Vaginismus and vulvodynia can both cause vaginal discomfort, pain during penetration or sex and often result in life-altering symptoms if left untreated. However, although they are sometimes interrelated and both respond to some similar treatments, they are different conditions.
The good news is both conditions are treatable and most women make a full recovery. In this article, we'll outline the causes, symptoms, and most effective treatment options for vaginismus and vulvodynia.
What is Vaginismus?
Vaginismus is described as the involuntary or unintentional tightening of the vaginal and pelvic muscles at the prospect of vaginal penetration. This uncontrollable tightening can occur when trying to insert a tampon, a medical instrument during a pelvic exam, sex toys, or a penis.
For some women, penetration with vaginismus is possible but incredibly painful, while for others vaginal penetration and sex are impossible.
Vaginismus is typically categorized as primary or secondary. Primary vaginismus is when vaginal penetration has never been possible. Secondary vaginismus is when penetration was once possible and painless, but has become painful or impossible later in life.
Common Signs & Symptoms of Vaginismus
Although the signs and symptoms of vaginismus can vary for each person, the most common are listed below.
- An underlying fear or anxiety about sex
- Vaginal muscle spasms during foreplay or oral sex
- Painful contractions of the pelvic floor
- A lack of desire for sex due to the expectancy of pain
- Stinging or burning when something is inserted into the vagina
- Tightness in the pelvic area (including the hips, lower back and abdominals)
- Painful sex (dyspareunia)
- The feeling like your partner’s penis is hitting a wall in your vagina during sex
- Unable to insert tampons or a sex toy
- Unable to undergo a pelvic exam or pap smear
Not every woman will experience all of the symptoms mentioned above, and for some women, the symptoms can be milder. That aside, it’s important to understand that no matter how mild or severe the symptoms of vaginismus are, treatment will help. If left untreated, however, symptoms will only worsen.
What is Vulvodynia?
Vulvodynia affects the vulva or outer vagina, which includes the clitoris, labia, and vaginal opening. It is described as a chronic (long-term) pain or discomfort that lasts three months or more. For some women, the stinging or burning pain associated with vulvodynia is constant while for others it tends to come and go. However, most patients notice that the pain intensifies when the vulva is touched.
Sex is often too painful to contemplate for vulvodynia patients, and if left untreated, the pain will not go away on its own.
Symptoms of Vulvodynia
The core symptom of vulvodynia is pain in the vulva, but it can manifest differently for each patient. For some, the pain feels like burning or stinging, whereas for others it feels like a raw soreness or sharp, stabbing, knife-like pain. Throbbing and inflammation of the vulva, as well as discomfort during urination, are also common with vulvodynia.
The pain can come and go or linger constantly, but it typically worsens after sitting for some time, when the vulva is touched, or when tight pants or underwear rub against the outer vagina.
Vaginismus vs Vulvodynia: How They Are Interrelated
The main connection between vaginismus and vulvodynia is that they both cause vaginal pain and dyspareunia, as well as the resulting conditions like infertility, anxiety, depression, low confidence, and relationship issues.
The main difference between these two conditions is that vaginismus typically causes pain within the vagina, whereas vulvodynia causes pain in the outer part of the vagina.
The interrelation of both conditions comes down to the connection with the pelvic floor. The tightening of the pelvic floor muscles associated with vaginismus can lead to vulvodynia. However, the pain and discomfort associated with vulvodynia can also lead to vaginismus due to the fear of painful penetration and the involuntary tightening of the pelvic floor muscles.
Treating Vaginismus & Vulvodynia
Due to the varying physical and psychological causes of vaginismus and vulvodynia, treating both often requires a multi-faceted approach. This could incorporate a primary care provider, pelvic physical therapist, psychologist, sex therapist, gynecologist, or all of the above, depending on each patient’s condition.
Home therapy is also a foundational part of the treatment for vaginismus and vulvodynia, as is education. Learning about the anatomy of the vagina and how the pelvic floor functions is key to understanding what causes the symptoms and how to relieve them.
Where to Begin?
Treating vaginismus typically begins with a visit to a primary care provider or gynecologist who will enquire about your pelvic health, previous traumas, injuries, surgeries, or vaginal infections, as well as allergies, and bladder and bowel health.
Depending on their findings, they could recommend medication to relieve pelvic pain or nerve irritation and advise a consultation with a physical therapist, psychologist, or sex therapist for further treatment.
Pelvic Health Physical Therapy
Physical therapists specializing in pelvic health are trained to relax the pelvic floor muscles when they are tight and restore them for comfortable penetration and pelvic function. In addition to relieving pelvic floor disorders, physical therapists also teach patients how to relax and rejuvenate the vaginal and pelvic floor muscles at home.
Home Therapy
Home therapy for vaginismus and vulvodynia is usually performed with the help of vaginal dilators. Ranging in circumference and length from the size of a female pinkie finger to an erect penis, dilators are designed to slowly relax and gently stretch vaginal and pelvic floor muscles to relieve tightness and pain.
Vaginismus and vulvodynia patients are typically advised to start with the smallest dilator and insert it slowly with a generous amount of lubricant. It may take days or weeks to fully insert the first dilator but once it’s comfortably held in place for the time agreed upon with your physical therapist, you are ready to move up to the next size.
By gently progressing through a set of dilators, the vaginal and pelvic muscles slowly learn to relax and re-accommodate pain-free penetration.
Psychology or Sex Therapy
If the underlying cause of the reflexive muscle tightening associated with vaginismus is due to an underlying psychological factor rather than a physical injury, a consultation with a psychologist can be helpful. When the underlying cause is due to previous sexual abuse, a lack of education about sex, or a deep-rooted childhood fear that sex is painful, a sex therapist can help patients work through their fears and previous experiences.
Relaxation Techniques
When it comes to treating vaginismus and vulvodynia, relaxing tight vaginal muscles is vital. However, learning to relax the entire body, as well as a busy or fearful mind, is also beneficial. Relaxation techniques like meditation, conscious breathing, and gentle yoga can not only help to relax the mind, they can also help to relieve pain.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is based on speaking to a therapist to change the way patients think or behave toward a particular situation in life. Although commonly used to relieve anxiety, stress, and depression, CBT is also helpful in changing how patients react to the pain of a chronic condition like vaginismus or vulvodynia.
Conclusion
Vaginismus and vulvodynia are two conditions that cause pain and discomfort in and around the vagina. While vulvodynia typically affects the outer vagina and vaginismus feels more like internal vaginal tightness, both often result in painful sex (dyspareunia).
Due to the pain, sex often becomes impossible, causing additional issues like infertility, embarrassment, relationship problems, anxiety, and depression.
Although they are different conditions, vaginismus and vulvodynia can be interrelated and treated with similar therapies. These can include physical therapy, pain management, dilation therapy, cognitive behavioral therapy, and relaxation techniques.
If you feel repeated pain, burning, or stinging during penetration, or your outer vagina is inflamed and sore to the touch, don’t be embarrassed. Contact your healthcare provider for a diagnosis and start treatment ASAP.
References
Science Direct – Vaginismus: An Overview - https://www.sciencedirect.com/science/article/abs/pii/S1743609522011304
Mayo Clinic – Vulvodynia - https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423
National Library of Medicine - Vaginismus Treatment: Clinical Trials Follow Up 241 Patients - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440634/
National Vulvodynia Association – Vulvodynia Treatments - https://www.nva.org/learnpatient/medical-management/