Public Education Pamphlets
The SOGC provides the following public education pamphlets designed for patients, clinics and health-care facilities. This material has been reviewed and endorsed by the SOGC’s subject matter experts.
When Sex Hurts – VaginismusVaginismus is an involuntary contraction, or reflex muscle tightening, of the pelvic floor muscles that generally occurs when an attempt is made to insert an object (tampon, penis, speculum used for a Pap test) into the vagina. This muscle tightening causes pain, which can range from mild discomfort to severe burning and aching. Vaginismus may be primary (i.e. lifelong), or secondary (occurring after a period of normal sexual function). It may also be global (occurs in all situations and with any object) or situational (may only occur in certain situations, such as with one partner but not others, or with sexual intercourse but not with tampons or pelvic exams or vice versa). Women with vaginismus often think that they're "too small" and that their vagina needs to be stretched. Just imagining this is painful! The truth is that women with vaginismus don't need to "stretch" anything; they need to learn to control the muscles around the vagina. This can be done with exercises.
- How do I know if the pain I have with intercourse is vaginismus?
- Is the pain all in my head?
- How common is vaginismus?
- What can I do if I have vaginismus?
- How exactly do I do these exercises?
- How long do I have to do the exercises before I can try to have sexual intercourse again?
- What are the chances that these exercises will work for me?
- Suggested Reading
How do I know if the pain I have with intercourse is vaginismus?Your doctor should be able to answer that after he or she has asked you a few questions and examined you. The pain with vaginismus occurs only with penetration. It starts as soon as the partner attempts to insert his penis and usually, but not always, goes away after he withdraws. The pain is often burning or tearing. Women may describe it as "It feels like he's hitting a wall", "It feels like he's too big for me" or "I feel like I'm being torn". The pain may or may not improve as sexual intercourse progresses, and there may be times when the pain is not as bad. Women with vaginismus often, but not always, also have discomfort when inserting tampons or having an internal exam.
Is the pain all in my head?Vaginismus is a learned reflex. A useful way to look at it is to compare it to getting a finger in our eye. We've all been poked in the eye at some time in our life and if we see a finger or other object approaching our eyes, we shut them automatically. In the same way, a woman with vaginismus has had an experience of painful intercourse (or other object in the vagina). Later on when she or someone else tries to insert an object in the vagina, the vagina "shuts" to protect itself from pain without the woman even being conscious of it. The muscle spasm is what causes the pain and that is definitely real.
How common is vaginismus?Vaginismus is a much more common problem than you may realize. Women with vaginismus tend to be very embarrassed about it and not mention it to anyone. That is too bad because it is a lot easier to treat vaginismus if it has only been going on for a few months than it is if it has been going on for several years. Many women have mild degrees of it at some point in their lives. Vaginismus can vary from mild discomfort with intercourse to the man being unable to enter because of pain and spasm. There are many couples who have been together for years but have never had intercourse because of vaginismus. They may even have had children by means of a "splash pregnancy" (the man ejaculates near the vaginal opening and sperm make their way up the vagina). Many women with vaginismus have very active sex lives; they just don't have intercourse. Sometimes a couple is happy with the way things are and would rather not try to change things; if you and your partner both agree - that is perfectly fine.
What can I do if I have vaginismus?The good news is that there is a cure for vaginismus; it simply involves learning how to control and relax the muscles that are tightening involuntarily. The bad news is that this does not happen overnight and requires you to do "exercises" for several weeks to several months. How long it takes for the exercises to work depends on how faithful you are in doing them and also on how long the vaginismus has been a problem. During the time period that you are doing the exercises, you should avoid intercourse. It may be hard to explain to your partner that you won't be having intercourse for several weeks and possibly several months. However, every time you have painful intercourse, you are reinforcing the reflex and it will take that much longer to get rid of it. You can still do all the other things that give you and your partner pleasure including touching each other, oral sex, etc., just not intercourse.
How exactly do I do these exercises?Start by doing Kegel exercises. If you have had a baby, you probably learned to do Kegels in prenatal class. These involve tightening the muscles of the pelvic floor – the same muscles you would contract if you were on the toilet urinating and wanted to stop the flow of urine. You should contract your muscles, hold for a couple of seconds, then relax. Initially, you can do the exercises on the toilet to make sure that you are contracting your pelvic floor muscles and not your abdominal muscles instead; however, as soon as you are certain that you are doing them correctly, you should no longer do them on the toilet but whenever you think about it during the day. Each time you do them, do about 20 contractions. You can do these while talking on the phone, watching television, etc. Don't forget to relax the muscles for a few seconds after each contraction. After a few days you should try doing the exercises with fingers in your vagina, starting with one finger and working your way up to three. It is a good idea to cut your fingernails and to use a lubricant such as K-Y Jelly. The fingers must be inserted to a depth of at least 5 to 6 cm or to the level of the first joint after your knuckle. We ask you to do this for several reasons: you can feel your pelvic floor muscles contract and relax around your fingers so that you can be sure you are contracting and relaxing the right muscle. It also helps you get used to having something in your vagina. Why fingers? They are the easiest object to remove if it starts to hurt and they don't cost anything. Women will sometimes wonder if they can use their partner's fingers instead; this is generally not a good idea since you have less control if you use your partner's fingers than if you use your own. You also want to avoid associating your partner with pain. Many women like to do the exercises in the bathtub where water acts as a natural lubricant. You should do the exercises daily if possible. Don't get discouraged if some days you can't insert as many fingers as others; this is normal. If you find that you can't get your fingers in far enough, try doing the Kegels; as you relax the muscles you should be able to get the fingers in a little bit further.
How long do I have to do the exercises before I can try to have sexual intercourse again?The time it takes to get to three fingers varies from weeks to months, depending on the duration of the problem and on how faithfully you do the exercises. When you can insert three fingers without pain a few times, then it is time to try intercourse. The first few times you try intercourse you should be on top so that you have total control and lubricants should be used. You can try pushing out as if you were having a bowel movement as you insert your partner's penis. This is because you can't push out and contract your muscles at the same time. If it hurts, you should stop, contract your pelvic floor muscles, then relax. It is not a bad idea to just lie still with your partner's penis in your vagina the first few times, with no movement. When that is successful, the next couple of times you only should move, so that you have total control over the situation. (It's a good idea to discuss this with your partner beforehand). If that doesn't hurt, then the next time you can do whatever you wish. If you find you just can't have intercourse the first time you try, don't panic. Just go back to the fingers for a few days, then try again.
What are the chances that these exercises will work for me?These exercises, though they may seem very simple, are successful more than 90% of the time, as long as there is no history of sexual trauma. Obviously, if you are suffering from flashbacks or nightmares as a result of sexual assault or abuse, these issues also have to be dealt with. The exercises also won't work if you have physical problems causing pain such as an infection or inflammation of the vulvar glands. Usually, though, when the exercises "don't work" the problem is that the woman hasn't done them for some reason or other. If you just can't seem to make yourself do these exercises, you should discuss it with your doctor. He or she may have some suggestions or may be able to refer you to someone who can help.
Suggested ReadingOne very good book on sexuality in general is Woman's Experience of Sex by Sheila Kitzinger. Ms. Kitzinger is a nurse/midwife and the mother of five daughters. This is a great book overall and it has a good section on vaginismus. Another good book is A Woman's Guide to Overcoming Sexual Fear and Pain by Goodwin and Agronin. New Harbinger Publications, Inc. (1997)