PELVIC FLOOR SERIES: The 4 Main Causes of Vaginismus

by | Jun 14, 2021 | For Women, Making Sex Feel Good, Uncategorized | 15 comments

4 Main Causes of Vaginismus
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Why do some women develop vaginismus?

In the month of June, I’m concentrating on pelvic floor issues, whether it’s with postpartum pain or other sexual pain. I started off this series talking about why the pelvic floor matters, and what can go wrong.

Today I want to concentrate on a particular pelvic floor issue: vaginismus.

Vaginismus is not the only thing that can cause pain during sex–other conditions like lichen sclerosus or vulvodynia can as well. But today I’d like to focus on vaginsimus because it’s the most common and it seems triggered, at least in part, by our beliefs.

;Ever since the beginning of January I’ve been a guest on at least 3-4 podcasts a week talking about our new book The Great Sex Rescue. And one of my goals, whenever I’m on another podcast, is that I manage to get the word “vaginismus” in each time.

I like to tell people that, of couples under the age of 45, vaginismus is far more common than erectile dysfunction (we found over 22% of women reported having experienced sexual pain, of which vaginismus is the most common form). And yet we’ve all heard the word “erectile dysfunction.” Few of us know the word “vaginsimus.”

And because we don’t know it, when a woman who waited to get married to have intercourse tries for the first time and finds it extremely painful if not impossible, she’s bewildered. She had no idea this could happen. She figures the problem must be with her. So she concludes, “I must be a freak.”

That’s my story, and I’ve shared it several times. Vaginismus is an involuntary tightening of the muscles in the vaginal wall, which makes penetration difficult if not impossible. Some women may find they aren’t even able to insert a tampon. But, again: it’s involuntary. You aren’t deliberately causing it.

So what IS causing vaginismus?

Almost thirty years ago now, when I first had it, I was marched off to counselors because it was assumed that I must have trauma in my past, and if I can deal with those memories I’d be fine. I was also taken to a gynecologist who was sure the root was shame, and he was going to put me on an examining table with my feet in stirrups and touch each part and name it, and have me watch with a mirror, until I was comfortable.

I ran out of his office and never went back.

Thankfully there’s been more research done on this since (including by us, in our survey of 20,000 women), and I’d like to share it today. However, to be frank, in many cases we just don’t know. There hasn’t been nearly enough research into vaginsimus (there’s been way more research into male sexual dysfunction). So we’re still largely figuring this out, and I’m going to mention here some of the things that we’ve learned and that have appeared in academic journals. I hope one day we’ll have a clearer picture.

1. Physical risk factors for vaginismus

Vaginismus affects the muscles in the pelvic floor, so anything that impacts that area of the body can trigger vaginismus. Researchers have identified a number of risk factors for vaginismus, including:

  • Trauma in that part of your body, including bad tears from childbirth; surgery; or traumatic injury.
  • Menopause (this is rare, but in some women the changes in blood flow to the area can cause a tightening; don’t be paranoid about it though! If it happens, just know that there’s treatment).
  • Bowel issues, including chronic constipation or pain
  • Participation in some sports. There’s research currently underway looking more at this, but sports like cycling and horseback riding have been shown to affect the pelvic floor and sexual function in general. Also, sports that require certain postures–such as gymnastics and dance, seem to also trigger tight pelvic floor muscles when not done properly.

So those are the physical risk factors. Let’s move on to the others!

Note: when vaginismus is not due to primarily physical reasons, but stems mostly from trauma, beliefs, or relationship dynamics, vaginismus can be situational. For instance, it may occur only with sex but not with gynecological exams, or with gynecological exams but not with sex. When vaginismus has at least a partial physical component, it’s often more global–occurring in all situations. 

2. Trauma-response risk factors for vaginismus

It’s not surprising that vaginismus can also be a trauma response. If you have sexual abuse in your past, your chance of experiencing vaginismus increases. Trauma from a difficult birth situation can also trigger secondary vaginismus, or vaginismus that you develop later in life.

It was often assumed that all vaginismus was in this category, but increasingly people are realizing that while this is a factor for many, it is by all means not universal. Most of the women who comment on this blog or who talk to me about vaginismus were not sexually abused, and they’re really bewildered. Sexual abuse is a tragic but easily understandable cause; your body was traumatized, and so it is literally saying, “keep out!”

