Why Does It Hurt When I Have Sex? All Your Vaginismus Questions Answered.

pelvic floor physical therapy for painful sex painful intercourse, vaginismus.jpg

A diagnosis too frequently missed and under-diagnosed, vaginismus can be defined as vaginal tightness due to an involuntary contraction of the pelvic floor muscles.

The pelvic floor muscles are the muscles that surround the vagina, bladder and uterus; with vaginismus, these muscles exhibit involuntary spasm. Pain upon penetration can occur, making intercourse painful or even impossible. It has been demonstrated that a 10% increase in muscle tone of the pelvic floor muscles causes a 50% decrease in blood flow and oxygen going to these muscles. 


Why is decreased oxygen and blood flow problematic?

Blood flow is essential for a healthy muscle state as well as for orgasm. Vaginismus sets the stage for painful intercourse (known as dyspareunia) or inability to have intercourse (known as apareunia) due to this unhealthy muscle spasm state. This often leads to a cycle of emotional pain and avoidance surrounding all forms of intimacy.

Unfortunately, women often go years suffering with vaginismus before getting the help they deserve and need. Many women are incorrectly told that the problem is in their head when, in fact, the problem is within their pelvis.


  • Pain with tampon insertion

  • Pain with annual gynecological pelvic exam or pap smear

  • Pain with vaginal penetration

  • Pain with sex

  • Often pain is described as “It feels too tight down there”, “sharp pain”, “burning pain”, “aching and throbbing pain” during and after intercourse attempts.

What causes vaginismus?

Truly anything that triggers the body to anticipate pain can set the stage for vaginismus. Some of the more common causes of vaginismus (tight pelvic floor muscles) include anxiety, stress, traumatic events, an abuse history, back pain, abnormal holding patterns with urine or breath, traumatic childbirth experience, injury to the hips, SI joints or menopause. After the initial onset is put into play, a pain spasm cycle often is set into motion; unfortunately, this can become a self-perpetuating process. See the flow sheet below to understand how this happens.

What Causes Vaginismus?

 How common is it?

Prevalence is thought to be up to 15% of women who suffer with vaginismus. However, the literature states that 1 in 4 women have pain with sex regardless of what the cause it—not acceptable! Accurate statistics are difficult to determine as vaginismus is a largely unrecognizable and under-diagnosed sexual pain condition.

How is it diagnosed?

A pelvic floor physical therapist who has extensive experience treating vaginismus and evaluating the pelvic floor muscular component can tell you what state your pelvic floor muscles are in. Fortunately, California is a direct access state which means you can refer yourself in for a pelvic floor physical therapy evaluation at any time.  If needed, a referral to a physician who specializes in sexual pain can happen, and we are fortunate to work with incredibly knowledgeable MDs throughout Southern California.

How is it treated?

At Sarton Physical Therapy, we have developed a specialized treatment and plan of care for patients who suffer with vaginismus.

This successful treatment involves addressing all underlying causes and perpetuating factors and is multi-modaloften using pelvic floor physical therapy, guided imagery, and sex therapy. The mainstay of treatment at our clinic utilizes manual therapy to normalize the tone of the pelvic floor muscles. The treatment should be done by a licensed women’s health physical therapist. 

Dilator use in conjunction with manual physical therapy is standard of care. Please note, however, that dilator work alone is often not sufficient enough and many patients require one on one personal instruction on how to self treat their muscles and target their specific problematic areas. Additionally, Kegels and contracting and shortening the pelvic floor with this diagnosis is often contra-indicated, as this can often make symptoms worse. Further treatment options include muscle relaxant suppositories, warm baths, yoga and injections of botox to the pelvic floor.

Is it possible to heal from vaginismus?

Absolutely! Help is available to treat vaginismus successfully with pelvic floor physical therapy. Read about Sue's story here.