You know how your eye flinches if someone tries to poke it?

Vaginismus is like that — a vaginal flinch, so to speak. It’s an involuntary contraction, clenching, or spasm of the pelvic floor muscles that makes vaginal insertion either very difficult or downright impossible — and extremely painful.

The body is trying to protect the area, even though the person doesn’t want their muscles to react that way.

These muscle contractions are totally involuntary, NOT deliberate or intentional, and NOT within the person’s control — and sometimes not even within their conscious awareness.

Different types of insertion can trigger vaginismus in different people. Some people are triggered by insertive sex and gynecological exams but can still use a tampon without pain. Still others experience pain with ALL kinds of insertion. It’s normal to fall anywhere on this spectrum.

The pelvic floor muscles usually soften and return to their normal, relaxed state when the attempted insertion stops.

There are different degrees of vaginismus, from mild to severe.

• In milder cases, insertion is physically possible but feels TERRIBLE, like burning, stinging, or sharp, stabbing pain. It can feel like their partner is “hitting a wall” during insertive sex.
• In severe cases, insertion is completely impossible, which can be for physical reasons (extreme pain), emotional ones (extreme fear), or both.

It’s common for people experiencing vaginismus to have a sense of fear, anxiety, dread, revulsion, or general “DO NOT WANT” gut feeling associated with the thought of insertion. And sometimes this is an even bigger part of the vaginismus than the actual muscle contraction!

When vaginismus is activated, you might find that other muscle groups in the body — like the gluteals, inner thighs, and abdominal muscles — start to contract too. Your activities might be limited: for instance, if you can’t use a tampon, maybe that means you can’t swimming while you’re having your period. You also might not be able to have a routine gynecological exam or get a pap, preventing you from getting needed medical care.

Perhaps the worst part of all is that vaginismus can prevent you from having the romantic relationship and sex life you want, which can wreak havoc on a marriage or partnership. Your vaginismus might be so overwhelming that you find yourself avoiding all kinds of sexual or intimate encounters entirely.

You might start to believe that something is terribly wrong with you, that your body is broken and has betrayed them. This can lead to debilitating negative self-talk, which makes the situation worse and destroys your motivation and sense of hope that you will ever get better. 🙁

Many people who experience vaginismus feel intense shame and devastation — understandably! — and so they don’t talk about it.

I want you to know it doesn’t have to be this way. I know you desperately want to have satisfying, confident, pain-free, fulfilling sex life with your partner or spouse. You CAN get better. Vaginismus is entirely treatable.

TL;DR:

The most common, cost-effective, and successful treatment options are a combination of dilators + pelvic floor therapy. There’s often an emotional/brain-health component to vaginismus as well, which can be addressed through hypnotherapy, sex therapy, talk therapy, EMDR, energy healing, or whatever each person finds most nourishing as they start to mend their emotions and spirit.

Full answer:

To recover from vaginismus, the goal is to stop the pain and muscle spasm that happens with attempted insertion. With most cases of vaginismus, it’s necessary to treat the underlying causes.

• For some people, this will involve therapy or mindset work if emotional issues are involved.
• Others will need to address pain conditions like vestibulodynia or vulvodynia.
• Still others may not need to focus on what initially caused their problem (some may not even know their cause) and instead simply focus on relearning how to properly engage and relax the pelvic floor muscles — that is, changing the learned muscle patterns.

Learning new pelvic floor muscle patterns can be done in many different ways. The most common way is to gently insert progressively larger objects (called dilators) into the vagina so that the body and mind learn not to trigger the muscle spasm response.

Sometimes, the muscle spasm remains even after the person has worked through their anxieties and resolved any physical issues. So, learning to control, reduce, and eventually eliminate this spasm is how you fully recover from vaginismus.

Physical treatment options

Currently, the most popular treatment option with the highest success rate is using a set of dilators to learn new patterns of muscle contraction and relaxation. This helps your body and mind learn what pain-free insertion feels like and to start getting comfortable with the sensation. Dilators help you re-train your muscles, your mind, and your nervous system so that insertion no longer triggers vaginismus.

Treatment with dilators is very gentle, slow, and progressive — meaning you keep moving up in size until you either get to the end of the dilator set or you get to the size you want to stop at (for instance, the size of your partner’s penis or the toy you wish to use).

