Vaginismus can be experienced at any age and at any time in life. It is one of the most treatable sexual pain disorders and is the most common reason for sexless, unconsummated marriages. Once successfully treated this condition rarely results in a recurrence of symptoms.
Primary vaginismus refers to a patient who has always had pain with intercourse and typically occurs with first time attempts at intercourse. Many patients give a history of inability to use a tampon, and this is often the first awareness that something is different for them. Less severe forms of vaginismus will suffer through pain and burning. Severe vaginismus patients usually give a history of never having been able to have intercourse or that intercourse “is impossible”.
A 29 year old severe vaginismus patient writes:
“Vaginismus has kept my husband and I from consummating our marriage. I feel we have missed out on the closeness and bond that couples form when they are first married. The distance between us has, overtime, become a giant pink elephant in the room that neither one of us wants to discuss. We make it through the day by pretending it doesn’t exist, which pulls us even further apart. We’ve also passed the age in our lives where we thought we’d begin having children. As though this isn’t heart breaking enough, our family, friends, students, co-workers or anyone who meets us pours salt on the wound, by asking when we’re having kids or “why haven’t we had kids yet”, or “what are you waiting on”. – Mind you, these are some of the more kind questions. I don’t think that curing my vaginismus will solve all of our marital problems, however, I feel it would be a giant leap in the right direction.”
In secondary vaginismus a woman has usually had a normal sex life. Something happens such as a yeast infection, childbirth, menopause or a number of other conditions, sometimes unknown, causing increasing pain with intercourse and reaching a point where the pain is too severe and intercourse can no longer be tolerated.
A 46 year old who had a hysterectomy and removal of her ovaries at age 40 writes:
“I know we have been very busy with our business but we always had a romantic and healthy sex life. Now of course it is null and void. It has made us very distant and it has made both of us unhappy. I feel it has ruined our relationship and it is not fair for him to stay with someone who can’t have intercourse. We try to overcome it verbally and say it doesn’t matter, but how long can you just play and do oral sex? I know he needs more, and frankly I do as well. I am terrified because he is threatening to leave if I can’t function. Please help me!”
Even after treatment of conditions that may have precipitated secondary vaginismus such as yeast infections, painful sex or impossible sex may persist. Despite this, secondary vaginismus is highly treatable. If a recurrence of vaginismus occurs in this group, the same treatment that was initially successful can be repeated such as the use of dilators and repeat Botox injections for vaginismus, though the latter would be rare.
Even though this term is not used in the literature, vaginismus associated with menopause is yet another widespread reason for sexual pain and inability to have intercourse. With menopause there is a drying of the vaginal tissues and loss of volume of the vulva. “Let down” is not what it used to be and sometimes “no amount of lube helps” as shared by a patient. I have found that this condition usually starts with small micro tears of the vagina leading to initial burning or pain. This becomes progressively more severe until the woman is no longer able to tolerate intercourse. Of interest is that these women have the same vaginal spasm that I see in my primary vaginismus patients, and find that they respond equally well to Botox injections and progressive dilation. An estrogen cream or estrogen replacement is very helpful in restoring the quality of the vaginal and vulvar structures and these tissues become more robust with these supplements. I have found that by combining estrogen replacement with the Botox treatment program and the use of dilators, sexual function can be restored.
Primary vaginismus, secondary vaginismus and menopausal vaginismus all result in sexual pain and all share similar medical findings. These three forms of vaginismus are highly treatable.