Vaginismus

What it is

Vaginismus is the involuntary, persistent contraction of the muscles around the vaginal entrance, which hinders or prevents penetration — during intercourse, a gynecological exam or tampon use — and often causes pain, fear and anxiety. It can be present from the first attempts at intercourse (primary) or arise after a period of pain-free sexual activity (secondary), for example after an infection, a traumatic childbirth, menopause or negative experiences. It is not a matter of unwillingness or exaggeration: it is a reflex response of the body. Diagnosis is made during the consultation, with a supportive conversation and a respectful examination, at the patient's own pace. Treatment combines education about one's own body, pelvic floor physical therapy, progressive use of dilators, relaxation techniques and, when indicated, sex therapy or psychological support, always respecting each woman's own timing.

Most common symptoms

• Pain, burning or a sense of a barrier when attempting penetration
• Involuntary contraction of the muscles at the vaginal entrance
• Difficulty or inability to undergo a gynecological exam
• Difficulty using a tampon or menstrual cup
• Fear and anxiety before intercourse
• Avoidance of intimacy, affecting the relationship

Causes and risk factors

• Fear of pain, anxiety or negative sexual experiences
• Restrictive sex education or beliefs linking sex to pain or guilt
• Infections, vulvodynia or vaginal atrophy that made intercourse painful
• Traumatic childbirth, surgeries or painful gynecological procedures
• Hypertonicity of the pelvic floor muscles

How it is diagnosed

The diagnosis is made during the consultation, through a supportive conversation about sexual history, attempts at penetration, the fear and pain experienced, and when the problem started. The gynecological exam is performed with each step explained and only as far as the patient feels comfortable, to observe reflex muscle contraction and rule out physical causes such as infections, atrophy or vulvodynia. Additional tests are requested only when another associated condition is suspected.

How we treat it at Femi Saúde

Treatment for vaginismus respects each woman's own pace and usually combines several approaches. The gynecology team at Femi Saúde starts with education about anatomy and the body's own response, relaxation techniques and guidance for the partner, when desired. Pelvic floor physical therapy helps recognize and release the muscles, and the progressive use of vaginal dilators allows gradual advancement. Any associated infection, atrophy or vulvar pain is treated in parallel. Sex therapy and psychological support are indicated depending on the case, especially when fear and anxiety are intense. The plan is individualized and reviewed at each stage.

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