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HomeFeatureYour v@gina is not too small: You might have V@ginismus

Your v@gina is not too small: You might have V@ginismus

S@x is an erotic experience that many describe as the closest thing to paradise. However, it can be a huge nightmare for some people, especially women. While psychological and religious considerations may play significant roles in how it feels, biological and medical issues may well affect your s@x life.

One of these is v@ginismus, which is medically defined as a woman’s body’s automatic reaction to the fear of vaginal penetration, causing the v@ginal muscles to tighten involuntarily whenever penetration is attempted.

Johannesburg-based medical doctor and sexologist Dr Elna Rudolph explains that, depending on the intensity, vaginismus symptoms range from minor burning sensations with tightness to total closure of the vaginal opening, making penetration impossible.

She says, 

V@ginismus is a common cause of ongoing sexual pain and is also the primary female cause of sexless (unconsummated) marriages. Sexual pain can affect women in all stages of life, even those who’ve had years of comfortable s@x. While temporarily experiencing discomfort during s@xual intercourse isn’t unusual, ongoing problems should be diagnosed and treated.

Mostly out of embarrassment, many women across the world have been suffering in silence, which has made finding accurate and credible statistics challenging, and misdiagnosis is common.

This was the case for Daveyton-based Tshepiso Maluleke* (40), who began experiencing symptoms of v@ginismus after undergoing radiation therapy.

“A few years ago, I was diagnosed with cervical cancer. It came as a shock, because there was no history of cancer on either side of my family. I immediately underwent radiation therapy, which continued for a few months. During treatment, I was given the green light by my oncologist to have sex with my husband. At first it was uncomfortable, but then it became very painful. Since I thought the pain was associated with stress and the effects of radiation, we decided to stop having intercourse until I’d finished treatment. However, when the time came for us to resume sex, penetration was impossible.

“It felt as if he was hitting against a brick wall. When I approached my doctor about it, he said I was experiencing premature menopause, which was a common side-effect of the radiation. The emotional and financial toll of radiation was hard enough, but being unable to be intimate with my husband added to the burden. It [took a toll] on our marriage,” she recalls.

What causes V@ginismus?

While medical journals claim that most doctors do not know exactly why vaginismus happens, Rudolph believes that physical and/or emotional factors may trigger the condition.

She says,

For many women, vaginismus comes as a surprise. The pain results from the tightening of the muscles around the pubococcygeus [PC] muscle [the muscle stretching from the pubic bone to the bottom of the spine]. Since this occurs without the conscious control of the woman, it can be very perplexing,

Nonphysical causes, she adds, include fear or anticipation of pain during intercourse, fear of not being completely physically healed following pelvic trauma or concern that a pelvic medical problem may reoccur, anxiety or stress from previous unpleasant sexual experiences, negativity towards s@x, guilt or emotional traumas, partner issues (including emotional abuse, detachment or mistrust), traumatic experiences of sexual abuse, repressed memories of overly rigid parenting, unbalanced religious teaching (“sex is bad/dirty”) and inadequate or inaccurate sex education. Sometimes, however, there is no identifiable cause of vaginismus.

Physical causes include medical conditions, childbirth, age-related changes such as menopause or hormonal changes and pelvic trauma.

“Vaginismus may coexist with other medical conditions, possibly triggered by temporary pelvic pain resulting from them. If the underlying cause has been resolved or managed and ongoing pain, discomfort or penetration difficulties continue, this is typically due to vaginismus,” says Rudolph.

Symptoms to look out for 

Rudolph says that symptoms to look out for include burning or stinging with tightness during sex, difficult or impossible penetration, ongoing sexual discomfort or pain following childbirth, yeast/urinary tract infections, sexually transmitted diseases, hysterectomy, cancer and surgeries, rape, menopause and difficulty inserting tampons or undergoing a pelvic/gynaecological examination.

However, she stresses that a diagnosis should only be reached after a gynaecological examination.

“Confirming a formal diagnosis of vaginismus may take some planning and perseverance, as no definitive medical test exists for detecting it,” explains Rudolph.

“It could take a number of visits to several specialists before a medical diagnosis is obtained. When physicians are initially unable to find any specific medical problem, which is a common experience of vaginismus sufferers, no diagnosis or misdiagnosis is often the outcome of initial medical examinations. Many physicians are unfamiliar with vaginismus, so part of the process is simply finding one who is knowledgeable about the condition. A successful medical diagnosis of vaginismus is typically determined through the patient’s history and description of the problem, a gynaecological examination and the process of ruling out the possibility of other conditions.”

Is there treatment?

Fortunately, vaginismus is highly treatable, with full restoration of enjoyable penetrative intercourse, says Rudolph.

Since misdiagnosis and the promotion of invasive or unhelpful surgeries are sometimes the unfortunate results of all this confusion, she warns that there is no surgery to cure vaginismus: 

It’s very important to seek a second opinion if surgery to ‘widen’ the vaginal opening has been recommended, as this doesn’t normally resolve the penetration problem. In fact, it could further complicate the issue.

Successful vaginismus treatment, she adds, does not usually require drugs, surgery, hypnosis, or any other complex invasive technique.

“Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her healthcare provider.”

According to, steps to treat vaginismus include sexual pain anatomy, which is when women are educated about their body’s sexual organs, their function and the causes of pelvic pain and penetration problems. Another step includes the woman’s practise of PC muscle control techniques by allowing the entry of a small object (a cotton swab, a tampon or finger) into their vagina, working completely under their control and pace.

“Women begin to take full control over their pelvic floor and learn how to relax the pelvic floor at will, eliminating unwanted tightness and allowing entry,” explains Rudolph.

From there, vaginal dilators are used to further help eliminate pelvic tightness due to vaginismus, as they provide a substitute means of triggering pelvic muscle reactions.

Another treatment Rudolph recommends is botox, which she says has been proven to be a safe and effective treatment for sexual pain and vaginismus.

“Depending on the diagnosis and cause of the pain, it’s used in conjunction with various other medical treatments, physiotherapy, counselling, hypnotherapy and sex therapy.

“We don’t recommend it as first-line therapy for any form of sexual pain, but we’ve helped many patients by adding it to their treatment plan.”

*Not her real name

For further information about vaginismus, visit



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