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Vaginismus: description, treatment, causes

by Josephine Andrews
Published: Last Updated on 221 views

Vaginismus describes a painful, spasmodic contraction of the vagina and pelvic muscles, for example during sexual intercourse. Penetration into the vagina is then impossible or only possible with pain. Physical causes cannot be determined, the trigger lies in the psyche. Read here what causes vaginal cramps and how it is treated!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

N94 F52

quick overview

  • What is vaginismus? Spasmodic contraction of the vagina and pelvic floor muscles, for example during sexual intercourse. In severe cases, just the thought of having sex is enough to trigger a painful vaginal spasm.
  • Treatment: vaginal dilators, psychotherapy and sex therapy, relaxation techniques, pelvic floor training, in rare cases medication.
  • Causes: Fear of pain or injury during sexual intercourse, fear of pregnancy, traumatic experiences (abuse, birth trauma), partnership problems, emotional stress, depression
  • Risk factors: General diseases such as diabetes or high blood pressure , disturbed relationship to one’s own sexuality.
  • Symptoms: painful cramping of the vaginal and pelvic floor muscles, pain during sex , fear of pain and injury, penis cannot penetrate or only with pain, feelings of guilt
  • Diagnostics: Detailed doctor’s consultation, exclusion of physical causes such as infections or inflammation in the genital area.
  • Prevention: Healthy relationship with one’s own intimate area, processing of traumatic experiences, well-trained pelvic floor , low-conflict partnership

What is vaginismus?

Vaginismus (vaginal spasm, vaginal spasm) occurs when the muscles of the vagina and pelvic floor contract spasmodically, for example during sexual intercourse, and penetration into the vagina (penetration), for example through a penis, is not possible or is associated with great pain. In many of those affected, the vagina also cramps when trying to insert a tampon or during a gynecological examination. In severe cases, the mere thought of manipulation in the genital area is enough for the vagina and pelvic floor to contract spasmodically.

A vaginal cramp that occurs usually triggers a spiral of fear and pain. For example, although the woman actually desires intercourse, she is overwhelmed by the fear of pain. This causes the muscles in the intimate area to contract even more, causing or increasing the pain.

It is typical for vaginismus that there are no physical causes such as infections or inflammation. The cause of the spasm lies in the psyche.

Vaginismus is not a disease but a painful sexual dysfunction. One speaks of a sexual dysfunction when one’s own sexuality cannot be lived out satisfactorily. These include, for example, difficulties with orgasm or erection as well as a lack of sexual interest. With vaginismus, the woman has a sexual desire, but penetration is not possible or only possible with pain.

forms of vaginismus

There are two forms of vaginismus, the decisive factor for the distinction is the time at which the vaginal spasm first occurs. In primary vaginismus, the dysfunction is present from birth , in secondary, the disorder develops over the course of life.

Primary vaginismus: Primary vaginismus is congenital. The dysfunction is usually recognized during the first sexual intercourse.

Secondary vaginismus: In the case of secondary vaginismus, sexual intercourse or penetration into the vagina was previously possible without pain. Vaginal spasm is triggered by a traumatic event such as sexual abuse or birth trauma.

What is GPSPS?

GPSPS is the acronym for Genito-Pelvine Pain Penetration Disorder. This is a sexual dysfunction in which the clinical pictures vaginismus (spasm of the vagina) and dyspareunia (pain during sexual intercourse) occur at the same time.

How Is Vaginismus Treated?

The aim of the treatment is to reduce the reflexive contraction of the vagina and pelvic floor muscles and to give the woman back the self-determination of her sexuality. The woman slowly and gradually learns that sexual intercourse is possible without pain.

vaginal dilators

Vaginal dilators are special plastic pins that come in different sizes. These are inserted into the vagina in increasing strength by the woman herself. They cause the vagina to widen and the muscles to get used to penetration. This creates a feeling for her own vagina and the woman experiences that insertion is possible without pain.

In the further course, the sexual partner is sometimes included in the exercises. However, it is important that the patient retains control over the exercise sequences, for example by inserting the penis herself.

Psychotherapy and sex therapy

In many cases of vaginismus, accompanying psychotherapy is helpful, especially when traumatic events such as abuse or problems in the partnership cause the vaginismus.

In sex therapy, the patient deals intensively with the relationship to her own body and with sexuality. Ideally, a sexual partner is included in the therapy.

pelvic floor training

During pelvic floor training, women learn to tense and relax the pelvic floor muscles in a targeted manner. Some exercises can easily be incorporated into the daily routine at any time.

Tips for everyday life

  • Keep tensing your pelvic floor muscles in everyday life, for example when waiting at traffic lights or when on the phone.
  • Consciously tense the pelvic floor during physical exertion (e.g. when carrying heavy loads).
  • Avoid straining when you have a bowel movement.
  • Make sure you eat a balanced diet rich in fiber and drink enough!
  • Excess weight puts pressure on the pelvic floor. Try to reach your normal weight!

Special exercises for the pelvic floor

Pelvic floor lift (standing): Stand with your upper body hip-width apart. Think of the pelvic floor as a lift slowly moving upwards. Tighten your pelvic floor muscles and pull the imaginary lift up. Hold the tension for a moment. Then let the lift slowly – floor by floor – sink back down.

