Vaginismus FAQVaginismus FAQ - Frequently Asked Questions about Vaginismus
What is vaginismus?
Vaginismus is the experience of being unable to have penetrative sex because of an involuntary spasming of the vaginal muscles whenever intercourse is attempted.
Are there different types of vaginismus?
Vaginismus is classified as primary if the problem is lifelong and the woman has never been able to have penetrative intercourse. She may also have had difficulties with inserting tampons or having smear tests. Vaginismus is classified as secondary if penetrative intercourse has been possible in the past, but due to difficult experiences such as painful smear tests or childbirth, sexual intercourse has become impossible since those experiences. Further, vaginismus is classified as global if the tightening of the muscles occur in all situations involving vaginal penetration, e.g. with every partner, with tampon use, with smear tests; and as situational if the tightening occurs in certain situations, e.g. with one partner but not with another or during a smear test but not when using tampons.
What is the difference between vaginismus and dyspareunia?
Vaginismus refers to the impossibility of penetration because of the tightening of the vaginal muscles, whereas dyspareunia refers to painful sex, where sex is possible but is painful. However, these labels often overlap because some women with vaginismus may also experience pain and women with dyspareunia may also experience a tightening of the vaginal muscles as a result of pain.
Is an internal examination necessary for the diagnosis of vaginismus?
No, an internal examination is not necessary in order to diagnose vaginismus. The ability of a woman to tolerate an internal examination is not a reliable indicator of whether or not she can have intercourse and, in most cases, women with vaginismus are impossible to examine. The experience of being examined, if conducted insensitively, can add further trauma. If a woman can identify with the experience of being unable to have penetrative sex because of the involuntary spasming of vaginal muscles, then she is experiencing vaginismus. However, if a woman has any concerns such as unexplained vulval pain or discharge or if there are fears of any physical abnormality she may choose to have an internal examination to alleviate these fears. It is important to go to a practitioner that is knowledgeable about vaginismus and will carry out the examination sensitively.
What are the main contributing factors to vaginismus?
The reasons for the vaginal spasm will be different for each woman and couple. Because vaginismus manifests as a spasming of the vaginal muscles when intercourse is attempted, many medical practitioners will assume that the cause is physical. However, this is rarely the case; the spasm is more commonly related to other factors such as fear of actual or anticipated pain when attempting intercourse. Another common contributing factor are the messages from family about sexual behaviour that are often shaming and frightening in order to control the sexual behaviour of daughters. This is especially the case in societies where the reputation of daughters directly impact the reputation of the family. A study by Ward and Ogden (1994) found that the second most prevalent reason given by women with vaginismus (after fear of pain) was being brought up to believe that sex is wrong. Vaginismus can be thought of as an automatic protective response because an association has been made between sexual intercourse and anxiety, pain or shame.
The findings of this study suggests that the difficulties associated with vaginismus may have their roots in childhood and may be associated with the experience of negative and frightening messages regarding sex and pre-marital pregnancy. In many cultures, including Ireland, a daughter’s sexual reputation can be perceived to have wider implications for the reputation of the family leading to feelings of fear and shame being associated with sexual relationships. These feelings of fear and shame can manifest physically, as in the case of vaginismus, as an automatic tightening of the vaginal muscles whenever intercourse is attempted, and this may be interpreted not only as an attempt at physical protection of the body but also as an emotional protection from the shame associated with sexual behaviour. The shame of these early messages can persist for many years and impact relationships.
Is vaginismus more prevalent in certain cultures?
Relatively high prevalence rates are reported in Eastern cultures (e.g. Iran, Turkey) when compared to Western cultures and this is thought to be because of religious conservativism including the restriction of premarital intimacy, the prioritisation of male sexual satisfaction over female pleasure, and the expectation that brides will be virgins. In such cultures, there is often an absence of sex education in schools or at home and there can be an emphasis on sexual abstinence, especially for women. In these cultures, couples tend to go for help for vaginismus because it prevents procreation, and not because it reduces the sexual satisfaction and wellbeing of the woman. The primary goal of such therapy tends to be penetration and procreation and the need to address the sexual wellbeing of the woman may not be prioritised if it is not prioritised in the culture.
Does religion play a role in vaginismus?
