For many women, vaginismus comes as a surprise; unexplained tightness, discomfort, pain, and entry problems are unexpectedly experienced during intercourse attempts. The pain results from the tightening of the muscles around the vagina (PC muscles). Since this occurs without the conscious intent or control of the woman, it can be very perplexing.
Usually at the root of vaginismus is a combination of physical or non-physical triggers that cause the body to anticipate pain. Reacting to the anticipation of pain, 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. With attempts at sex, any resulting discomfort further reinforces the reflex 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'.
|Examples of Non-physical Causes|
|Fears||Fear or anticipation of intercourse pain, fear of not being completely physically healed following pelvic trauma, fear of tissue damage (ie. "being torn"), fear of getting pregnant, concern that a pelvic medical problem may reoccur, etc.|
|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.|
|Traumatic events||Past emotional/sexual abuse, witness of violence or abuse, repressed memories|
|Childhood experiences||Overly rigid parenting, unbalanced religious teaching (ie."Sex is BAD"), exposure to shocking sexual imagery, inadequate sex education|
|No cause||Sometimes there is no identifiable cause (physical or non-physical)|
Step 2 of the self-help program helps women review vaginismus causes in more detail with associated exercises to address and minimize their effects. Note that the lists on the left only include more common examples and are in no particular order.
Vaginismus does not always have an obvious cause (see Diagnosis). Sometimes women with near perfect childhoods, great relationships, strong education, and few anxieties, have trouble finding any plausible explanation for what caused their vaginismus. Understanding why they had vaginismus may remain a mystery even after it is fully resolved. Fortunately, though it is helpful to know the causes, full knowledge is not necessary to complete successful treatment.
|Examples of Physical Causes|
|Medical conditions||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|
|Temporary discomfort||Temporary pain or discomfort resulting from insufficient foreplay, inadequate vaginal lubrication, etc.|
|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|
Since vaginismus can be triggered by physical events as simple as having inadequate foreplay or lubrication, or non-physical emotions as simple as general anxiety, it is important that it be understood that vaginismus is not the woman's fault. Once triggered, 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. Women with vaginismus may initially be sexually responsive and deeply desire to make love but over time this desire may diminish due to pain and feelings of failure and discouragement. It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.
Why do these causes trigger vaginismus in some women but not in others?
Life experiences vary dramatically from person to person. Some women's bodies react with vaginismus, while others with nearly identical experiences do not.
The anticipation of pain, emotional anxieties, or unhealthy sexual messages can contribute to and reinforce the symptoms of vaginismus. Frequently, but not always, there are deep-seated underlying negative feelings of anxiety associated with vaginal penetration. Emotional triggers that result in vaginismus symptoms are not always readily apparent and require some exploration. It is important that effective treatment processes include addressing any emotional triggers so a full pain-free and pleasurable sexual relationship can be enjoyed upon resolution.
Vaginismus is often a complicating factor in the recovery from other pelvic pain conditions. Vaginismus may co-exist with other medical conditions, possibly triggered by temporary pelvic pain resulting from those conditions. Or, it can be the sole cause of sexual pain remaining after the original medical problems are addressed. When the underlying cause has been resolved or managed and ongoing pain, discomfort or penetration difficulties continue to remain, this is typically due to vaginismus.
In cases where there is clearly both vaginismus and another pelvic medical problem existing simultaneously, both problems will need to be treated to ensure full resolution. Without addressing the other medical condition, it will be difficult to resolve the vaginismus as it may continue to be triggered by pain from the other problem.
The pelvic floor muscles predominant in vaginismus are called the pubococcygeus (PC) muscle group. The PC muscle group plays a key role in the function of a woman's reproductive system, urinary tract, and bowels. The muscles enable a woman to urinate, have intercourse, orgasm, complete bowel movements, and deliver babies. Hence, they are also referred to as pelvic floor muscles, vaginal muscles, and love muscles.
With vaginismus, the mind and body have developed a muscle memory or conditioned response against penetration. The body has learned to expect or anticipate pain upon penetration, so that the powerful PC muscle 'flinches' or contracts to protect against the potential of intercourse pain. This can be equated to automatically blinking one's eyes and wincing when an object is hurled toward us. It is not something a woman thinks about doing - it just happens. Unfortunately, instead of preventing pain, the tightening of the PC muscle group ultimately causes pain; although acting as a defense mechanism against pain, the opposite effect results. The spasms cause burning or pain upon penetration or movement and may even completely block entry.
The PC muscle group is large and very powerful. It encircles the urinary opening, vagina, and anus in a figure-eight pattern with one loop of muscles surrounding the vaginal area and the other loop surrounding the anal area. On each end, the muscles are attached to the skeleton and support and hold in place the abdominal and pelvic organs like a net, forming the pelvic floor.
Never fully relaxed, but always partially contracted, the PC muscles are ready to spring into action the moment they sense the need, powerfully tightening even without the woman's awareness. For example, they enable a woman to retain urine or control her bowel movements until a convenient time without her thinking about it. In vaginismus, during attempted penetration, the PC muscles tighten involuntarily, without conscious intent (thought), and constrict the vaginal opening. This tightening is what makes intercourse uncomfortable, painful, or unachievable. The pain is often experienced without any awareness of the cause. Frustration is often common as a woman knows that there is something wrong, but is unaware her problem is vaginismus and treatment is available.
Retraining the PC muscle group to respond differently to the anticipation of intercourse is key to the successful treatment of vaginismus. The process of learning to take conscious control of this muscle group changes the conditioned reflex so involuntary tightness no longer occurs (modifying the muscle memories or conditioned responses). Effective program steps will comprehensively address both body and mind components to resolve all triggers so that when intercourse is attempted involuntary spasms no longer occur and pain is eliminated (see Treatment for more information).