The Association of Minimally Invasive Gynecologic Surgeons
…dedicated to safe, state-of-the-art surgery and health life-styles for women of all ages
R. Wayne Whitted MD, MPH
Paul A. Pietro MD
8740 N Kendall Dr. Suite 101
Miami, Florida 33176
Phone: 305-596-3744
Understanding Vaginismus
Vaginismus affects hundreds of thousands of women from every different background. Poorly understood and rarely
discussed even within the medical community, vaginismus causes many women to suffer in silence with great difficulty
obtaining a proper diagnosis or correct treatment. The pain, anxiety, isolation, stress, low self-esteem, and marital
discord that often results from this frustrating sexual problem can feel overwhelming.
The good news is that vaginismus is treatable, in fact self-treatable. Informed health care professionals generally
agree that a full recovery from vaginismus can be expected with proper understanding and a well
adhered to treatment program. Successful vaginismus treatment does not require drugs, surgery, hypnosis, nor any
other complex invasive technique. Following a straight-forward program, pain-free and pleasurable intercourse is
attainable for most couples.
The information we have gathered here can speed you in your efforts to resolve this painful condition and move on to
a fulfilling life free of vaginismus. This web site was specifically designed to provide women, their partners, and health
care professionals with quality information on all aspects of vaginismus and access to the resources used to overcome
Vaginismus Stories
"I can't have sex…"
"Sex seems incredibly painful and virtually impossible…"
"My vagina seems too small…"
I feel like a failure. Why can't I have sex? The worst part is how it has affected my relationship with Dave, my
husband of over four years. I have never been able to let him inside me and yet I so desire to be close in that way and
to return his love. The fear of being molested so many years ago keeps surfacing. Could this be the problem? I have
unhealthy thoughts about myself and feel trapped. My mom teases and
pressures me about starting a family, but how can I even get pregnant?
We were both virgins and waited until marriage to have intercourse. But on our honeymoon we were surprised and
disappointed to find that we could just not seem to consummate. I had always suspected that my vagina was too
small, because I could never insert a tampon (no matter how hard I tried). A trip to my doctor was so embarrassing.
She callously told me that I just needed to try harder. We have now tried countless times, yet any attempt to push the
penis inside fails and causes burning pain. It just does not seem to fit. Nothing that I have read about sex says
anything about this. What can I do?
I am excited about a new guy in my life. I would just love to develop a closer relationship with him. Yet, I wonder why
any man would want me when I can't even have sex. My last boyfriend got tired of waiting around and left. That was
three years ago. Should I take another chance? How and when should I tell him about the vaginismus? I just do not
know if I could handle the pain and rejection of another broken relationship. Sometimes it just seems easier to be
We enjoyed a normal sex life until after complications arising from pelvic surgery. After I had healed, my husband was
no longer able to penetrate. It was almost as though there was a wall where the opening had been. I would hurt
whenever we tried, even though the doctors said there was no longer anything physically wrong. A specialist
suggested that I might have vaginismus, an involuntary subconscious reflex that causes the muscles around my
vagina to go into spasm whenever intercourse is attempted. Can this be treated or am I destined to be this way
I am a twenty-eight-year-old married teacher, yet I still feel like a child. My high school students are always talking
about how great sex is. I get angry and wonder why they are able to have sex so easily. They're just sleeping around
and don't even care about each other. It's not fair that it's so hard for me. My husband does not understand my pain,
and I think he might leave me if I do not get help soon. There is this huge disappointment in our lives, and so far we
have been unable to share it with anyone.
We have been in counseling for three years trying to find out why Diana cannot seem to have intercourse. We are
emotionally exhausted and financially strapped. It feels like all we do is "talk, talk, talk" while our lives are passing us
by. Sex still is not happening and I question our future together, though we love and care for each other deeply. We
wonder if there is something physically wrong, yet the doctor ruled out any problem. The counselor thinks something
in Diana's clouded past is causing the condition but cannot seem to draw it out. We try hard to maintain a cheery
disposition and keep up appearances that everything is fine, but it is not.
What is Vaginismus?
Vaginismus is an involuntary contraction of the muscles surrounding the entrance to the vagina, making penetration
impossible and/or painful. The primary muscle group involved is called the pubococcygeus (PC) muscle group.
On the left, you can see in vaginismus how the PC muscle group spasms, tightly closing the vaginal entrance. On
the right, the PC muscle group is not in spasm - the vaginal opening potentially accommodates a man's penis.
