Vaginismus: Care built around safety and individual needs

Understanding an involuntary response

Vaginismus is associated with involuntary tightening of the muscles when vaginal entry is attempted or anticipated, and with the pain or difficulty that may accompany it. It may be noticed during sexual intercourse, when using a tampon or during a gynaecological examination. This response is not chosen consciously; it cannot be explained by the person not pushing themselves hard enough. It can also develop in someone who has previously had pain-free sexual experiences. Difficulty with vaginal penetration does not mean that the person cannot be intimate or cannot take pleasure from other kinds of touch. The details of the person’s experience are important in setting the goals of assessment and care.

Other causes of pain are also investigated

Burning or pain on entry does not always mean vaginismus. Infection, menopause-related dryness, skin irritation and other pelvic problems can cause similar complaints, and more than one cause may be present at the same time. The consultation covers where the pain is, when it began, past experiences and its effect on daily life. Why an examination is being considered and how it would be carried out should be discussed in advance. Arrangements to increase comfort and support from a trusted person can be considered. The person expressing their anxiety, asking for time to prepare for the assessment and sharing their limits makes the process easier to understand.

Physical and psychosocial care go hand in hand

Care may include explanatory information, psychosexual therapy, relaxation exercises and approaches aimed at getting to know the pelvic floor muscles. For some people, gradual exercises or vaginal trainers are considered under specialist guidance. Which method is chosen depends on the complaints, any accompanying causes and the person’s readiness. It is not appropriate to give everyone the same exercise programme. The aim is to create a process that supports a sense of safety and bodily control. If there has been a traumatic experience, the person can be referred to appropriate support without being pressed to share details. A partner becomes part of care only if the person wishes.

Progress is assessed against personal goals

The length of treatment, or the result to be expected after a certain number of sessions, is not the same for everyone. Identifying at the start which situations cause difficulty makes it possible to follow change over time more meaningfully. Less anxiety, reduced pain, being able to talk about an examination more comfortably or being able to express limits during intimacy are also important steps forward. Continuing with penetration despite pain is not a measure of progress. When increasing pain is accompanied by bleeding or unusual discharge, medical assessment should be sought without delay. The care plan is updated in line with the person’s feedback and the clinical findings. Questions can be raised openly throughout the process.