Other types of physical treatment options can include:

• Seeing a pelvic floor therapist
• Using a pelvic wand to release trigger points and adhesions in the pelvic floor muscles
• Biofeedback-assisted muscle rehab
• Using topical medication (such as lidocaine) or suppositories for muscle relaxation
• Stretches
• Movement exercises
• Botox injections (for severe cases)

Emotional & nervous-system treatment options

It’s crucial to supplement the physical treatment with tools and techniques that address the emotional health and nervous-system aspects of vaginismus. If these aren’t addressed, the physical treatment either may not work or may not last very long — in other words, it may not “stick.”

To address the emotional component of vaginismus, treatment options can include:

• Talk therapy
• Sex therapy
• Hypnotherapy
• EMDR
• Brainspotting
• Time Line Therapy®
• Neurolinguistic programming (NLP)
• Sound therapy
• Movement therapy
• Energy healing
• Relaxation exercises (yoga, qi gong)

These tools are essential for down-training the nervous system (that is, learning to fully relax, have a deep sense of internal calm, and not feel constantly on edge), discovering the root cause of the issue, untangling your limiting beliefs, stopping your critical self-talk, staying motivated, and healing your broken spirit. This is why I’m also a certified Hypnotherapist, Time Line Therapy® Practitioner, NLP Practitioner & Coach, EFT (Emotional Freedom Technique, aka “tapping”) Practitioner, and Reiki Master.

• Primary vaginismus is when you’ve experienced vaginismus for your whole life, including when trying to use tampons or getting gynecological exams. In this case, insertion has always been painful, and there’s never been a time it wasn’t.
• Secondary vaginismus is when you previously had pain-free vaginal insertion at some point in your life, and vaginismus showed up later.

Not necessarily. Painful insertion can be caused by any number of factors (see the question immediately below for examples). Vaginismus isn’t even the most common of these!

Often, painful insertion due to other causes may lead to vaginismus — so even if you do have vaginismus, you may have another underlying primary cause of pain.

The most common causes of chronic painful insertion (or attempts at insertion) are vulvodynia or vestibulodynia.

• Vaginismus is painful vaginal insertion caused by involuntary spasm of the pelvic floor muscles.
• Vulvodynia is pain and increased sensitivity on, in, or around the vulva, including the labia, clitoris, perineum, etc. The location and severity vary by person.
• Vestibulodynia is a subtype of vulvodynia that shows up specifically in, on, or around the vaginal opening or the vestibule (area of skin between the vaginal opening and the urethra).

Vulvodynia and vestibulodynia are both examples of vulvar pain, and in some cases, they may lead to vaginismus. They can occur at any age and typically show up with no visible symptoms. They can be essential (which means the pain is constant) or provoked (which means the pain only arises when touched).

It shouldn’t hurt to gently touch any part of your vulva. If it does, you should see a doctor and look into the possibility of a vulvar pain condition. Vulvar pain is extremely common but rarely diagnosed. Vulvar pain is often misdiagnosed as (or alongside) vaginismus.

Many gynecologists unfortunately do not widely understand, recognize, or test for vulvar pain. The test simply involves using a moistened Q-tip to gently touch certain areas (corresponding to your vestibular glands) and seeing if you feel any pain. Sometimes the doctor will take a culture of your vestibular microbiome.

Some of the causes of vulvar pain can include an overgrowth of nerves, increased sensitivity of nerve endings, skin changes (e.g., lichen sclerosis) hormonal changes, overactive pelvic floor muscles, infections, allergies, physical irritation, and more.

Treatment can include dilators, pelvic floor therapy, creams, muscle relaxants, behavioral/technique changes, and more.

A little history note: Until about 2013/2014, the medical establishment widely referred to vulvodynia and vestibulodynia collectively as “vulvar vestibulitis syndrome (VVS)” or even just “vestibulitis” for short. Vestibulitis means “inflammation of the vestibule,” with the suffix “-itis” indicating inflammation. However, there’s often no inflammation present, so “vestibulitis” was recognized as a bit of a misnomer. Now the medical establishment recognizes the condition as vulvodynia or vestibulodynia.

This might happen for a few reasons. Remember, though, that you don’t need a diagnosis in order to begin treatment and start feeling better.

First, some doctors are hesitant to give a formal diagnosis of vaginismus unless all four of these elements are present:

1. Painful vaginal insertion…
   
2. Caused by involuntary pelvic floor muscle contractions…
   
3. Coupled with an unconscious fear-avoidance response from the nervous system…
   
4. Which has lasted for at least three months.

Notably, the official medical pathology name of the condition is GPPPD, genito-pelvic pain/penetration disorder — but we still call it “vaginismus” conversationally. Both terms refer to the same condition.