The involuntary vaginal reflex can be triggered by attempts at intercourse with the entry or approach of a penis to the
vagina and/or by the approach of other objects such as a tampon, a doctor's finger, or even your own fingers. The
spasms constrict the vaginal opening making it virtually impossible to have entry. When tightened, attempts to insert
anything into the vagina are painful and uncomfortable. There can also be related spasms in other body muscle groups
and even halted breathing. Generally, when the attempt to put something in the vagina has ended, the muscles relax
and return to normal.
The severity of vaginismus varies from woman to woman. Some are able to insert a tampon and complete a
gynecological exam but are unable to insert a penis. Others are unable to insert anything into their vagina.
Vaginismus is NOT due to a physical abnormality of the genitals. Some women wonder if their vagina is too small to fit
a penis in or perhaps they have no vaginal hole at all and that is why sex is so difficult. This is understandable
especially when the vaginal muscles are in spasm as they can give the appearance that the opening is non-existent.
These concerns, however, are erroneous as the genital area is completely normal.
In addition to vaginismus, there are a number of other disorders (e.g. vulvar vestibulitis, pelvic inflammatory disease,
etc.) that can result in sexual pain. It is important that a reliable diagnosis is obtained so that the appropriate
treatment can be recommended.
Why is this Happening?
Sexual intercourse is an activity that involves many complex conditioned responses. When everything is in harmony
with your spouse, your bodies can almost go into autopilot. You can experience deep pleasure as your bodies dance
and react together. However, couples do not start with bodies that are highly coordinated skilled reactors to sexual
activity. They learn how to have successful sexual intercourse through experience and interaction. The nervous system
and musculature learns and remembers what feels good, what works, and what is uncomfortable.
With vaginismus, the process of your body learning how to have successful intercourse is cut short when your PC
muscle group does the unthinkable: It prevents the entry of your partner's penis.
In the vaginismus condition, as the man approaches the woman, her PC muscle group (darkly shaded) goes into
spasm and tightly closes the vaginal entrance making intercourse painfully impossible.
Your body is a buzz of activity during sexual contact. Normally, the transition to intercourse becomes more
pleasurable after the first few experiences. The mind and body allow entry and learn to anticipate intercourse
positively. Healthy messages result and they generate arousal in anticipation of intercourse.
In a woman with vaginismus, the mind and body never get the chance to be trained through positive intercourse
experiences. Negative sexual messages vary widely among women, but in those with vaginismus, the messages are
sufficient to trigger this conditioned reflex response in the PC muscle group. Intercourse is impossible and the only
training the muscles receive is when they learn that any attempt is painful. This in effect develops into a 'muscle
memory'. With the absence of any direct conscious control on your part, the nerves controlling your PC muscle group
interpret the messages as a call to spasm and tightly constrict to brace, hold, protect, or react to the onset of
potential penetration. Furthermore, this conditioned reflex continues to happen every time that there is a potential for
vaginal penetration.
The effect of this tight squeezing of your PC muscle group is that your partner is unable to enter you through your
tightened vaginal entrance, and the attempt gives the feedback of pain and discomfort. This can further reinforce the
conditioned reflex as your PC muscles essentially learn ,See, it is good to tighten up when this happens because it is
uncomfortable and painful. We want to protect ourselves from pain and discomfort.
When this happens, your conscious mind may be trying hard to consummate and receive your spouse vaginally as you
think ,I want to have sexual intercourse with him,, but your muscles act rebelliously, and refuse to allow entry. This is
extremely frustrating. For the aroused man it is like running into a brick wall. For the woman it is like her body is no
longer under her control.
PC Muscles Explained
When your friend acts like your enemy...
Surrounding the entrance of the vagina are the very powerful PC (pubococcygeus) muscles. The PC muscle group has
a key role in the function of your reproductive system, urinary tract, and bowels. These muscles enable you to urinate,
have intercourse, orgasm, have bowel movements, and deliver babies. Hence, they are also sometimes referred to as
love muscles, vaginal muscles, or pelvic floor muscles. These muscles encircle the urinary opening, vagina, and anus
in a 'figure eight' pattern as shown below in the simplified anatomy diagram. One loop of muscles surround the vaginal
area and the other loop surround the anal area. On each end, the muscles are attached to the skeleton and support
and hold in place the abdominal and pelvic organs like a net.
The anatomy of the female pelvic floor area highlights the internal muscles called the pubococcygeus or PC
muscle group. This is the muscle group going into involuntary spasm when vaginismus is experienced. The
powerful muscle group encircles the entire vaginal area and the anus.
Never fully relaxed, but always partially contracted, the PC muscles are ready to spring into action the moment they
sense the need. They can powerfully tighten without you even being aware. For example, they enable you to retain
urine and control your bowel movements without you thinking about it until a convenient time. In vaginismus, during
attempted penetration, the PC muscles tighten involuntarily, without conscious thought, and close off your vaginal
opening. This tightening is what makes intercourse unachievable.