Katzenbuckel (on all fours): Kneel on the floor and support yourself on your hands, keeping your back straight. Breathe in deeply and then breathe out through your mouth . Form a cat’s hump (pull your rounded back up, head between your arms). Then breathe in again and straighten your back.

Chair March (seated): Sit in a chair and move to the front edge. Legs are hip-width apart at right angles. Now press your heels firmly against the floor. This activates the rear part of the pelvic floor. Hold the tension. To activate the front pelvic floor, press your toes firmly against the floor.

relaxation exercises

Emotional stress and inner tension sometimes exacerbate existing problems. Relaxation exercises help to achieve more inner peace. Breathing exercises or “progressive muscle relaxation” are particularly recommended . Ask your doctor about therapists who can guide you.

medication

In rare cases, the doctor uses medication to prevent further spasms. By injecting so-called “muscle relaxants” – these are active ingredients that relax the muscles – the symptoms improve, at least temporarily.

Solve vaginal cramps yourself?

Talk to your partner about it as soon as you feel pain when the penis enters the vagina, for example. Don’t try to force penetration. This creates a vicious circle that only increases the symptoms. Try to relax and see a doctor soon. He will help you to find out the cause of the vaginismus and to find an appropriate therapy.

Treating vaginismus requires a lot of patience – also from your partner, but in most cases it is very successful!

What are the causes of vaginismus?

causes

The cause of vaginismus lies in the psyche. Physical causes such as infections or inflammation in the genital area (such as endometriosis ), which also cause cramping pain, are usually not present. The cramping in the lower third of the vagina is a strong unconscious defense reflex in women, triggered by fear of pain or injury.

Possible causes are:

  • Affected women believe, for example, that the vagina is too narrow (e.g. for the penis of the sexual partner) and are afraid of pain when penetrating.
  • Fear of injuring the intimate area, for example by the partner’s penis
  • fear of pregnancy
  • Rejection of penetration in general
  • Rejection of the sex partner
  • partnership problems
  • Traumatic experiences such as sexual abuse, birth trauma or a painful examination by a gynaecologist
  • Emotional stress, depression

symptoms

Symptoms of vaginismus vary from woman to woman. In lighter forms, the cramping only occurs in certain situations, such as under stress. In “total vaginismus” the vagina always cramps as soon as it is touched. Both sexual intercourse and the insertion of tampons are impossible for affected women. The gynecological examination with the speculum can also cause major problems.

Symptoms:

  • Painful spasms of the pelvic floor and vaginal muscles.
  • The spasm cannot be controlled at will.
  • Insertion of the penis, fingers, a dildo or a tampon is not possible or only possible with severe pain.
  • avoidance of sexual activity.
  • Avoidance or fear of an examination by the gynecologist.
  • In some cases, just the thought of penetration can trigger a vaginal spasm.
  • Affected women often suffer from a great emotional burden. This can go so far that they do not feel like a full woman, have feelings of guilt towards their partner and suffer from feelings of inferiority.

If you have sexual problems, contact your trusted gynecologist. He will work with you to determine the cause of the problem and initiate appropriate therapy. Especially with vaginismus, the treatment successes are usually very good!

risk factors

Studies show that sexual dysfunction is generally associated with risk factors such as diabetes, high blood pressure, dyslipidemia and depression. Girls and women who view sexuality as something shameful or who grew up in families where the subject was taboo are also more prone to vaginismus.

examination and diagnosis

The first point of contact if you suspect vaginismus is the gynaecologist. In a detailed initial consultation ( anamnesis ), the doctor asks about the existing problems. He will also ask questions about previous illnesses and sexual history, for example whether there have been any experiences of abuse or problems in the partnership. It is also important for the doctor to know whether the patient experiences vaginal cramps with any type of penetration and how long the problem has existed. The doctor also asks about past pregnancies and births.

Even if the inhibition threshold to talk about one’s own sexuality is often high, it is important to talk openly about it with the doctor. This is the only way to find out the cause of the fault and how to counteract it!

If it is possible – and the affected woman tolerates the examination – the doctor examines the genital tract for changes that also cause pain and vaginal cramps. These include vaginal infections, injuries, scars or diseases such as endometriosis.

If a gynecological examination is not (yet) possible, the doctor will advise the woman on how to proceed. The examination only takes place when the woman is ready for it.

In order to prepare for the examination, it helps to familiarize yourself with your own private parts beforehand. This can be, for example, looking at the vagina in front of the mirror or lightly touching it with your fingers. If this succeeds without pain, the woman begins with insertion exercises: under relaxed conditions, she tries to insert her fingers or so-called vaginal dilators into the vagina. These are special sticks that are available in different sizes. The patient learns that she may still feel discomfort but not pain, and that the negative feelings diminish over time.

prevention

A vaginal spasm cannot be completely prevented because it is not controlled voluntarily. A healthy relationship with your private parts and a well-trained pelvic floor reduce the likelihood of developing vaginismus. Equally important is the processing of traumatic events (abuse, difficult birth) and the support of confidants.

Course of the disease and prognosis

If left untreated, vaginismus rarely goes away on its own. If the woman is treated, the prognosis is very good, even if the vaginismus has existed for many years. Success is around 90 percent.

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