What Causes Severe Vaginismus?

General Causes of Vaginismus

Sexual molestation

For vaginismus in general, the causes are unknown. It is thought that sexual molestation may play a role however there continue to be mixed feelings about this in the literature. While it may be a factor, our own patients do not show a higher incidence than what would be expected in the general population (about 25%).

Strict religious or sexual upbringing

Women who have had a very strict sexual or religious upbringing, or both, have been thought to be more vulnerable to the development of vaginismus.

Vaginismus patients have a fear of first time sexFear of first time sex

Women with vaginismus often share their concerns with fear of first time sex such as the vagina being too small, the penis too large, and tearing or ripping of the vagina with first time intercourse. Some are afraid of bleeding as a result, others fear sexually transmitted diseases, some fear pregnancy and others fear childbirth.

Problems with these interpretations

All of the above potential causes share a similar problem with analysis in that many women who do not have vaginismus have experienced sexual molestation, strict sexual or religious upbringing and/or fear of first time intercourse. It is therefore difficult to pinpoint any of the above events as the cause of vaginismus.

Protective reflex

It is my feeling that vaginismus does represent a protective reflex. The body is able to protect itself in a microsecond to avoid injury. The well known avoidance of an object approaching our eye does not have to be processed to prevent injury, There is a rapid turning of the face and strong blink that occurs far more quickly than if one were to “think it out’. In a similar way it is my thought that the brain has been programmed to think of vaginal penetration as being painful. In response there is an uncontrolled and involuntary spasm of the entry muscle to the vagina that in effect says “no entry”.

Anxiety and VaginismusWhat causes Pacik level 5 severe vaginismus?

So the question is why do some women have this more severe form of vaginismus. Why is there is such heightened pain, such severe anxiety and such strong avoidance to any form of penetration?

My thoughts are that vaginismus is a form of phobia. People who are phobic may simply have an uncomfortable feeling when faced with a (perceived) stressful situation, while others may decompensate when faced with similar circumstances. Cases in point would be two people who have a phobia about heights. One may notice an increase heart rate while another has a complete meltdown with uncontrollable shaking and screaming, and has to be helped to a safer place. Fears of bridges, elevators, crowds, animals, spiders, and needles all share similar ranges of potential decompensation.

Finding a Vaginismus CureIt does not appear to be any different with vaginismus. Some patients are able to tolerate a GYN exam but not intercourse, while more severe forms of vaginismus decompensate with just the thought of having a GYN exam. It is my opinion that there is greater spasm in the more severe cases of vaginismus, causing the vagina to look and feel like a tightly closed fist. This is proving to be so in my data analysis of over 180 patients who have been examined and treated. The severe form of vaginismus is accompanied with a stronger level of spasm, usually at the entry muscle. Most of the patients I treat are level 5 severe vaginismus.


It is my opinion that vaginismus represents a protective reflex. The brain says “pain”, the vagina responds with “no entry”. In the same way some people have stronger phobic reactions to perceived noxious stimuli, here too, in severe level 5 vaginismus, the response is greater than what would be expected.

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About Dr. Pacik

Peter Pacik, MD, FACS is a recognized pioneer in treating patients with Botox for vaginismus and the author of When Sex Seems Impossible: Stories of Vaginismus and How You Can Achieve Intimacy. He has been in practice for over thirty years and belongs to a small group of prestigious surgeons who are double board certified by both the American Board of Surgery and the American Board of Plastic Surgery. In 2010, Dr. Pacik received FDA approval to continue his study to treat vaginismus using intravaginal injections of Botox together with progressive dilation under anesthesia.
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