Retraining your PC muscle group to respond differently to the anticipation of intercourse is key to the successful
treatment of vaginismus. The process of learning to take conscious control of this muscle group, will systematically
change the conditioned reflex so that spasms no longer occur. At the same time, you will be retraining other related
organs and your subconscious mind so that they will eventually send out different messages when intercourse is
attempted (modifying muscle memories).
What Causes Vaginismus?
For most women, vaginismus comes as a complete surprise. This is due to the involuntary tightening of the muscles in
the vagina. These muscles are tightening independently and are not under the conscious control of the woman.
Women with vaginismus are sexually responsive and deeply desire to make love. It is extremely frustrating to not be
able to engage in pleasurable sexual intercourse.
Why do some women's bodies react this way? What causes this? Generally, there are a variety of sexually unhealthy
messages, both from the body and the mind that may be interpreted by the PC muscle group and result in the reflex
spasm. Negative messages may stem from a wide variety of factors such as:
past sexual abuse
exposure as a child to shocking sexual imagery
violence in the home
painful intercourse as a result of a medical/physical condition
overly strict or unbalanced religious teaching in the home
rigid parenting
inadequate sex education
no known experience
(This list is in no particular order and is by no means exhaustive. The Completely Overcome Vaginismus program
contains a much more extensive list.)
Frequently, there are deep-seated subconscious negative feelings such as anxiety or fear associated with vaginal
penetration. The vaginal PC muscles, as they contract, are in effect often acting as a protective mechanism against
penetration. Typically, the negative feelings that are resulting in the vaginismus are not readily apparent and require
some exploration. In some women, the cause never becomes completely understood. Fortunately, it is not always
necessary to know the cause to overcome vaginismus.
You may wonder why some of these factors trigger a condition of vaginismus in some women but not in others. No
one really knows the answer to that question. Responses to life experiences vary dramatically from person to person.
The Completely Overcome Vaginismus program advocates a balanced approach to confronting and overcoming any of
the sexually unhealthy messages that may be consciously or unconsciously having an influence on the PC muscles.
The treatment process does involve self-exploration but only to the extent that you acknowledge any obvious pain or
emotions that you can with quiet concentration recall.
Vaginismus Diagnosis
It can be really difficult for a woman who is experiencing painful sex to seek help. Sharing this most intimate of
personal information, even with a physician/gynecologist, can be terrifying. However, it is very important to rule out
any medical/physical conditions that may be preventing intercourse and properly confirm the vaginismus condition so
that the correct treatment plan can be designed.
You may want to consider asking your physician if she/he is familiar and experienced with treating vaginismus before
you are examined. Gynecological exams can be difficult for a woman with vaginismus. The exam itself can sometimes
trigger spasms making it challenging for the physician to complete the exam. A physician who is familiar with the
condition will be more suited to providing a comfortable and sensitive environment.
If you are not comfortable with your current physician or do not have one, ask a friend or co-worker for a
recommendation. Often women tend to feel more comfortable expressing themselves and being examined by female
health care professionals. A good physician or specialist, who is knowledgeable about vaginismus, can be a great ally
in your road to recovery.
There are many dangers in being given an improper diagnosis from an uninformed professional. Unnecessary,
invasive, and potentially harmful surgeries and medications have been suggested for women with vaginismus who
have been misdiagnosed. However, in most cases, women with vaginismus are simply left undiagnosed and turned
away by physicians who see nothing physically wrong, fail to give due attention to the woman's concerns, and do not
consider a diagnosis of vaginismus. If you are not satisfied with the results of your examination, seek a second
Once your diagnosis is confirmed, counseling or sex therapy can be helpful. Support from a knowledgeable, skillful,
and compassionate therapist is not to be underestimated and can greatly speed the recovery process.
Types of Vaginismus
We define Vaginismus to be an involuntary contraction of the muscles surrounding the entrance to the vagina, making
penetration impossible and/or painful. The primary muscle group involved is called the pubococcygeus or PC muscle
Besides this basic definition, however, physicians and therapists may use a variety of more specific terms referring to
vaginismus such as:
Primary Vaginismus
Occurs when a woman has never, at any time, been able to have pain free sexual intercourse due to the PC muscle
spasm. The vaginismus condition becomes evident during initial attempts at sexual penetration or gynecological
examination and continues to persist.
Secondary Vaginismus
Occurs when a woman who had previously enjoyed sexual intercourse without pain, develops the vaginismus condition
later, possibly following some trauma or surgery. She is no longer able to have intercourse, even though the physical
concerns have been resolved.
