What is vaginismus?

In women, the anatomical area where sexual intercourse takes place is called the “vagina”.

Vaginismus is a pathological indication that is defined as the inability to have sexual intercourse or the suffering of pain during intercourse resulting from the involuntary contractions of the pelvic floor muscles surrounding vagina.

Due to certain fears and misinformation in sexual matters founded in the subconscious, the muscles that are set one-third outside the vaginal channel contract involuntarily almost as a result of the body’s “self protection mechanism” and this way, sexual intercourse (penetration) becomes impossible. Among these pelvic floor muscles the best known is the Pubococcygeus muscle. (It can also be abbreviated as the PC.)
In people with vaginismus, when the moment of sexual penetration arises, the PC muscle involuntarily contracts (by itself). Actually, the PC muscle is normally under our control, which means that it is a muscle that we can voluntarily contract and relax. For example when we need to urinate, racing to the WC, we contract it (meaning we contract it ourselves) and then relax it when urinating.
Vaginismus is a problem widely and very frequently encountered by psychiatrists and gynecologists “all around the world”. In this regard it should not be considered as a problem only endemic to Muslim and conservative societies like ours.

In women who have vaginismus, contractions not only occur at the vaginal entrance but may also occur simultaneously in many other parts of the body such as the belly, waist, back, and the legs. Thus after a couple’s attempts at sexual intercourse, in these regions of the body, muscle pains can be widely encountered. This depends to some extent on the degree of vaginismus.

The most important feature of the vaginal contractions is that they take place “involuntarily”, in other words as a “reflex”, totally out of the person’s control.

With vaginismus, it is not possible for any object to enter the vagina and every attempt at penetration is either impossible or extremely uncomfortable.

The vaginal reflex that manifests itself as the involuntary contraction in the PC muscle can take place not only during sexual intercourse but also during any situation that involves any kind of insertion, such as during a woman’s gynecological examination, with the use of tampons, or the insertion of a finger into the vagina.

What kinds of reactions arise during attempts at sexual intercourse?

In couples who happily love each other and have no other problems than sexual matters, and when everything is going perfectly well, even if they are having good and pleasurable sexual foreplay, the moment when the interaction moves to the stage of sexual intercourse, the misinformation and prejudices present in the consciousness of the woman, through the manifestation of worry and fear, develop a state “similar to a panic attack”.
In this state similar to a panic attack, after the increase in heartbeat, palpitation, fear and excitement, the woman contracts herself as much as she can and in this way it becomes impossible for the penis to penetrate. In this state, it is sometimes possible to encounter pain and sometimes there is just fear. Then the woman, who does not want intercourse, closes her legs tight and by refuses her partner, thus ending the attempt at sexual intercourse.

After each failed attempt at intercourse, feelings of sadness, uneasiness, despair and regret on the part of both partners affect the couple’s entire psychology. In time, the problem ceases to be just a sexual one, expanding until it affects the entire social lives and marriage of the couple.
Sexuality is one of the factors of family solidarity. In this respect, in the situation where there is a lack of sexuality, other problems emerge as a chain reaction like a line of so many dominoes.

According to another description, vaginismus is a “delay-avoid disease”. Patients that delay and needlessly avoid treatment with a multitude of excuses such as promotion anxiety, career, school, a busy work life and more – after a few sessions of a simple treatment program, they see the positive results and always ask themselves the same question: “Why did I wait for so long if it was this easy? I wish I had come earlier…”

Why is sexual intercourse (penetration) not possible?

By trusting your partner, by loving him, you can experience beautiful moments of consensual, intense pleasure. You can have a happy and harmonious connection during sexual intimacy too.
However, the moment when sexual foreplay turns into sexual intercourse, your vagina suddenly contracts, quite possibly giving you the sensation that “that region is entirely closed, as if the penis is hitting a wall in the attempt to penetrate” and sometimes, this contraction might hurt.
Sometimes, “your predetermined expectation of pain” might cause you to feel pains that are not real. This increase in the expectancy of pain during intercourse might cause the person to contract and by contracting might cause the person to feel more real pain, thus creating a vicious circle.

However, there should be no pain or discomfort during sexual intercourse, which is considered one of the most pleasurable activities, but there is only pleasure and joy. As a matter of fact, the most important aim of sexual intercourse is to feel pleasure.
The picture below shows: A) Natural anatomic stance B) Contraction of the PC muscle seen in the case of vaginismus.
In women suffering from vaginismus, the body and mind never have a consensual and positive experience towards sexual intercourse. These negative sexual messages in women are varied and the messages trigger the muscles in the vagina (especially the PC muscle) to contract in an involuntary reaction.

As a result of the contractions and the expectation of pain, sexual intercourse may become impossible and sometimes may turn out to be very painful. Thus the pain experienced, “installing itself into the memory” of the vagina muscle, causes it to contract during every attempt and with every passing day feeds an increase in anxiety and fear. At the same time, every painful attempt helps to make this memory stronger. When this condition is fully embedded, although the woman says “I desire to have sexual intercourse with my partner”, after each attempted intercourse, the man feels as if “he has hit himself against a wall”, and the woman experiences “the anxiety of losing total control over her body”.
The problem might pass beyond being just a sexual one in time and turn into a “family problem”, and, by expanding like an avalanche, may cause a variety of different problems that cannot be predicted beforehand.

Therefore, it is important to get professional support as soon as possible.

In women, the vagina has four important functions:

The vagina is,

  • The channel where intercourse takes place,
  • The channel where birth takes place,
  • The channel through which the urinary channel passes, and
  • The channel through which menstruation passes.

The vagina is “an ordinary organ” just like our other organs with certain functions inherent to itself. Actually it is a passage zone. The strong PC muscle surrounding the vagina plays a key role both in the functioning of the reproduction and the urinary (peeing) systems.

Normally, a woman, when she needs to go to the toilet, contracts her PC muscle and while urinating relaxes it. Thus the PC muscle is a muscle that works voluntarily under a person’s own control. Yet in vaginismus patients, during sexual intercourse, this control is lost. So, a person who can normally hold it in, during sexual intercourse is unable to command her muscles in that area. The muscle works on its own account, considering everything that is external (gynecological examination, vaginal tampon, etc., or the penis during sexual intercourse) as a threat, denies them.

For those suffering from vaginismus, during sexual intercourse, the PC muscle, without any voluntary thought, works involuntarily and closes the entrance to the vagina. Thus, intercourse fails.

In the treatment for vaginismus at the Hera Clinic, it is our aim to eliminate involuntary contractions by helping regain control over these muscles. The main element in the treatment is the “restructuring of muscle memory in order to learn to command the pelvic muscles”. This is made possible by the cognitive and behavioral therapies to be conducted.