Sexual Wellness

Discourse About Intercourse Miniseries: Vaginismus 

June 28, 2023

By: Rachel Noonan, PharmD

Your body seems to have a mind of its own. Reacting without warning, your pelvic floor muscles contract, making penetration impossible. Vaginismus is a sexual problem that can be caused by actual or anticipatory pain and fear regarding vaginal penetration. The causes of the condition are not well understood, but the anxiety and distress surrounding the issue are real. Spasm severity can range from the inability to experience penile penetration to a gynecological exam. 

Conditions like vaginismus can have an isolating effect on the person suffering. Patients have a hard time talking about it, which is in part why the medical community doesn’t have a firm handle on the number of people affected. As with many sexual issues that predominantly impact women, the silence on the subject is deafening. 

What are my options? 

Next steps depend on the severity of the vaginismus symptoms. Studies show that approaching the issue with multiple methods can help. Tackling the physical and emotional reasons behind the condition seems most successful. 

How to target the physical aspect: 

  • Over-the-counter medications like lubricants may help, but often prescription medications are necessary. Vaginal suppositories made with medications like diazepam may help ease the involuntary muscle spasms that block penetrative activities. More therapies are available to you once you seek a professional consultation. 
  • Medical devices like dilators are vaginal tools that help patients understand mentally and feel physically that penetration is possible.  Other non-pharmacologic options include kegel exercises to strengthen the pelvic floor. 

How to target the emotional piece: 

  • Cognitive behavioral therapy is as important as any medication or physical tool you use. Vaginismus has an emotional component that cannot be ignored.  

How do I talk to my doctor about my fear of vaginal penetration? 

If you don’t feel comfortable expressing your feelings with a general healthcare provider, seek a counselor or therapist, especially if your symptoms could be the result of trauma or abuse. They can help pinpoint the source of your anxiety and may identify the triggers holding you and your partner back from experiencing the intimacy you deserve.  Finding an individual who specializes in those conversations can create a healing space for you to share. 

Describe in detail (verbally or in writing): 

  • What do you think and feel when you anticipate sexual intercourse? 
  • Do you have age-related or body image beliefs that affect your readiness for intimacy? 
  • What happens when you attempt penetration? What does it feel like? 
  • Does your partner experience any sexual problems? 

How do I talk to my sexual partner about my intimacy issues? 

Most sexual conditions depend heavily on the health and support of your partner. Vaginismus is no different. Remember, no one is to blame. Improving the sexual function of one will ultimately benefit the other. Emotional connection is the key. Creating space for open dialogue can shift the outcome of your future intimate moments together.  

Vaginismus and dyspareunia have similar symptoms, so it’s possible to have both. Review dyspareunia content to have the full picture when you seek medical support.  

Your pain should never be ignored. 

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