The second factor to consider is that some people feel safe and comfortable in medical settings, and so their vaginismus might not show up during a gynecological exam. Unless the hallmark of vaginismus — that involuntary pelvic floor muscle spasm — happens during your exam, your doctor might not have noticed anything amiss or unusual.

Third, your doctor may simply not know much about vaginismus and therefore wasn’t able to identify or diagnose it even though you presented with it during your appointment. See the question below for more information on this aspect.

First, I’m so sorry that happened and that your doctor didn’t take you seriously. You deserve better care than that.

Unfortunately, many gynecologists and urologists, and especially doctors in other fields (family doctors, GPs, etc.), do not understand vaginismus because medical schools do not teach it as part of the curriculum. And if doctors don’t encounter it in an actual living, breathing patient during their residency, they may very likely go into medical practice never having learned about vaginismus or the different treatment options.

So unless your doctor has:

• Experienced vaginismus themselves
• Personally known someone with it
• Seen patients who have had it
• Done extra training and/or taken it upon themselves to learn about it

…they may not even know it exists.

They aren’t intentionally trying to gaslight you or deny you the care you need; they’re just doing the best they can with the information they have, which is likely super limited when it comes to vaginismus. 🙁

Basically, they don’t know enough about it to provide the kind of compassionate care you need.

Fortunately, this is changing with newer doctors, who are generally more informed than their predecessors about psychosexual (mind-body) conditions and overall healthcare needs for people with vulvas.

Doctors do incredible, life-saving work and deserve our gratitude and respect. But it’s important to recognize that they are human beings, just like the rest of us. They aren’t encyclopedias and do not necessarily know everything about every possible medical condition. Sometimes they get it wrong or respond in a way that is unhelpful, hurtful, or even traumatic for the patient.

Remember: you always have the option to switch doctors or get a second (or third, or fourth) opinion. It’s okay to call around and ask if the clinicians at a certain medical practice specialize in vaginismus or other types of pelvic pain or sexual dysfunction. If they don’t, ask they can provide a recommendation or referral.

Honestly, it’s different for each person. Some people find that their vaginismus gets better after being pregnant and giving birth; for others, it stays the same or even gets worse.

Additionally, there’s no way to predict ahead of time how the birth will go and whether the baby will pass through the canal (and thus through the opening in the pelvic floor muscles) or through an abdominal incision.

For these reasons, childbirth is not a “cure” for vaginismus, nor is it viewed as a viable or reliable treatment option.

Botox is fantastic for some people but not for everyone. The vast majority of people do NOT need Botox to overcome vaginismus. It is not a “magic bullet” cure, and it is definitely not the first step we turn to as pelvic therapists when creating a treatment plan. 

That said, it can be a great option for more severe cases of vaginismus, when people have tried everything else — dilators, pelvic therapy, pelvic wands, sex therapy, etc. — but nothing has worked!

Botox is an injection containing botulinum toxin, which essentially “turns off” the muscles and prevents them from contracting. With vaginismus, Botox is injected directly into the pelvic floor muscles while the patient is under anesthesia. It costs $5,000-8,000 (USD) and is not covered by insurance. The effects typically last three months.

The main benefit of Botox is that it’s like a “hard reset” of the brain-pain connection. It allows people to have pain-free insertion right away. But, they still need to do the physical work (dilators, wand, pelvic therapy) to lengthen the muscles and release restrictions in the fascia.

I do not perform Botox injections but will be glad to help you find resources if this is something that is right for you.

Your partner may not be interested in having insertive sex right now — which is their right, because it’s their body. Start exploring other forms of intimacy and sex.

Sex means so many different things to different people. It does not mean “only intercourse, where a penis is inserted into another person’s body” — that’s probably what you learned as a kid, but it’s important to recognize that that’s a myth created by sociocultural narratives that prioritize cisgender male pleasure. Now that you’re an adult, it’s time to start expanding and evolving your thinking around sex. As a first step, I recommend you check out the “What’s Sex?” article over at Scarleteen.

It’s wonderful that you want to help your partner. To this aim, please try to let go of your own expectations around this. Your partner’s pain is NOT about you, and they are NOT rejecting you. There may be deeper issues that your partner doesn’t feel comfortable addressing (or may not even be consciously aware of), and pushing them to resolve their physical pain so that you can resume insertive sex will only make things worse.

If you are in the United States, I strongly encourage you to find an AASECT-certified sex therapist who sees couples and specializes in pain with sex. You can locate one through the AASECT directory at https://www.aasect.org/.