The four main world religion forbid sexual experiences prior to marriage and emphasise the importance of virginity and sexual abstinence for women. Associating a woman’s sexual behaviour with sin adds another level of shame. Religious orthodoxy, regardless of which religion, is linked to sexual guilt and to a range of sexual dysfunctions including vaginismus. The dominance of the Catholic Church in Ireland suppressed the teaching of sex education in state schools for decades which may partially explain why Ireland was reported as having the highest rates of vaginismus in Europe in clinical surveys in 1979 and 1986. Preliminary findings from the DCU study in 2018 reported that the legacy of the Catholic Church still contributes to the culture of silence and shame regarding sexuality and sexual difficulties and influences the conservative negative messages from family about the sexual behaviour of daughters and the shame of pregnancy outside of marriage.
Does the family play a role in vaginismus?
Although vaginismus is more prevalent in conservative, religious cultures not every woman in those cultures are affected by vaginismus. Cultural and religious norms are socialised within the family structure. Women who are affected by vaginismus are more likely to be sensitive to these messages and to perceive these messages as rigid, inflexible and dogmatic. In most families, these messages come from the mother and the relationship between mother and daughter has been found to be a significant factor in the development of vaginismus. In a recent book Sex for Simple Humans, Rogan (2017), an Irish doctor who works with women with vaginismus, stated that Irish women with vaginismus tended to have mothers that either forbid discussions about sex with their daughters or gave explicitly negative messages about sex, the trustworthiness of men or pre-marital pregnancy. Similarly, the DCU study found that, for women experiencing vaginismus, the messages from mothers about sex and pregnancy had been perceived as frightening and that, as young girls, the women were made aware that their sexual behaviour would bring shame on the family. The DCU study has found that difficulties associated with vaginismus may originate in the family of origin and that family dynamics, particularly the mother-daughter relationship, provide the conditions for the emergence of vaginismus. In this context, vaginismus predates the partner relationship and has its roots in the family of origin.
Is vaginismus related to sexual abuse?
Sexual abuse is a factor in only a minority of cases of vaginismus. The vast majority of women experiencing vaginismus have not experienced sexual abuse but the belief that this link exists prevent many women from seeking help because of shame and because they may presume that health care professionals will make this assumption or the fear that counselling will lead to the discovery of repressed childhood events. The link between vaginismus and sexual abuse is not supported by research.
Is vaginismus a relationship problem or a couple problem?
According to the research, generally vaginismus is not indicative of deeper problems in the relationship. It is more usual that the relationship is sound and that vaginismus is the only problem to be dealt with. It is more helpfully thought of as a couple problem that couples can solve together. If a woman has a partner, it is very helpful to include her partner in the therapy as the woman will need support during this time and the love of a partner can be very beneficial for the resolution of the problem.
What support services are most prevalent?
There is a dominance of medical and behavioural interventions focused on treating the spasm. Most sex therapies seeks to reduce the spasm by engaging with gradual exposure to penetration combined with relaxation techniques. Exercises for vaginal dilation such as vaginal trainers or Botox are commonly offered to reduce the spasm. If these techniques are used, it is important that it is in the context of a supportive therapeutic programme that also incorporates the emotional needs of the woman or couple. Although these techniques may be effective at reducing the spasm, they have not always been successful in reducing levels of pain, anxiety, fear or sexual distress. If the outcome measure of success for these therapies is successful penetration rather than the sexual satisfaction of the woman, the use of such techniques are questionable. Kleinplatz (1998) states that the use of such techniques may infantilise and disempower a woman and encourage a woman to ignore her physical and emotional needs and to alienate her from her own body.
What support services are most helpful?
Because the reasons for vaginismus will be different for each woman and couple, a multidisciplinary approach in recommended. One of the most important factors for a woman in overcoming vaginismus is to think about the problem as psychological rather than physical. It is important to look at the meaning of penetration and the closed vagina in the context of the couple relationship. The reasons for vaginismus will be unique to each woman and couple and practitioners should incorporate psychosocial, developmental and interpersonal issues to deal with its complexities.
What are the main barriers to support services in Ireland?
Unfortunately, most practitioners trained in psychosexual therapy in the South of Ireland are in private practice and so it is not only necessary to search online for help but also to pay privately for their services. It is important, therefore, to find appropriate help earlier to avoid moving from professional to professional and wasting time and money in the process. This website contains a section listing reputable support services available in Ireland for women and couples.
If there are any questions you have which are not answered in this Vaginismus FAQ please get in touch.