When a woman experiences penetration difficulties or tightness, it is rarely due to a small or abnormal vagina, and nearly always due to vaginismus.
When penetration or sexual tightness problems first become apparent, it is very common for women to wonder if their vagina is too small for intercourse or has become smaller due to lack of use. Problems with penetration or sexual tightness may occur at any time in life, and are most commonly due to vaginismus, although age related issues may contribute.
Women with first-time sex difficulties, difficulties inserting tampons, or difficulties allowing the insertion of a doctor's speculum during pelvic exams, often mistakenly believe their vagina is too small. In the vast majority of these cases, involuntary constrictions of the vaginal muscles due to vaginismus is the sole cause of the problem. The vagina may seem unusually small, even to physicians, but there is no physical abnormality. The constriction of the pubococcygeus (PC) muscles causes the unusual tightness and the appearance of an abnormality.
Young women are often misdiagnosed by health care providers who do not realize it is the underlying muscle constriction making the vagina appear small or unusually tight. Typically, no matter the woman's physical height, size, or age (see below), the vagina is physically able to accommodate a man's penis of any size. In principal, the vagina will widen much larger to accommodate the delivery of a baby during childbirth. It is vaginismus that disables the vagina and causes intercourse attempts to be either impossible, painful, or difficult (see below for Exceptions.)
Similarly, later in life, women may begin to experience tightness or penetration problems. Some women may find that following menopause, surgery, or many years of sexual inactivity, sex is no longer possible due to tightness and pain. With age or disuse, the vagina may atrophy or shrink. In these cases, physicians frequently prescribe the use of dilators to gently stretch the vaginal tissues and help restore health. Often women do not realize that involuntary tightness relates also to vaginismus, and fail to address this problem. The vaginismus self-help program may be helpful for those needing help to improve pelvic floor health and control in the context of working toward restored intercourse (use in consultation with a physician).
Exceptions: 1. A short, small, inelastic or absent vagina is a rare condition experienced by a small group of women. It is a symptom of MRKH and vaginal agenesis. Dilator therapy is often prescribed to help enlarge the vaginal space. 2. Unusually thick or inelastic hymens are rare occurrences that may cause penetration difficulties.
"I can recommend use of this resource by all patients with vaginismus" - APTA Journal of Women's Health Physical Therapy
- Beth Shelly, PT, BCIA-PMDB