If you’re not in the U.S., please try to find a sex therapist who is certified in your country or region.

A sex therapist is the professional who is best qualified to help you work through these issues, as most psychologists and marriage therapists have never worked with sexual pain (unless they specifically say they do). A sex therapist will give you a path forward and will let you know if you would each benefit from individual therapy as well.

After these issues get resolved, then your partner can decide if they want to try dilators or other ways to overcome vaginismus. Regardless, the emotional, sexual, and relationship issues need to be addressed first.

Yep! Although I am a pelvic therapist and have worked with a variety of different pelvic conditions, vaginismus is my area of expertise — including other pelvic issues that commonly arise alongside vaginismus, like chronic constipation, difficulty fully emptying the bladder, trigger points in surrounding muscle groups, and more. I’m happy to advise you on these topics during your session!

Not at this time. Here’s why:

• In the U.S., insurance companies are financially incentivized to deny you coverage, so they create an intentionally complicated, confusing “obstacle course” that you are forced to navigate as a health consumer. If you don’t properly jump through those hoops, they will deny payment, even for services they claim are covered.
• Second, insurance plans have a limited, preset number of appointments they are willing to pay for — usually 6-8. That number is determined in negotiations between your employer’s HR department and the broker working for the insurance company, neither of whom are medical providers. Their decision is based purely on profits and has zero to do with your diagnosis or the care you actually need in order to recover.
• The same concept goes for the appointment length. Insurance companies limit individual sessions to 45-50 minutes. My clients often benefit from longer sessions based on the severity of their symptoms and their current progress. Have you ever been in an appointment and felt like you finally got into a good healing space with only five minutes left? That’s happened to me too! You deserve to NOT be shortchanged just because insurance won’t pay for a 60, 90, or 120-minute session.

I’m on your side in your recovery, and I want you to have the tools, time, and freedom to follow the path that honors your own unique healing journey — not some insurance company’s arbitrary window of time they’ve determined is best for their profits rather than your recovery.

Not necessarily. However, as a first step, you should see a physician, midwife, or other medical doctor for an in-person exam to rule out other possible causes of painful insertion, like vulvodynia, endometriosis, skin conditions, cysts, fibroids, or variations in anatomical structures (such as with the labia, hymen, cervix, etc.). If you have one of these other issues, vaginismus treatment may not help you because a different underlying condition is what’s causing your pain. When you have a session with me, I can share some common signs of these issues, but just know that I can’t give you a diagnosis.

That said, I realize it’s not always possible to get a diagnosis based on cost, location, insurance, accessibility, doctor availability/knowledge, and many other factors. I’m also an advocate for challenging the ways in which the medical industrial complex makes it difficult for marginalized folx to obtain not just diagnoses but even a baseline of compassionate, informed medical care.

Perhaps there’s only one gynecologist in your town, and maybe they have never heard of vaginismus. Maybe you went in for an appointment, bravely advocated for yourself, and had to explain vaginismus TO the doctor. But perhaps they brushed you off, unhelpfully told you to “drink a glass of wine and use more lube,” and refused to give you a diagnosis. Ugh!

These kinds of frustrating situations unfortunately do sometimes happen with doctors. But I never want that to stop you from healing. You can (and should!) absolutely still seek treatment and a full recovery even if you don’t have a formal diagnosis in hand.

My clients are incredibly smart, resourceful people and have typically spent hundreds of hours researching, scouring medical sources, and talking to healthcare professionals as they try to figure out what is happening in their body that makes insertion so painful. I want you to know that, as a person who has professional training and certification in this area AND subscribes to radical healing culture, I validate your self-diagnosis and your lived experience.

In short: A diagnosis is helpful but not necessary to work with me. If your doctor won’t give you a diagnosis of vaginismus, they at least need to do a physical exam and tell you that they “can’t find anything.”

In the absence of being able to see a doctor at all, I request that you do your research and come to me 99% sure that what you’re experiencing is vaginismus and NOT another pelvic pain condition. I’ll help you figure out your next steps.

No — for a few reasons, and certainly not if you don’t want to.

First, we may not even get to the point of doing dilator work right away because there’s so much I want to hear from you about your unique situation, including your emotional health, how you feel about your relationship, how your menstrual cycles have been, and more.

Second, there are so many external muscle groups and regions we need to assess first. Because of the way trigger-point pain works, we can address a LOT of pelvic pain just by working with external muscle groups. I will show you specific exercises, tools, and techniques to relieve these trigger points in the comfort of your own home. (This is one of the benefits of me being an LMT in addition to a pelvic therapist!)