If trauma is a part of your history, please, along with a pelvic floor physiotherapist, see a trauma counselor who can do exercises with  you to help stop the trauma response–that fight, flight or freeze mode your body goes into automatically.

3. Psychological risk factors for vaginismus

As I’ve said before, one of the reasons that we wanted such a large sample size for our survey for The Great Sex Rescue was so that we could isolate those who have suffered from vaginismus and see if we could discover some underlying commonalities.

And we did! Yay!

We found that some of the harmful messages that we can internalize about sex can make vaginismus more likely. Specifically, two particular beliefs increased the rates of sexual pain:

  • The obligation sex message: believing “I am obligated to have sex with my husband when he wants it” can increase your risk of experiencing vaginismus by 39%.
  • Believing “I must have sex with my husband frequently to keep him from watching porn” increases your risk of vaginismus by 19%.

The interesting thing about these two findings is that they include marriages where the husband doesn’t believe these things at all! This is true even if the dynamic in their marriage doesn’t bear this out. When women feel as if they are having sex under threat–that they don’t have a choice, they’re not allowed to say no, and their needs don’t matter, the chance of experiencing vaginismus goes up.

Other researchers have also found that purity culture beliefs, specifically around shame of sex, also increase vaginismus. Rachel Joy Welcher, in her book Talking Back to Purity Culture, talked to so many women who had experienced this.

Many doctors know that “negative beliefs about sex” impact vaginsimus, but they don’t break it down into which beliefs in particular.

It’s usually assumed that women have shame around sex. That’s certainly how I was treated–I must be ashamed of my body. For many women this is true, but for many it’s not. I certainly wasn’t. We can have negative beliefs about sex that aren’t related to feeling shameful about sex, and we’re hoping to develop a diagnostic tool that physiotherapists can use to help them isolate which beliefs, in particular, may be exacerbating the problem.

What needs to be understood is that in these cases, women are experiencing these messages as trauma, as I’ve explained in my post about The Body Keeps the Score and vaginismus. Even women who haven’t experienced sexual trauma can have traumatic responses to these messages, because the messages themselves are traumatic. They tell women: “you don’t matter. He has the right to use you.” And our bodies can internalize that.

I was on a podcast recently where a man was talking about his and his wife’s faith journeys since realizing how toxic their purity culture upbringing had been. She has now left the faith; he’s trying to find Jesus while discarding toxic teaching. When I started talking about how the body interprets the obligation sex message as trauma, he began tearing up. He told me that the week before his wife had started reading books on purity culture’s effects, and it had affected her body. She stopped sleeping. She began having migraines again. She started to have stomach pains. And so she had to put the books down for a time. It brought back the trauma that she had carried in her body from these messages.

4. Sexual dynamic risk factors for vaginismus

What happens when our harmful beliefs get acted out in the bedroom? Very, very bad things.

Our survey found that:

  • Women who feel their voice doesn’t matter in marriage are 138% more likely to report experiencing vaginismus.
  • Women who report that their main motivation for having sex is because they’re obligated to are 180% more likely to experience vaginismus.

When women feel pressured by their husbands, and feel as if they don’t matter in marriage, vaginismus rates skyrocket even more than when women simply believe these messages themselves.

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But there’s another dynamic that can lead to vaginismus, even with kind-hearted and good-willed men, and for that, I have a behind-the-scenes research story.

Joanna and Rebecca, my co-authors for The Great Sex Rescue, made one thing perfectly clear going into this project:

They were not, under any circumstances, going to reinforce purity culture.

They are both millennials who grew up in purity culture, and they didn’t want to reinforce those messages.

So even though we asked about sexual history before marriage, Joanna was determined not to run any stats on those findings. They figured, “if we find out sex is better if you wait until marriage, do we really want to say that? It makes everyone who is married and can’t do anything about it now feel badly.”

But then I pushed back, because there was one stat I really wanted, and they relented.

I said, “I just want to know if waiting until the wedding increases the chance of vaginsimus.”

You see, we had done so many focus groups with women who had told us, “even though I do believe in a Christian sexual ethic, and I was a virgin when we married, I sometimes wish we had given in and had sex before we were married when we were making out and I was actually aroused, because I wonder then if I wouldn’t have had vaginismus.”

