Vaginismus: treatment, symptoms, causes and what to expect

The NHS says treatment usually focuses on managing your feelings around vaginal penetration and exercises to gradually get you used to penetration. Treatment is initially done under the guidance of specialised therapists, and you will then usually be expected to practise some exercises at home. If you are in a relationship, you can choose to involve your partner.

The main symptom is the vaginal muscles tightening up when you try to put something in your vagina, which can cause a burning or stinging pain. The NHS says it can happen when you put in a tampon, when you try to have vaginal penetration during sex including with a finger, sex toy or penis, when you have cervical screening, or when something is put near your vagina because of fear of penetration.

The NHS adds that vaginismus does not necessarily affect your ability to get aroused or to enjoy other types of sexual contact. This matters for couples, because many people with vaginismus have a full and satisfying sex life that does not involve penetration, and treatment is about widening choice rather than imposing a goal.

The NHS defines vaginismus as when the vagina suddenly tightens up when you try to insert something into it. It stresses that this can be painful and upsetting but can be treated. The vaginal muscles tighten on their own, and the NHS describes it as an automatic reaction over which you have no control.

The NHS says vaginismus is more common in women in their late teens to early 30s, but anyone with a vagina can get it. Occasionally it can arise even if you have previously enjoyed painless penetrative sex, so it is not only a problem of first experiences.

The NHS says the reasons for vaginismus are not always clear. Things thought to cause it include anxiety or fears about having sex, a painful sexual experience, sexual assault or abuse, an unpleasant medical examination or difficult experience giving birth, believing sex is shameful or wrong, and a painful medical condition such as thrush.

Several of these causes involve fear or past experience, which is why the NHS places managing feelings about penetration at the centre of treatment. None of them means you are doing something wrong.

Pain is not always vaginismus. The NHS lists other things that can cause vaginal pain during sex: thrush, sexually transmitted infections, menopause, a bad reaction to condoms, soap or shampoo, pelvic inflammatory disease and endometriosis. A quick examination by a doctor helps rule out conditions such as infection.

If pain is deep, started recently along with discharge or bleeding, or comes with fever, see a clinician rather than assuming it is muscle tightening.

The NHS says vaginismus can happen when you have cervical screening (a smear test). The NHS cervical screening page says it is usually done by a female nurse or doctor, who will explain the test before they start, and that you are in control of the test and can ask to stop at any time.

The NHS lists things that might make the test easier: bring someone with you for support, try breathing exercises, ask the nurse or doctor to use a smaller speculum if you feel any discomfort, ask if you can put the speculum in yourself, ask about lying in a different position, and bring something to listen to or read. It adds that the test itself should take less than 5 minutes and that you can say how you feel so the nurse or doctor understands what support you need.

The NHS says you can see a GP or go to a sexual health clinic if you think you have vaginismus. The GP will ask about your symptoms and may ask to examine your vagina. You can ask to be seen by a female doctor and can bring someone you trust for support, and before the examination you can discuss ways to make it as comfortable as possible.

The examination is usually very quick, and the doctor takes a quick look to rule out other conditions like an infection. If the doctor thinks you have vaginismus, you may be referred to a specialist such as a sex therapist.

The NHS says that treatment is initially done under the guidance of specialised therapists and that you will then usually be expected to practise some of the exercises at home. If you are in a relationship, you can choose to involve your partner. Treatment moves gradually and at your pace.

If you use lubricant, the NHS vaginal dryness page suggests water-based lubricants before sex, and advises against perfumed soaps, washes and douches around the vagina.

• Tell the clinician before any examination that you have or suspect vaginismus.

• Ask for a female doctor or nurse and bring someone you trust if you wish.

• Practise any exercises at home as advised, at your own pace.

• If you are in a relationship, decide together whether and how to involve your partner.

The NHS does not give a set timescale. It describes treatment as exercises to gradually get you used to vaginal penetration, begun under the guidance of specialised therapists and then continued at home. Progress is different for each person, so ask your therapist what to expect and how progress will be reviewed.

On the NHS, a GP or sexual health clinic is the usual starting point, with referral to a specialist such as a sex therapist where available, as the NHS describes. Services and waiting times vary by area.

Some people choose a private psychosexual therapist, specialist physiotherapist or gynaecologist. Check the therapist's qualifications and professional registration, ask about the approach and the number of sessions expected, and be cautious about any programme that promises a fast cure, since the NHS describes treatment as gradual.