Vaginismus – Causes, Symptoms and Evidence‑Based Treatment

Vaginismus is a common, under‑diagnosed pelvic health condition that affects an estimated 1 in 10 Australian women. Despite how frequently it occurs, it is often misunderstood, minimised, or left untreated.

What Is Vaginismus?

Vaginismus is a condition characterised by involuntary tightening or spasm of the pelvic floor muscles, particularly those surrounding the entrance of the vagina, which interferes with penetration.

This muscle response is not intentional and cannot be controlled by willpower alone.

Vaginismus may make it difficult or impossible to tolerate:

• Vaginal penetration during sex

• Tampons or menstrual cups

• Fingers, vibrators or dilators

• Gynaecological or internal examinations

For many people, the experience can feel as though the vagina is “closed” or that penetration is simply not possible - even when the desire to allow penetration is present.

Primary vs Secondary Vaginismus

Vaginismus is often described in two broad categories:

Primary vaginismus

• Penetration has never been comfortable or possible

• Difficulties may have been present from first attempts at tampon use or intercourse

Secondary vaginismus

• Penetration was previously possible

• Symptoms develop later, often following:

  • Trauma or painful experiences

  • Pelvic surgery or childbirth

  • Gynaecological procedures

  • Hormonal changes

  • An insidious or gradual onset without a clear trigger

Both presentations are valid and treatable.

Why Does Vaginismus Happen?

The sensation of tightness or blockage is caused by involuntary contraction of the pelvic floor muscles, particularly the bulbospongiosus muscle, which surrounds the vaginal opening.

When this muscle contracts reflexively:

• The vaginal opening cannot relax

• Penetration becomes painful or impossible

• Attempts to push through often increase pain and guarding

This response is commonly driven by a threat or protection response in the nervous system.

Contributing Factors

Vaginismus rarely has a single cause. It is most often influenced by a combination of physical, psychological and nervous system factors, which may include:

• Previous pain or trauma

• Fear or anticipation of pain

• Medical or gynaecological trauma

• Shame or anxiety around sexuality or masturbation

• Body image concerns or genital appearance concerns

• Chronic pelvic floor muscle tension

• Repeated painful penetration attempts

Importantly, vaginismus is not “all in your head” - and it is also not purely physical. Both aspects matter.

Common Symptoms of Vaginismus

Symptoms may vary between individuals but often include:

• Pain or inability to use tampons or menstrual products

• Painful intercourse, often described as burning, stinging or tightness

• Pain or inability to insert fingers, vibrators or dilators

• Penetration feeling restricted or impossible

• Pain during gynaecological or internal pelvic exams

Symptoms may be consistent or fluctuate depending on stress, fatigue, or context.

How Is Vaginismus Treated?

Vaginismus is a highly treatable condition, particularly when addressed using a multidisciplinary approach.

Treatment focuses on reducing threat, restoring muscle relaxation, and rebuilding comfort and confidence with penetration - at a pace that feels safe and controlled.

Psychological & Emotional Support

Working with a sexologist or psychologist can be a vital part of recovery.

These professionals may help explore:

• Beliefs around sex, shame and body image

• Fear‑pain cycles

• Trauma responses

• Anxiety related to penetration or intimacy

Addressing the nervous system and emotional contributors is often essential for lasting improvement.

Pelvic Floor Physiotherapy

A pelvic health physiotherapist plays a key role in the physical management of vaginismus.

Treatment is individualised and may include:

• Education about pelvic floor function

• External and internal techniques (with consent)

• Pelvic floor muscle relaxation and down‑training

• Manual muscle release (similar to a massage for the pelvic floor)

• Biofeedback or ultrasound guidance

• Breathing and nervous system regulation

• Stretching and movement strategies

Importantly, treatment is never about forcing penetration.

Dilator Therapy

Dilators can be a very effective tool when used appropriately and gently.

Dilator therapy works by:

• Gradually exposing the pelvic floor and nervous system to penetration

• Allowing penetration to occur in a controlled, pain‑free way

• Reducing fear responses over time

• Supporting both physical relaxation and neural desensitisation

Dilators are typically introduced:

• With education and guidance

• Starting with the smallest size

• Progressing only when comfort allows

For people with vaginismus, starting with our small set  or full set is often most appropriate.

The Importance of Accurate Diagnosis

Seeing a pelvic floor physiotherapist or gynaecologist who specialises in pelvic pain is essential.

An accurate diagnosis:

• Validates your experience

• Rules out other causes of pain

• Guides appropriate treatment

• Prevents worsening symptoms through incorrect advice

You deserve to be believed and supported.

Vaginismus is not rare, not a personal failure, and not something you have to live with forever.

With the right support, education and care, vaginismus is treatable - and in many cases fully resolvable.

You do not need to suffer in silence.

Disclaimer: Pelvic health conditions are highly individual. This information is general in nature and does not replace personalised assessment or medical advice.