Vaginismus
TYPICAL CAUSES
The Internal Alarm
What Causes Vaginismus?
Within the brain, there are a set of structures that perceive sensory information and control reactive bodily functions called the Limbic System. Although this system is still not fully understood by science, we know that involuntary vaginal tightening (vaginismus) is triggered by a limbic system overreaction. The various circumstances already discussed, ranging from unconsummated marriages to tightness experienced by women later in life, all result from this same common, resolvable overreaction. The involuntary muscle tightness occurs without conscious direction; the woman has not intentionally “caused” or directed her body to tighten and cannot simply make it stop without a resolution process.
Vaginal muscles tighten in overreaction when the limbic sensory system detects various forms of touch, pelvic vulnerability, or the negative anticipation of potential penetration. Some clinicians have described vaginismus as a fight or flight reaction in the pelvic floor and surrounding musculature. The body interprets signals incorrectly, responding with intense body tightening and reflexive movement away from potential penetration.
For women experiencing tightness later in life, after years of normal, pleasurable intercourse, the limbic overreaction typically develops through a vaginismus cycle-of-pain experience. At some point in their lives, either temporary pelvic issues or trauma causes the limbic system to be in heightened anxiety about the resumption of sex potentially causing pain or damage.
For example, a woman who undergoes pelvic cancer surgery may have heightened underlying anxiety about her body not being fully healed from the stitches where an incision was made. The anxiety is less emotional and more of a complex body memory of recent trauma and tissue recovery pain. The limbic system senses the mix of general physical and internal emotional anxiety, and involuntarily causes the muscles in the pelvic floor to partially tighten to protect the area from pain or damage when attempts to resume intercourse begin. The partially tightened muscles cause intercourse attempts to be uncomfortable or painful, increasing the limbic system overreaction response and making the body overreact in the future with even greater tightening - an ongoing cycle of tightening and pain. The body develops a limbic response when it perceives that penetration is not safe, even though the physical or medical condition that originally triggered it may have been fully resolved. The mind and body learn to anticipate that what was once pleasurable is no longer safe.
Vaginismus may result from a combination of physical or non-physical causes, or seem to have no direct cause at all. Generally, there are internal body and mind messages interpreted by the limbic system with overreaction resulting in the reflex spasm. Why do do some women’s bodies react this way and not others? Everybody reacts to life experiences and concerns differently, just as everyone has their own unique perceptions and personality. In younger women, sometimes there are deep-seated, subconscious, negative feelings such as anxiety or fear that may be associated with a vaginal insertion, but there also could physical memories of brief pelvic pain. The vaginal muscles, as they tighten, are in effect acting as a protective mechanism. A negative experience is anticipated (pain, danger, etc.) - the internal alarm (limbic system) sounds - and the body reacts with pelvic tightening - and insertion becomes impossible.
As you read through the following lists, you may come to a better understanding of why your body is responding to intercourse as it is. However, please know that often the cause is not one single thing, but rather a result of many experiences and emotions, and as such the cause may never be completely understood. Fortunately, almost all women are able to overcome their penetration problem even without a clear understanding of what originally triggered it.
Examples of Physical Causes
Temporary Discomfort
Temporary pain or discomfort resulting from insufficient foreplay, inadequate vaginal lubrication, etc.
Pelvic Trauma
Any type of pelvic surgery, difficult pelvic examinations, or other pelvic trauma
Abuse
Physical attack, rape, sexual/physical abuse or assault
Medications
Side-effects may cause
pelvic pain
Medical Reasons
Urinary tract infections or urination problems, yeast infections, sexually transmitted disease, endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammatory disease, lichen planus, lichen sclerosus, eczema, psoriasis, vaginal prolapse, etc.
Childbirth
Pain from normal or difficult vaginal deliveries and complications, C-sections, miscarriages, etc.
Age-related Changes
Menopause and hormonal changes, vaginal dryness / inadequate lubrication, vaginal atrophy
Examples of Non-Physical Causes
Fear or anticipation of intercourse pain, fear of not being completely physically healed following pelvic trauma, fear of tissue damage (i.e. "being torn"), fear of pregnancy, a concern that a pelvic medical problem may reoccur, etc.
Traumatic Events
Past emotional/sexual abuse, witness of violence or abuse, repressed memories
Childhood Experiences
Overly rigid parenting, unbalanced religious teaching (i.e. "Sex is BAD"), exposure to shocking sexual imagery, inadequate sex education
Unexplainable
Sometimes there is no identifiable cause (physical or non-physical)
Fears
Anxiety or Stress
General anxiety, performance pressures, previous unpleasant sexual experiences, negativity toward sex, guilt, emotional traumas, or other unhealthy sexual emotions
Partner Issues
Abuse, emotional detachment, fear of commitment, distrust, anxiety about being vulnerable, losing control, etc.
Cycle of Pain
The Internal Alarm
The limbic system sounds an internal alarm, alerting the body of potential pain. Once triggered, the body automatically tightens the vaginal muscles, bracing to protect itself from harm.
Sex becomes uncomfortable or painful, and entry may be more difficult or impossible depending upon the severity of this tightened state.
Additional sexual attempts result in discomfort, further reinforcing the limbic system response so that it intensifies more.
The body experiences increased pain and reacts by bracing more on an ongoing basis, further entrenching this response and creating a vaginismus cycle of pain.
Successful treatment of vaginismus focuses on retraining the vaginal muscles to respond differently to the anticipation of intercourse. This process of muscle retraining combined with a series of limbic reduction exercises change the muscular response so that the mind and body no longer over-react to penetration. Our practical program will completely address both mind and body components to resolve all triggers, disabling involuntary spasms and pain, and enabling pain-free intercourse.