Is vaginismus affecting your sex life?


By Violeta Jawdokimova, Psychosexual Therapist

Vaginismus is a female sexual problem. It is an inability or difficulty for a woman to experience vaginal penetration. For a woman or a couple this is a source of many painful emotions.

The discovery often happens when a girl starts menstruation and tries to insert a tampon. Tampons are not very conducive to a non-lubricated vagina, so penetration can be difficult and very often scary. From here things can snowball where that first experience could colour every subsequent penetration or lead to avoidance of any genital exploration, which is crucial for a healthy relationship with a body, including genitals. The girl might ask for help and very often she is referred to a gynaecologist which could make it even more troublesome. Very often girls do not want to deal with this and when she starts sexual activity she might struggle with penetrative sex. We also see a lot of couples who are undertaking fertility treatment who report vaginismus.

What causes vaginismus?

The picture is not clear and various experts are offering their views on this. At this point we can say that the causes for vaginismus are multiple and complex and it could be either one or more factors involved in it. Here are some possible causes:

  1. Negative beliefs, ideas and feelings about vagina

  2. Not knowing vaginal anatomy

  3. Sexual trauma (sex assault, rape, sex abuse….)

  4. Any trauma

  5. Not having anyone she can trust to talk openly about her concerns

  6. Absence of secure parental relationship, especially the female one

  7. Absence of body positive message

  8. Absence of female positive message

How do we treat vaginismus?

Vaginismus is considered to be a psychological problem and does not have its basis in the physical body. This means that vaginas of the women with vaginismus are completely healthy and developed. However, very rarely are young women referred to a psychosexual therapist straight away.

The physical examination is the usual first step, but this can just increase a young women’s anxiety. I would advocate that girls are referred for psychosexual therapy first and once that treatment is completed doctors can carry necessary physical examination. The examination can wait until a woman is very confident and secure about her own body and can examine it herself.

Some health care professional, in order to “reassure” women that there is nothing wrong with their vaginas say “it is all in your head”, which is not very helpful as for a woman who is not able to have penetrative sex, the reality is very “physical” in that she physically feels that nothing can get inside her. These type of comments also make women feel even more inadequate as they already feel a huge amount of pressure to be “normal”,  shame that they are not “normal”, so not only are their vaginas “not working” but also now their heads too.

Sensitive and understanding therapists will acknowledge this and patiently and lovingly work with a woman. Upon establishing a secure relationship with the clients’, which might take a considerable time, therapist will work with either set of vaginal trainers or encourage vaginal and genital exploration, which involves penetration with fingers. This is also an empowering process where women start taking ownership of their own examination. This is a gradual work and at a later stage it will involve partners. Psychosexual Therapy or simply Sex Therapy, is a very successful talking therapy and as long as you commit yourself to it, success is a very realistic possibility.

Violeta Jawdokimova