Is a general term that refers to a condition where one is unable to have sexual intercourse. Vaginismus is one type of
Is a general term that refers to a condition where there is pain during sexual intercourse. Typically, this is due to a
physical or medical condition. In some cases this can lead to secondary vaginismus when, even after the diminishment
or healing of the physical condition that previously caused the pain, the woman's subconscious mind and body
continue to anticipate pain and resist intercourse by tightening the PC muscles.
Please note that if you have dyspareunia with no accompanying vaginismus (purely a physical or medical problem),
the Completely Overcome Vaginismus program may not be appropriate.
A physician's care is highly recommended if you have a medical condition that may be associated with your
Treatment Process
We advocate the involvement of your partner and informed health care professionals throughout the treatment
process to provide the most balanced program for you and your specific needs. A professionally trained and
knowledgeable therapist can be a wonderful asset to assist you in both understanding your condition and overcoming
it. Unfortunately, highly skilled therapists are not always easily found or available within commuting distance. The
financial costs of ongoing therapy can also be prohibitive for many individuals. The Completely Overcome Vaginismus
program was developed to guide you through the process of overcoming vaginismus with or without the involvement
of a therapist.
Overcoming vaginismus involves retraining the mind and the body. The mind needs to be freed of any negative
inhibitions towards sex, for whatever reason, and the body needs to be retrained to accept penile entry and to receive
sexual pleasure.
The Completely Overcome Vaginismus program addresses each of these components through a step-by-step format.
Below is a brief description of each step.
Step 1
Information/Education: Educating yourself about vaginismus is fundamental to the process of overcoming it. This step
focuses on the basics of understanding vaginismus, obtaining a proper diagnosis, terminology, relationship matters,
and basic relaxation techniques.
Step 2
Mind Over Matter: Many women with vaginismus have experienced negative events, feelings, or memories, that
collectively send subconscious signals to the PC muscle group to spasm whenever penetration is attempted. In this
step, you will map out your sexual history and feelings, identify any unhealthy messages, and then consciously
override them through written and verbal declarations.
Steps 3 & 4
Anatomy 101 & The PC Muscle Group: These steps primarily focus on reviewing your own sexual body parts and their
role in sexual activity as well as learning to identify, selectively control, and exercise the PC Muscle Group.
Steps 5 & 6
First Insertion & Vaginal Trainers: Focus on retraining your PC muscles through the use of vaginal dilator exercises.
Steps 7 - 10
Working Together Towards Intercourse: With your partner you will complete a series of exercises designed to educate
each other, build sexual trust, and transition to full sexual intercourse.
Relationship Matters
By the time you read this, you may have been married many months or years or have been in a
relationship without ever having successfully completed sexual intercourse. Over time, complacency can develop. It is
not unusual for women with vaginismus to have husbands with increasingly passive character traits that tend to
'adapt' to the unconsummated relationship and feelings of continual rejection. You may now be in a relationship that
seems to be 'getting by' without a sexual component.
Although it may be hard to hear this when you are suffering from vaginismus, you must understand and accept, that it
is unhealthy for you, your spouse, and your relationship to continue with any complacency when it comes to your
sexual health and relationship.
Sexual difficulties from vaginismus can cause a continual strain and generate a wide range of emotions. Although the
woman experiences the consequences of having vaginismus most acutely, it is important to acknowledge that the
male partner will also be experiencing feelings unique to his role in the relationship. Some typical emotions the male
spouse may experience are:
Rejection - "I'm so tired of being rejected all the time. We probably had a better physical relationship
before we were married. What's wrong with me that keeps her from wanting to have sex or romance with
me? First, it was just being unable to have intercourse, but now she hardly wants me at all."
Empathy - "My wife would be crushed if anyone found out about this. I feel so badly for her, that she
is going through so much pain. I believe that she means well and doesn't intend to hurt me, but my life is
miserable too. I feel lower than low, stuck, and I have no idea what to do."
Distancing - "My home life is a mess, so I might as well put my all into my work or time with the
guys. At least by putting myself into my work, I'll get somewhere and think about something else."
Going through the trials of vaginismus can definitely test a relationship to the limit. Encouragement, love, patience,
and communication can go a long way in helping to sustain your relationship during this time. By overcoming
together, you will be able to make your future what you want it to be, by creating new and pleasurable sexual
A Note For The Spouse:
It is important that you truly understand that vaginismus is not your partner's fault. The muscle spasms she
experiences in her vagina make entry by your penis impossible and the attempts painful. These spasms are
involuntary and have occurred without her conscious direction. She has not 'caused' this to happen. Your patience and
cooperation are extremely helpful in overcoming this condition.