Third, if you’re scared about starting to use dilators, I want to reassure you that I will NEVER hurry you to do something you aren’t ready for. We will always go at the pace you are most comfortable with.

Check their credentials, training, and experience. There are a few other vaginismus guides out there, but they either (1) aren’t licensed healthcare providers and are certainly not pelvic therapists, or (2) haven’t experienced vaginismus in their own body. Some guides have more training than others, and that matters because vaginismus is a medical condition.

Being a pelvic therapist means I have the training, licensure, and professional scope to develop treatment plans, perform internal pelvic floor manual therapy, address related pelvic health issues, and collaborate with doctors and therapists.

Additionally, I’m the only vaginismus expert in the entire world who’s also an LMT and Board-Certified Hypnotherapist, Time Line Therapy^® Practitioner, Neurolinguistic Programming (NLP) Coach, and Reiki Master. These certifications demonstrate my commitment to providing my clients with holistic tools and techniques to soothe the mind-body connection and facilitate rapid, transformational healing in the unconscious mind — to supplement the physical treatment!

I’m also the only vaginismus expert who:

• Uses a trauma-informed approach
• Is a HAES^® registered provider
• Is trained in LGBTQIA+ care
• Incorporates gender affirmation into every level of my practice

What’s more, I’ve recovered from vaginismus myself, so I have the wisdom of personal experience in this exact area. Your frustrations, hopes, triumphs, tribulations? I know those, because I’ve lived them, too!

That combination is about as close to a golden ticket as you can get. 😉

No, I am not a physical therapist (PT). I’m a Licensed Massage Therapist (LMT) located in Oregon, where it’s legally in scope for LMTs to perform internal pelvic-floor manual therapy¹, provided that specialized clinical training has been completed in this field — which I have, of course, in spades!

I’m certified in both Integrative Pelvic Bodywork and Holistic Pelvic Care™, and I have completed hundreds of hours of training in evidence-based pelvic floor diagnostics, treatment, and rehabilitation — more than many pelvic PTs have, in fact. I’ve trained with some of the biggest and most respected names in pelvic physical therapy, as well as several local doctors specializing in pelvic floor conditions. See my credentials for details.

Like some (but not all) pelvic PTs, I use a biopsychosocial approach to treatment. I also use the same assessments, outcome measures, manual techniques, and home programs that pelvic PTs use. Some clients see a PT in addition to working with me, and my licensure enables me to collaborate with these providers on treatment planning. And, lastly, just like a PT, what remains outside my scope of practice is diagnosing pathologies and prescribing medications, so I refer out to medical doctors for those.

1. Per Oregon statutes OAR 334-010-0029 and ORS 687.121.

YES! I am delighted to work with folx who identify as nonbinary, trans, or any or no gender at all, regardless of anatomy.

I do not do work with:

• Anyone under 18 years of age without written parent/guardian permission.
• People who are not committed to doing their homework and/or who are not interested in getting better.
• People who are experiencing active PTSD, substance addictions, major mood or personality disorders, or excessively high levels of distress. If this is you, please reach out to a licensed mental health provider first. After you begin working with them, you and I can start working together as well. Because of the topics we delve into in vaginismus recovery, you need to already have some healthy coping skills and a baseline level of awareness about your history, trauma, and triggers.

I am not a psychotherapist and do not offer psychotherapy. Although I have many tools and certifications to help you with emotional healing, these are not substitutes for psychotherapy. I offer manual therapy for the pelvic floor and virtual coaching to help you recover from vaginismus and related pelvic pain conditions. Some clients see a therapist or counselor in addition to working with me.

I will NEVER recommend weight loss, restrictive eating, or dieting to my clients. I know how triggering “diet talk” can be, so I actually have a policy on it. What I do like to talk about are ways we can foster love and acceptance for the bodies we’re in!

During your session, we might talk about ways you find joyful movement, or various sources of fiber or vitamins that support pelvic health; but it will never be in the context of weight loss or scrutiny of your food choices.

I am a student of Lindo Bacon, Evelyn Tribole, and Christy Harrison — I follow a Health At Every Size (HAES^®) approach in my work, and I support intuitive eating and body liberation principles. Proudly listed on the HAES Provider Registry, my practice is fat-positive and size-inclusive.

If possible, try to wear stretchy/loose clothing that will move with you. Yoga clothes, loungewear, or activewear are all fantastic! I often do therapeutic movement and muscle-energy techniques with my clients, which are easier if you’re wearing stretchy or loose clothing.