Vaginismus

Symptoms of vaginismus include pain and tightness in the vagina which makes penetrative sex extremely difficult. In some cases, patients may find it hard to even use a tampon. The fear of pain can start a painful muscle spasm. If you feel pain while having sex or even during a PAP smear, then you must consult a doctor.

(Consult a doctor with doctor consultation app)

There are two types of vaginismus: primary and secondary. 

• Primary vaginismus: In this type, the woman has never had successful sexual intercourse due to pain or the anticipation of pain. 
• Secondary vaginismus: In this type, the woman has had successful sexual intercourse without any pain but now experiences pain.

Vaginismus does not have a specific cause, but it is believed to be due to past sexual trauma or other painful events. Vaginismus is a physical as well as a psychological condition. The factors that can lead to vaginismus are:

• Fear or negative emotions towards sex 
• Fear that the vagina is too small for penetration
• Sexual abuse, assault or trauma in the past
• Physical trauma during childbirth
• Painful medical examination in the past
• Fear of getting pregnant 
• Vaginal yeast or fungal infections such as thrush
• Recurrent urinary tract infections
• Endometriosis: A condition in which uterus tissues start growing elsewhere in the body. The condition can be excruciatingly painful.
• Chronic pain syndrome (long-term pain due to diseases like cancer and fibromyalgia)

If the condition is seen after menopause, it can be mistaken with atrophic vaginitis in which the vagina becomes dry and thick due to the lack of estrogen. This causes painful vaginal penetration. (Read more: Vaginal atrophy)

This condition cannot be prevented as the cause of the disease can be a past traumatic incident or a fear. Also, you will only get to know about the condition while attempting vaginal penetration.

Your doctor may start by taking your complete medical history along with the symptoms you are facing. The doctor would then do your pelvic examination to find out the cause of the pain. If there is no physical cause associated with the disease and the pain arises only during penetration, then the condition is most likely to be vaginismus.

The doctor may inject long-acting anaesthesia to a woman suffering from vaginal scars, which would help in making a further diagnosis of the vaginal area.

The aim of the treatment is to relax the vaginal muscles so that penetration becomes easy and painless. The treatment may involve the following:

• The first step towards treatment involves educating the patient about the nature of the problem and then assuring them that it can be solved. The doctor may use diagrams or hand them a mirror to show them their problem. Once the patient has accepted the problem, it gets easy for them to accept the rest of the treatment.
• Relaxation techniques such as mindfulness meditation, deep breathing exercises and gentle touching over the vagina can help in relaxing the vaginal muscles. 
• Pelvic floor exercises that involve squeezing and releasing of vaginal muscles such as kegel exercises can help the person to gain voluntary control over her levator muscles. The woman can insert her fingers inside her vagina during the exercise to get immediate feedback of the contraction and relaxation of this muscle.
• Sensate focus, a sex therapy, can be recommended by the doctors which can help in relaxing the muscles during sex. This can also help in increasing your sex drive (libido).
• The doctors would provide you with smooth tampon-shaped vaginal training objects which would help in improving the vaginal elasticity. The woman can involve her partner while doing these exercises.
• The person may require psychological treatment to deal with the fear (phobia) associated with sex.
• The doctor may prescribe anaesthetic creams, estrogen cream, or anti-allergic creams for vaginal itching, burning, and discomfort.
• Another treatment used for vaginismus is giving botox injections into the pelvic floor muscle. This was first used in 1997 and since then it is being used throughout the world. Doctors have also been using the botox injections intravaginally.