So we wanted to test it! And Joanna did. And yep. It made a difference.

Sheila Wray Gregoire, Rebecca Lindenbach, Joanna Sawatsky

The Great Sex Rescue

This stat isn’t actually in The Great Sex Rescue; we ran it after it was published when we were writing The Good Guy’s Guide to Great Sex. But we found that women who:

  • had only had sex with their husbands
  • and their husbands had only had sex with them
  • and she has no abuse in her past

are 19% more likely to experience vaginismus if they wait for the honeymoon than if they have intercourse beforehand.

Now, I don’t believe that this invalidates a Christian sexual ethic. 

I think what this shows is that arousal matters! If you have sex before marriage when you plan on waiting for marriage, chances are you’re having sex because you got “carried away”–aka aroused. But on the wedding night we are often (1) exhausted; (2) awkward; (3) feel pressure to perform. We feel that “obligation sex” message because now we’re supposed to. And because we don’t know what we’re doing, we often miss important steps and go right to intercourse because now we can have it.

That’s why in our Honeymoon Prep Course we stress so much that the goal for the honeymoon is arousal, not intercourse. Just figure out the arousal piece, and even the orgasm piece, and then the rest will fall into place!

Are you ready for the honeymoon you always dreamed of?

The Honeymoon Course is here to help you plan the perfect honeymoon and start your marriage (and your sex life!) off with laughter, joy and fun!

Don’t make the same mistakes other couples have–get it right from the beginning! 

If you’re already married, The Great Sex Rescue spends chapter 4 on figuring out how to discover arousal if you missed that piece by rushing through the wedding night. 

When we continue to have sex when we aren’t aroused, and when we don’t know if we’ll get aroused, but we feel like we have to have sex anyway–vaginismus can be the result. 

These 4 causes of vaginismus often overlap each other. 

For some women one will be more of a factor, or the only factor (making treatment far easier). For others it may be more complicated. You have to treat the physical issues, but you also have to untangle the negative sexual dynamics that have often arisen because of vaginismus.

That’s why most people will need not just a pelvic floor physiotherapist (which I highly recommend!), but also some work untangling the psychological and trauma issues, with a trauma counselor if appropriate, or by reading books like The Great Sex Rescue to deconstruct some of the harmful things you’ve believed. Or maybe all of the above!

If you’re walking through vaginismus, I just want you to know that I get it.

This was my story for several years too, and we developed all kinds of horrible dynamics as I tried to fix it in all the wrong ways. Tomorrow we’ll look at some specific ways you can help your pelvic floor relax and help your body recover!

4 Main Causes of Vaginismus

Pelvic Floor Series

Sheila Wray Gregoire

Sheila Wray Gregoire

Founder of Bare Marriage

Sheila is determined to help Christians find biblical, healthy, evidence-based help for their marriages. And in doing so, she's turning the evangelical world on its head, challenging many of the toxic teachings, especially in her newest book The Great Sex Rescue. She’s an award-winning author of 8 books and a sought-after speaker. With her humorous, no-nonsense approach, Sheila works with her husband Keith and daughter Rebecca to create podcasts and courses to help couples find true intimacy. Plus she knits. All the time. ENTJ, straight 8

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Sheila Wray Gregoire

Author at Bare Marriage

Sheila is determined to help Christians find biblical, healthy, evidence-based help for their marriages. And in doing so, she's turning the evangelical world on its head, challenging many of the toxic teachings, especially in her newest book The Great Sex Rescue. She’s an award-winning author of 8 books and a sought-after speaker. With her humorous, no-nonsense approach, Sheila works with her husband Keith and daughter Rebecca to create podcasts and courses to help couples find true intimacy. Plus she knits. All the time. ENTJ, straight 8

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  1. Ylva

    The worst a husband or advice giver of any sorts can say is “you need to grit your teeth and get through with it and then it will get better”
    For me, this method did kinda work but why spend the first few times in pain and risk (emotional) damage if you can avoid that?
    I wish I would have figured out the arousal piece before trying to get to sex just to be able to check it off on my list.
    And when I get married and have sex again with my new partner, I will not compromise on that!

