Sex shouldn’t hurt, but with vaginismus, the story may be different

Vaginismus has been described as an involuntary, instantaneous tightening of the muscles of the pelvic floor.

Experts at the Oregon, United States-based Orthopaedic & TMJ Physical Therapy Centre say the spasm causes the vaginal opening to become constricted, making penetration painful or impossible.

They note that a woman may have always had this condition or she may have lost penetration ability after a trauma such as infection, injury, surgery, abuse, or high stress situations.

To check if you have the condition, the experts say if you answer ‘yes’ to any of the following questions, you may have vaginismus:

Are you unable to insert a finger, tampon, or medicine applicator into your vagina?
Are you unable to have a pelvic exam without pain?
Are you unable to have intercourse, or are you unable to have intercourse without pain?

Again, they ask, do you have complaints of:

Sharp pains in the vagina?
Pinching, pressure, or tightening in the vagina?
Radiating pain into the abdomen or groin?
Rectal pain, especially with a bowel movement?
Lack of sexual interest?

If your answers to most or all of these questions are affirmative ‘yes,’ then you need to see your doctor.

While most people living with vaginismus bear the inconvenience and pain in silence, experts say globally, it is estimated that between one and 17 percent of women experience the condition annually.

Associate professor of obstetrics and gynecology at Duke University Medical Center, Nazema Y. Siddiqui, told online portal, Health, that nearly three-quarters of women experience pain during sex at some point; but for a small number of women, the reason is vaginismus, a little-known condition that causes the muscles at the opening of the vagina to involuntarily squeeze.

Siddiqui noted that the contraction can cause pain during sex or gynaecological exams, as well as discomfort and difficulty when a woman tries to insert a tampon.

“In women, when something is inserted into the vagina, the muscles around the vaginal opening have to relax a bit in order for the opening to stretch.

“For women with vaginismus, this relaxation doesn’t happen, and instead, the muscles reflexively tighten up, thus narrowing the vaginal opening and making it more difficult to insert anything into the vagina,” Siddiqui explained.

Vaginismus types

Experts says there are several types of vaginismus.

“Primary vaginismus is when the pain and muscle contractions have always been present, in which case, the woman can never tolerate any kind of vaginal penetration,” a urogynecologist with the University of Nebraska Medical Centre, Kristin Rooney, told the magazine.

Secondary vaginismus is when a woman has had pain-free penetration at some point before symptoms start. Experts think that childbirth, a traumatic event (like sexual assault), or an infection may be triggers.

Global, general, or total vaginismus means a woman feels pain whenever anything enters her vagina; while situational vaginismus is when the pain happens only during certain types of penetration, for example, during sex, but not during a pelvic exam.

They, however, said that the exact cause of vaginismus is unknown, and that there are likely many different factors that contribute.

“Sometimes you see it after you give birth and have stitches, or after a really bad, long yeast infection,” says an obstetrician and gynecologist at Lenox Hill Hospital in New York City, Jennifer Wu.

“It could be due to trauma, infection, nerve damage; so it’s hard to know,” she said.

Vaginismus can also happen to women experiencing generalized anxiety. “This is the person who just tends to hold their body tight in that area,” says Dr. Rooney. Or, it can be due to more specific anxiety, like from a prior negative sexual experience.

It’s also possible that vaginismus is a response to pain on the vulva, the external parts of a woman’s genitalia. External irritation and discomfort, like vulvodynia, may make women tense up and have a hard time tolerating penetration, Dr. Rooney adds.

Menopause may also play a role, as sex can become painful as declining estrogen levels make the vagina less pliable. When this happens, muscles may involuntarily contract.

Researchers, in online journal, Psychiatric Times, argue that research did not support the premise that vaginal spasm was the crucial factor preventing intercourse.

“While such spasms can occur in some women, they account for only about a quarter of cases.

“What actually prevents intercourse appears to result from a variety of factors, including an intense fear of vaginal penetration or of pain during vaginal penetration, the experience of pain during penetration, and hypertonicity of the pelvic floor muscles,” says lead researcher, Samara Perez, of the department of psychology at McGill University, Montreal, Quebec, Canada.

Siddiqui counselled that vaginismus needs to be treated as soon as possible to stop the cycle of fear, even though there is no known test for the condition.