training

Cons:

-              Does not address the need for psychological support

-              Does not address relationship dynamics or phobic anxiety

-              Can ignore sexual pleasure

-              Time and financial commitment

Sex Therapy: explores the thoughts, fears and negative beliefs around sex.  Sex therapy also supports the relationship and invites couples to become a proactive sexual team.

Pros:

-              Empowers sexual self-worth

-              Addresses deep anxiety

-              Treats issues such as anxiety or trauma that is co-occurring

-              Treats the couple, not just the vagina

-              Supports intimacy and connection

Cons:

-              It is important to integrate pelvic floor physiotherapy, as talking does not address the physical elements of vaginismus

-              Time and financial investment

Can Sex Therapy Help Vaginismus?

Sex therapy supports the psychological and relational components of vaginismus. While pelvic floor physiotherapy addresses the physical aspects, therapy helps reduce fear, anxiety, and the anticipatory tension that maintains the cycle of pain.

In therapy, we explore beliefs about sex, safety, and control, while gently building comfort with intimacy and sensation. The focus is on reducing pressure, increasing a sense of safety in the body, and reconnecting with pleasure.

For couples, therapy supports communication, understanding, and a shared approach to healing. Rather than avoiding or forcing intimacy, the couple is supported to move forward together at a pace that feels safe and manageable.

I offer online sex therapy across Australia, supporting individuals and couples to understand the cycle of pain, reduce fear, and gradually rebuild comfort, confidence, and connection in sexual intimacy.

Final Reflection

Vaginismus can feel overwhelming, but it is also highly treatable. What may feel like your body working against you is often your body trying to protect you. With the right psychological and physical support, it is possible to reduce pain, restore a sense of safety, and experience sexual intimacy as something that is pleasurable rather than feared.

Written by Justine

References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

Unlubilgin E, Tetik S, Aksoy I, Yuksel D, Tekin OM. Relationship between adult separation anxiety and attachment styles and vaginismus. J Sex Med. 2021;18:1752-1758.

McEvoy M, McElvaney R, Glover R. Understanding vaginismus: a biopsychosocial perspective. Sex Relat Ther. 2024;39(3):680-701.