  2. Anon

    Thank you SO much for focusing on this topic. People need to be aware and educated.
    I suspect there is an expectation or an assumption around that women with vaginismus aren’t enjoying sex or orgasming (Sheila, what have you done to my vocabulary?? 🤣) and I’m just going to say I had ten years of painful sex in my marriage while still reaching orgasm during intercourse, with frequent sex (multiple times a week) and a high drive and no past sexual abuse. And I was the initiator.
    I still had pain, every time, for ten years. It resolved after the birth of my second child. I thought I was weird and I had no idea about vaginismus for several years.
    People wonder how a husband can put his wife through pain but the wife can be desperate to put up with the pain. It caused issues for my husband too which I won’t go into here except to say he wasn’t free to grow into his own arousal and enjoyment of my body because he associated my body parts with causing me pain.
    I also find even now that if I experience any pain amongst pleasure, I can’t separate the pain enough to be sure I’m feeling it. It’s confusing and only afterwards I realise I was hurting. Therefore it’s hard to say “I’ll stop as soon as there is pain!”
    I don’t recommend anyone goes down the path of putting up with pain and learning to be in pain!
    Some people may relate to this.
    Just thought I’d throw some thoughts out that I haven’t seen shared on your blog.

    • Sheila Wray Gregoire

      Yes, definitely! One of the best things those with vaginismus can do is reach orgasm in other ways (if penetration is impossible) so they still feel sexual and don’t feel like failures. And once you learn how to take it slow and relax, you can still reach orgasm through penetration too.
      I think many women rush through the pain and are desperate to have intercourse anyway because they feel broken and guilty and feel the obligation sex message so strongly. This only messes things up in the long run. I hope people will go see a pelvic floor physiotherapist, because it really can be treated!

    • M B

      Anon, your story could be mine except 5 years of pain. You described it all so well – the motivation on both sides that keep you locked in obligation sex and tiptoeing around your body…. both trying to make sure there’s no more pain….. me wanting orgasm as much as him and so not wanting to stop having sex…. but also feeling obligated to have it for all the reasons listed above… and so not knowing how to find sex to be sexy yet desperately wanting to… thankfully we are seeing a trauma counselor now and she is amazing and is helping so much! Plus Sheilas book helped a lot too!

    • Jane Eyre

      “I suspect there is an expectation or an assumption around that women with vaginismus aren’t enjoying sex or orgasming”
      Eh, the wrong assumptions go both ways. It makes sense that women could also feel pleasure, only because it explains the completely “disconnected from reality” responses I have gotten when seeking help. Personally, I hate every part of penetration, which feels like having a corn dog shoved down and up my throat, but that doesn’t stop people, medical professional included, from insisting that I must like it.

    • Lisa

      Having my first child greatly reduced my pain during intercourse. I didn’t have pain all the time and I don’t think I had vaginismus, I think I was just so dry because we didn’t understand the arousal aspect and I did feel like I had to give him intercourse whenever he wanted it.
      We did have sex with each other before marriage and there was zero pain and it was amazing. It was always after spending the entire day together, enjoying each other’s company. As soon as we got married, our relationship changed drastically. If he wasn’t working, he was on the couch, in front of the computer, or out with friends. I was left with getting everything done and I felt like I had an adult child living with me, not a husband. That’s the opposite of arousing.

  3. Katydid

    I used to wonder why other girls would tell me that they had no problem inserting tampons and that sex for the first time didn’t hurt or was only a little uncomfortable, yet my experience was completely different. I now realize a few things:
    1. I grew up with tremendous shame around the female body. Seriously, I was brought up to act like I didn’t even have female genitalia because any thoughts about it or attention to it beyond the very basics in hygiene was taboo and sinful. I wasn’t supposed to look, touch, talk about, or think about it.
    2. Ironically, I also grew up hearing about how much sex hurts women the first time (but it’s a terrible shame if she makes him wait and won’t consummate the marriage on the wedding night).
    3. I grew up with the idea that no one, NO ONE is to have anything to do with your genitalia except your husband. You begrudgingly allow your doctor out of medical necessity, but even so, any gynecological experience should be done surrounding reproduction AFTER marriage. There was this feeling that even medical examinations were shameful, tainted your virginity somehow, and thus cheated your future husband of the perfect intact purity you were supposed to give him. I went to Planned Parenthood for my pre-marriage gyn exam because I had no insurance (which increased my shame because Planned Parenthood was considered Satan’s institution). They didn’t help. They couldn’t find the smallest speculum and the nurse nicknamed me “super virgin” because I was so small and tight. She used a too-large speculum and really hurt me, but considered it a favor to me because it broke my hymen and “loosened me up a little” for my wedding night.
    4. Intercourse was scary. Definitely this idea of male entitlement. “Painful” “messy” and “necessary” were the ways it was described to me. There was also this message that my sexual pleasure was derived from not depriving him. He gets to orgasm. I get to hold back tears, paste on a smile, endure the pain, pretend to enjoy it, try to be sexy, and in accomplishing all that I will feel satisfied warm-fuzzies for “giving him sex.”
    All this nonsense also affected how I saw pregnancy, birth, and post-partum and contributed to not getting the healing and rest and post-partum care I needed. My religious and even political beliefs prevented me from seeking treatment for my post-partum depression.

