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Vaginismus and psuedovaginismus
Medical expert of the article
Last reviewed: 08.07.2025
Vaginismus is a reflex contraction of the vaginal constrictor muscles when the vaginal opening is filled (e.g., by the insertion of a penis, finger, or other object), despite the woman's expressed desire for the object to penetrate, in the absence of structural or other physical disorders. Vaginismus is often associated with fear of pain and fear of inserting a foreign body into the vagina.
Vaginismusually occurs with the onset of sexual activity. Convulsive contraction of the muscles is preceded by fear of pain during defloration, but in some cases it occurs suddenly, unexpectedly for the patient at the moment of painful defloration. Gentle, tactful husbands do not insist on coitus. With subsequent attempts, everything is repeated. Later, vaginismus also manifests itself during a gynecological examination. Three degrees of vaginismus can be distinguished: 1 degree - the reaction occurs when the penis or an instrument is inserted into the vagina during a gynecological examination; 2 degree - the reaction occurs when touching the genitals or expecting to touch them; 3 degree - the reaction occurs at the mere idea of sexual intercourse or a gynecological examination.
The absence of defloration in marriage is hard for spouses to endure, although in many cases it does not worsen interpersonal relationships, and the sexual adaptation of the couple occurs at the level of petting or (if possible) vestibular coitus. Women with vaginismus can often experience orgasm, but they are forced to seek medical attention by a feeling of inferiority or the desire to have a child.
Diagnosis of vaginismus
To diagnose vaginismus, physical causes must be ruled out. For this purpose, the examination is carried out after the end of treatment, which makes the examination possible. The patient is in a sitting position on a chair, after separating the labia minora, an examination is carried out in mirrors or a digital examination through the opening of the hymen. This simple technique (digital examination) can simultaneously confirm the presence of a normal vagina and suggest a diagnosis of vaginismus.
Vaginismus should be differentiated from pseudovaginismus, when pain during an attempt at introjection, convulsive spasm and the woman's defensive reaction are secondary, caused by damage to the genitosegmental component (developmental defects, colpitis, adhesions and other gynecological diseases that make introitus extremely painful). In addition, vaginismus should be differentiated from coitophobia - fear of pain during sexual intercourse that prevents it from being performed and is not accompanied by convulsive contraction of the vaginal muscles. Phenomena similar to vaginismus can also be caused by incorrect actions due to ignorance of the anatomy of the genitals by both partners. In this case, a single correction is sufficient to restore sexual function.
[ Treatment of vaginismus
Treatment of vaginismus involves behavioral modification, including the experience of using self-contact starting from the vaginal opening and moving slowly forward, thus reducing the fear of subsequent pain. The woman should touch the perineum daily as close as possible to the vaginal opening, spreading the labia minora with her fingers. When the fear and anxiety from contact with the vaginal opening has passed, the patient can insert a finger into the opening of the hymen, widening the vaginal opening. If inserting a finger does not cause any discomfort, vaginal dilators graduated in size may be recommended. These dilators can be recommended for natural bougienage. They allow the perivaginal muscles to get used to a gentle increase in pressure without reflex contraction. The woman may allow her partner to insert the first dilators during intercourse, which will be less painful, since the woman is sexually excited. If the use of dilators is painless, the sexual couple should excite the vulva by gently inserting the penis. During sexual play, the woman should get used to the feeling of the penis on her vulva. Eventually, the woman can insert her partner's penis partially or completely into her vagina. She may feel more confident in the top position. Some men experience situational erectile dysfunction in this position and may be advised to take phosphodiesterase inhibitors.