Key takeaways:
Vaginismus is a condition where the muscles around the opening of your vagina involuntarily contract, making penetration difficult and painful during sex.
Vaginismus can make it hard to have sex, use menstrual products, or have a pelvic exam.
Many treatments for vaginismus are available, including vaginal dilators, and different types of therapies and medications.
Painful sex is very common. In fact, about 3 out of 4 women will have painful sexual experiences at some point in their lives. For some, this is a temporary condition, but for others it can last a long time.
One cause of painful sex is a condition called vaginismus. Let’s take a closer look at what vaginismus is, what causes it, and what types of treatments are available.
What is vaginismus?
Vaginismus is when the muscles in your vaginal area tighten involuntarily. During sex, this can make penetration painful and sometimes impossible. Vaginismus can affect your sex life, your ability to use tampons and other menstrual products, and your ability to have a pelvic exam. Having vaginismus isn’t your fault, or caused by doing anything wrong. And fortunately, it’s often very treatable.
The contractions that vaginismus causes are involuntary. This is worth noting as many people can willfully contract the muscles of their pelvic floor. This is what happens when you have to stop your urine stream or when you do Kegel exercises. This is a voluntary action and different from the contractions that vaginismus causes.
Vaginismus symptoms
The hallmark symptom of vaginismus is involuntary muscle tightening in your genital area, leading to pain with sex (dyspareunia). But vaginismus will typically have other signs and symptoms, too. These may include:
Inability to insert things into the vagina
Burning or stinging during sex
Decreased desire or no desire for penetration
Intense fear of pain with sex
Because vaginismus causes pain, many women become fearful of penetration. This cycle of pain and fear can be devastating. This is especially true if you want to enjoy penetration as part of your sexual experience.
Vaginismus doesn’t have to occur with sexual intercourse. It can happen with insertion of any item into the vagina. For example, some women can’t use tampons for menstrual flow due to vaginismus. The use of vibrators or self-stimulation during masturbation can also sometimes be difficult for women with vaginismus.
Vaginismus causes
There are several factors that may cause vaginismus. Though in some cases, vaginismus doesn’t have a clear cause at all.
Here are some of the common causes of vaginismus.
Genital trauma
Genital trauma is a form of injury or damage to the outer sex organs. This can have many causes and may not always be intentional.
This type of trauma may occur from unwanted sexual advances or assault. But it can also occur from infections, medical procedures, or childbirth. Falls or accidents may also cause it. Any trauma that causes physical or emotional pain related to the genitals can lead to vaginismus.
Read more like this
Explore these related articles, suggested for readers like you.
Body image disorder
Some people with vaginismus have body image disorders, like dysmorphia. These conditions lead you to focus on one or more defects you believe you have in your physical appearance.
And it’s possible to have a perception that your vagina is too small to allow something to penetrate it. This is untrue, as the vagina can expand to allow a baby to pass through it. Therapy and education on the capacity of the vagina can help some people overcome this fear.
Shame
In some cultures and religions, there’s a belief that sex (under certain circumstances) is shameful or wrong. Believing that you shouldn’t enjoy sex, or that your choice of partner is wrong, can have lasting effects on your sexuality. Vaginismus is sometimes the direct result of shame.
Gender-identity conflicts
Gender-identity conflicts can also sometimes lead to sexual problems. If you have a vagina but identify as someone who shouldn’t, you may have sexual pain during penetration.
In addition, transgender women may also have vaginismus. This can occur if a new vagina is constructed for you during gender-affirming surgery.
How is vaginismus diagnosed?
Vaginismus can be diagnosed by a doctor, OB-GYN, or other health professional. When you meet, they will ask you about your symptoms and history. In some cases they may also suggest a physical exam, a pelvic exam, or additional testing.
Vaginismus treatment
Treatments with good success rates include those that combine treatment options. Here are six of the top treatment options for vaginismus.
1. Pelvic floor physical therapy
Pelvic floor therapy may be effective for vaginismus. It helps increase awareness of the pelvic floor muscles. So it may help you gain better control over these muscles and decrease the amount of spasms you have. It’s also useful alongside controlled breathing. Licensed therapists can teach both relaxation and controlled breathing.
2. Pharmacologic agents
Some medications may help decrease vaginal sensitivity. This includes medications that can help lower pain with sex, like lidocaine (local anesthetic) numbing cream, and Botox injections.
3. Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) can help to address the pain and fear that can come with vaginismus. It can help you replace unhelpful thoughts like “this will always hurt” with more realistic ones. CBT can teach you new skills related to sex and intimacy. CBT is also a good treatment for anxiety, depression, and relationship problems that often go along with vaginismus.
4. Sex therapy and biofeedback
In some cases, sex therapy can also help decrease your vaginal pain response through touch. Sex therapy incorporates many things, like couples counseling, physical touch therapy without penetration, and hypnotherapy.
Sometimes people can use biofeedback as a part of sex therapy. It allows you to check your body’s response to sexual touch. During biofeedback, you’re connected to sensors that help you receive information about your body. This feedback allows you to make subtle changes, like relaxing your muscles to lower pain.
5. Vaginal dilator therapy
Vaginal dilators are another common treatment. They come in various sizes to help you gradually learn to relax your muscles as a dilator is inserted into your vagina. They start with thin sizes and increase up to the size of an erect penis or large vibrator.
There’s no standard regimen for effective dilator use. Research is ongoing to find how best to use this treatment.
6. Relaxation techniques
Learning to consciously relax your body and mind can help some people with vaginismus. This might include working with a therapist or coach to practice deep breathing exercises, progressive muscle relaxation, or other mindfulness and relaxation techniques.
Remember that many of these treatment options complement each other well — like combining a vaginal dilator with relaxation techniques and/or biofeedback. So, as you start to work with a healthcare professional, don’t hesitate to ask them how you can incorporate other treatments into your plan.
Frequently asked questions
Yes, vaginismus can be cured. To be cured of vaginismus means to be able to achieve sexual penetration without significant pain. One study showed that after treatment, 79% of people with vaginismus were able to have sex successfully. And this was regardless of the therapy they used. If you’re willing and able to get treatment, the good news is that a cure is more likely than not.
There are many different mental and physical health conditions that can cause pain before, during, and after sex (dyspareunia). Common examples include hormone changes, infections, and chronic medical conditions.
Yes, vaginismus can be cured. To be cured of vaginismus means to be able to achieve sexual penetration without significant pain. One study showed that after treatment, 79% of people with vaginismus were able to have sex successfully. And this was regardless of the therapy they used. If you’re willing and able to get treatment, the good news is that a cure is more likely than not.
There are many different mental and physical health conditions that can cause pain before, during, and after sex (dyspareunia). Common examples include hormone changes, infections, and chronic medical conditions.
The bottom line
Vaginismus is a condition in which the muscles in the vaginal area tighten involuntarily. This can be disruptive to your sexual experiences. And it can be difficult to discuss.
If you have vaginismus, the first place to start is to find a healthcare professional with whom you feel comfortable. It’s OK if that takes a little time. It’s important to find someone who helps you feel safe when talking about your experience and symptoms. They can work with you to find the right combination of treatments that’s best for your body.
Why trust our experts?
References
Attia. (2023). What’s vaginismus and how do I know if I have it? Planned Parenthood.
Dalrymple, S. N., et al. (2025). Female sexual dysfunction: Common questions and answers. American Family Physician.
Grimstand, F., et al. (2021). The gynecologic examination of the transfeminine person after penile inversion vaginoplasty. Clinical Opinion.
Liu, M., et al. (2021). Vaginal dilators: Issues and answers. Sexual Medicine Reviews.
Maseroli, E., et al. (2018). Outcome of medical and psychosexual interventions for vaginismus: A systematic review and meta-analysis. The Journal of Sexual Medicine.
MedlinePlus. (2024). Vaginismus.
Melnik, T., et al. (2012). Interventions for vaginismus. Cochrane Library.
Mitchell, K. R., et al. (2017). Painful sex (dyspareunia) in women: Prevelance and associated factors in a British population probability survey. British Journal of Obstetrics and Gynecology.
Reissingg, E. D., et al. (2012). Pelvic floor physical therapy for lifelong vaginismus: A retrospective chart review and interview study. Journal of Sex & Martial Therapy.
ScienceDirect. (n.d.). Vaginism.
The American College of Obstetricians and Gynecologists. (2022). When sex is painful. Every Stage Health.
Velayati, A., et al. (2019). Can Botox offer help women with vaginismus? A systematic review and meta-analysis. International Journal of Sexual Health.