    • Sheila Wray Gregoire

      Oh, Katydid, that’s so sad about the doctor especially. No one should have treated you like that. And this is all too common in the church. I hope it’s doing better now!

      • Katydid

        @Sheila, things are much better, but because you addressed this I realized I probably had it, and probably because of shame, fear, and lies.
        Female reproductive healthcare is still terrible in the USA. Better in some areas than others, but I am angered and appalled at how women are treated in the US healthcare system. Even our insurance companies stink at good coverage for women.
        Even our sex ed is very male-centric. Anything about intercourse is male-directed. Anything about reproduction (periods, birth control, abortions, pregnancy) is female-directed. It amounts to male=pleasure and lack of responsibility, female=pain, full responsibility.

    • Mary

      My OBGYN who did my exam did the same thing to me Katydid!

      • Andrea

        I have heard so many stories like this now that the #MeToo movement is in full swing, which I hope will help because there is even discussion now of the term “medical rape,” so gynecologists will have to start behaving better. I’ve only ever gone to female physicians in hopes of avoiding being violated like that, but from the stories I’ve heard, they’re often no better than the men, or even worse because having the same genitalia as the patient makes them even less sensitive. As the saying goes, patriarchy has no gender.

  4. Anon

    The sad thing is that when vaginismus is mentioned, it’s usually in a way that makes the woman feel ashamed or guilty for suffering from it. Our national medical website until recently described vaginismus as usually occuring in religious women who thought sex was sinful! They’ve now amended the article to acknowledge that sexual trauma, painful examinations and some medical conditions can cause it.
    And when I was looking for Christian sex advice as a very ignorant bride-to-be, I found one blogger who wrote a ‘what to expect on your honeymoon’ article which included the comment that it was ‘abnormal’ for first time sex to be painful, and if it was, it was almost certainly due to fear and ignorance on the part of the woman. Christian women who are educated about sex apparently never have any trouble!!! (Great, so now you not only have to deal with painful sex, but also with knowing you’re ‘abnormal’ and…it’s ALL your fault for being ignorant and scared!) So glad I wandered on to this site shortly afterwards!

  5. Jacqui

    I only had a small tear and 2 small stitches after my first vaginal delivery but it was 3 hours of pushing with a whole hour of that with a crowning head… I got the ok at 6 weeks to resume intercourse but my husband literally could not enter my vagina. It was like it was blocked off. I went back to my OB a couple different times and the stitches had dissolved and the tear was healed so physically it looked ok. My OB then did the right thing and referred me to a pelvic floor therapist. However, it was a new year after my insurance deductible started over and I was in grad school at the time and money was tight so we couldn’t afford it. So at 12 weeks I decided to just grit my teeth and get the first time over with and sex hurt for a good year and I didn’t enjoy it for a few years after that. My husband never pressured me and actually felt really bad doing it but I felt guilty and encouraged it because I was on pelvic rest a good portion of my pregnancy and felt bad for that. I was in grad school to become a nurse practitioner then so I know medical stuff and even I didn’t know what was going on. It wasn’t talked about.

    • Sheila Wray Gregoire

      Oh, Jacqui that must have been awful! Yes, we don’t give ourselves permission to get better, and pushing through is often terrible, but we often feel like if we don’t we’re bad wives.


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