What Is Vaginismus?

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Not all sex is magical or glamorous, but penetrative sex should never be painful (unless you want it to be and have the full consent of all participants). If you do have painful or uncomfortable contractions or muscle spasms during vaginal penetration, check in with your doctor: you may be experiencing vaginismus.

Vaginismus is a type of sexual dysfunction that occurs when the vaginal muscles involuntarily contract or tense at the start of or during sex; it can also happen while inserting a menstrual product like a tampon or during a routine pelvic exam, according to Rajal Patel, MD, a gynecologist and vulvovaginal specialist at Northwestern Medicine Center For Sexual Medicine and Menopause. "It's a recurrent difficulty with vaginal penetration due to involuntary muscle spasms," she says. You might have heard of the condition more recently as singer Meghan Trainor recently opened up about her experience with vaginismus and painful sex.

Vaginismus can develop after a bladder or vaginal infection or a past surgery, or it can develop as the result of trauma, anxiety, or negative feelings about sex and sexual health. These can all lead to physical symptoms, including discomfort, pain, or muscle spasms during vaginal penetration and/or the inability to have intercourse, insert a tampon, or undergo a pelvic exam, Dr. Patel explains. The good news is vaginismus treatment is possible with pelvic-floor therapy, counseling, and medication.

The number of people who experience vaginismus is significantly underreported, Dr. Patel says. People are reluctant to bring up the symptoms to their doctors, often because of feelings of confusion, embarrassment, and shame. That's compounded by the fact that vaginismus is "particularly common in those who have a negative understanding about sex or an upbringing that makes sex taboo," Dr. Patel notes. And while the condition is more common in younger people, it's possible at all ages.

Dr. Patel emphasizes that it's not normal to feel involuntary contractions, muscle spasms, sharp pain, or a burning sensation when attempting vaginal penetration. "If it happens more than once and it's impacting your sexuality, ability to have exams, or use tampons, then it's time to make an appointment and see a doctor," she says.

To diagnose vaginismus, your healthcare provider will ask about your symptoms and do a thorough medical and sexual history before performing a pelvic exam to rule out any other physical conditions (like infection, scarring, ovarian cysts, or endometriosis), according to Cleveland Clinic.

For someone with vaginismus, a pelvic exam may sound scary. But Dr. Patel says the right gynecologist — ideally someone who specializes in sexual medicine or urogynecological disorders — will talk you through every step and be as gentle as possible. "It takes a lot of experience and very careful, gentle, and detailed examination to distinguish vaginismus from other pain disorders," she says. "I don't put in the speculum first. I do an outside exam very thoroughly, and then I use a single finger very slowly to first examine the outside [vaginal] muscles, then inch by inch I examine the inside muscles."

Ultimately, an exam is worth it, as diagnosis of vaginismus can help you get proper treatment.

The condition can be caused by a variety of different factors, per Dr. Patel, including:

All of these things can cause tensing when attempting to penetrate the vagina, the same way you might flinch if you saw something coming at your face. But the vaginal tensing happens unconsciously and is often an immediate impulse that is so strong it causes pain — even if your conscious mind is not afraid and wants to have sex or use a tampon.

Vaginismus is a treatable disorder, Dr. Patel says. But there isn't one single, immediate solution. "This condition really needs a multimodal approach," she explains. Studies show that effective treatments are ones that are focused on reducing the reflex in your vaginal muscles that tense up and cause pain while also addressing any anxiety, fear, or nervousness around sex and penetration.

Pelvic physical therapy with a therapist trained in the pelvic floor can be very effective, Dr. Patel says, adding that she calls these therapists "magicians, because they're very good at what they do." A pelvic physical therapist will teach you how to calm your pelvic-floor muscles with relaxation techniques and breathing exercises to help reduce pain and minimize discomfort.

Vaginal-dilator therapy can also be helpful when performed under the guidance of a doctor or professional therapist, according to research out of the University of Iowa Hospitals and Clinics. This therapy involves placing cone-shaped dilators of increasing sizes into your vagina to help gently stretch the vaginal muscles. Just be sure to talk with an expert before using a dilator to learn proper insertion technique and effective uses.

Addressing mental barriers or anxiety around sex is also extremely important when dealing with vaginismus, Dr. Patel stresses. Cognitive behavioral therapy can help you understand how your thoughts affect your behavior, ultimately teaching you to calm your mental and physical reactions to the negative associations you may have about sex. This can be particularly helpful if you have experienced sexual trauma or assault, she says. Sex therapy or counseling with a trained sex therapist can also be beneficial for couples or individuals looking to promote trust, intimacy, and pleasure.

In addition, prescription medicines such as topical lidocaine or compound cream can also help minimize pain associated with vaginismus by blocking the signals at the nerve endings on the surrounding skin and numbing the vagina. In some cases, injections or more invasive treatments can help reduce pain and relax the muscles, Dr. Patel adds.

Bottom line: find a doctor who specializes in sexual health and listens to you and your concerns. "Unfortunately, there's still stigma about discussing sexual conditions openly, and so many women feel embarrassed to talk to their doctor about it, but I really advise women to see a specialist," Dr. Patel says. "There are so many doctors out there who want to help, but you have to go to the right one."