What is Vaginismus? A Comprehensive Guide
Authored by the Bodyful Physical Therapy and Wellness Team
Are You Looking for Vaginismus Treatment?
Do you experience pain with sex that feels like hitting a wall during penetration?
Does penetration feel impossible, sharply painful, or abruptly blocked—like something stops it?
You are not alone.
In this blog, you’ll learn:
What vaginismus is
The difference between primary and secondary vaginismus
Common causes, including trauma and endometriosis and vaginismus
What effective, compassionate vaginismus treatment can look like
What Is Vaginismus?
Vaginismus can affect anyone with a vulva. It commonly shows up during:
Vaginal sexual intercourse
Pelvic exams
Tampon or menstrual cup use
Vaginismus involves involuntary tensing of the pelvic floor muscles in anticipation of vaginal penetration. Because the pelvic floor muscles must lengthen and soften for penetration, this reflexive tightening in response to fear can make penetration painful—or feel impossible.
Many people describe it as:
“It feels like he’s hitting something”
“It feels like a wall”
“My body won’t let anything in”
Vaginismus deserves care and attention. You deserve access to pain-free intimacy, pleasure, autonomy, and choice—whether for connection, exploration, or family planning.
Vaginismus Is Not Only About Sex
The pelvic floor tightening associated with vaginismus can also affect:
Gynecological exams
Cervical screenings
Finger penetration
This can create barriers to routine healthcare and deepen feelings of fear, shame, or frustration.
Research and clinical experience continue to show that physical symptoms cannot be fully separated from emotional, psychological, and nervous system experiences. While physical therapists are trained to diagnose and treat muscles and fascia, your story, medical history, trauma exposure, and sense of safety all influence whether those muscles can release and receive.
How the Nervous System Plays a Role
When you are anxious, stressed, or afraid your chest and shoulders often tense and your ribs lift and pull forward. This limits how fully your respiratory diaphragm can move.
When breathing becomes shallow or restricted—even for short periods—the pelvic floor receives less rhythmic movement and pressure variation. Over time, this lack of movement can contribute to stiffness, guarding, and heightened sensitivity in the pelvic floor muscles.
Vaginismus has been described in the research as a reflexive protective response:
“Vaginismus may be a phobic reflexive response to protect the individual against actual, perceived, or anticipated harm from vaginal penetration.”
If fear, trauma, or stress are not addressed, stretching exercises or vaginal dilators alone may not feel accessible or resourceful enough.
Vaginismus vs. Dyspareunia
Vaginismus is distinct from dyspareunia, though they can overlap.
Dyspareunia often has a more acute physiological origin (surgery, childbirth injury, infection, inflammation).
People with dyspareunia may still attempt penetration despite pain.
People with vaginismus often experience avoidance driven by fear, anticipation, or involuntary muscle guarding.
Chronic pelvic pain conditions—such as endometriosis, interstitial cystitis, or recurrent infections—can increase pelvic floor tension over time. In these cases, vaginismus may develop secondarily as the body learns to protect itself from ongoing pain.
Anxiety-proneness has been identified as a risk factor for vaginismus (Watts & Nettle, 2010).
Types of Vaginismus
Primary Vaginismus
Present from the first attempt at vaginal penetration
Tampon use or pelvic exams may never have been possible
Secondary Vaginismus
Develops after a period of previously pain-free penetration
Often associated with trauma, injury, surgery, childbirth, inflammation, or chronic pelvic pain
Both forms are real. Both are treatable.
Common Symptoms of Vaginismus
You might notice:
Involuntary tightening of the pelvic floor, glutes, abdomen, or inner thighs
Fear or dread around penetration
Pain that feels like pressure, burning, stabbing, or “hitting a wall”
A ring-like squeezing sensation at the vaginal opening
Lingering soreness after penetration attempts
You may also experience:
Constipation or straining
Urinary urgency, frequency, incomplete emptying, or leakage
These symptoms often reflect pelvic floor muscles that are chronically tense and over-recruited.
The Emotional Impact of Vaginismus
Vaginismus can deeply affect:
Sexual intimacy
Fertility planning
Self-trust and body confidence
Feelings of shame, guilt, isolation, or frustration are common—but vaginismus is more common than most people realize. Silence often intensifies pain. Support and attuned care can be profoundly relieving.
Vaginismus Treatment Options
Effective vaginismus treatment is integrated and individualized. Options may include:
Education about vulvovaginal anatomy and pelvic floor function
Pelvic floor muscle relaxation training
EMG or ultrasound biofeedback
Vaginal trainers (you may have heard of dilators for dyspareunia) or gentle, gradual finger penetration practices
Gradual, paced exposure and desensitization
Somatic psychotherapy or sex therapy
Pharmacological treatments have limited evidence. Botulinum toxin injections are being explored but remain controversial and not first-line.
How Somatic Pelvic Floor Physical Therapy Helps
Somatic pelvic floor therapy emphasizes:
Pacing that honors the pace of your nervous system
Choice, consent, and agency
Learning to listen to and discern your body’s cues
Treatment often begins outside the pelvis, working with:
Breath support and diaphragm strengthening
Abdomen
Inner thighs and hips
Posture training and movement patterns
This helps establish safety and supports your pelvic health before gradually approaching vaginal work—if and when you choose.
Visceral fascial mobilization may also support breath coordination, core support, and pelvic floor integration.
What Vaginal Trainer (Dilator) Practice Can Look Like
If trainers are part of your care:
You may start with the smallest size—or your own finger
Practice is paired with slow, calming breath
Gentle movement, sound, and sensory exploration are encouraged
The goal is new experiences of safety, not forcing progress
Partners may be included in care if desired. Sex therapy can be a valuable adjunct.
This practice is also easy to train you virtually.
Where to Seek Support
Trauma-informed or phobia treatment psychotherapy
Sex therapy (individual or partnered)
Pelvic floor physical therapy
Community movement practices that support embodiment
A Closing Reflection
Vaginismus is not a failure of your body.
It is a communication.
With the right support, your body can learn new responses, new meanings, and new possibilities.
References
Chalmers KJ. Clinical assessment and management of vaginismus. Aust J Gen Pract. 2024 Jan-Feb;53(1-2):37-41. doi: 10.31128/AJGP/06-23-6870. PMID: 38316477.
Maria McEvoy, Rosaleen McElvaney & Rita Glover (2024) Understanding vaginismus: a biopsychosocial perspective, Sexual and Relationship Therapy, 39:3, 680-701, DOI: 10.1080/14681994.2021.2007233.
Raveendran AV, Rajini P. Vaginismus: Diagnostic Challenges and Proposed Diagnostic Criteria. Balkan Med J. 2024 Jan 3;41(1):80-82. doi: 10.4274/balkanmedj.galenos.2023.2022-9-62. PMID: 38173226; PMCID: PMC10767778.
