• Before or during sex
• When inserting a tampon or sex toy
• During a vaginal examination”.²

• Primary — where vaginal penetration has never been achieved
• Secondary — where vaginal penetration was possible but is no longer possible for different reasons”.⁴

• Burning or stinging with tightness during sex
• Difficult or impossible penetration, entry pain, uncomfortable insertion of penis
• Unconsummated marriage
• Ongoing sexual discomfort or pain following childbirth, yeast/urinary infections, STDs, hysterectomy, cancer, surgeries, SA, menopause, or other pelvic issues
• Ongoing sexual pain of unknown origin, with no apparent cause
• Difficulty inserting tampons or undergoing pelvic/gynecological exams
• Spasms in other body muscle groups (legs, lower back, etc.) and/or halted breathing during attempts at intercourse
• Avoidance of sex due to pain and/or failure”.⁵

• Medical conditions (e.g. recurrent urinary tract infections (UTIs), thrush, persistent pain syndromes, endometriosis)
• Sexually transmitted infections (STIs) and ongoing pain after an STI has been treated
• Vulval skin conditions (e.g. lichen sclerosis)
• Vulval pain, including changes to the vulval skin and lining of the vagina, which happens at menopause.

Psychological factors may play a role. For example, fear due to trauma during childbirth or surgery, or negative messages about sex.

Fear may also be due to previous experience of:

• Painful vaginal examinations
• Painful sex (dyspareunia)
• Sexual assault or rape.

Other psychological factors might include:

• Anxiety
• Depression
• Relationship problems
• Feeling self-conscious
• Fear of intimacy
• Fear of pregnancy
• Lack of arousal”.⁶

Fortunately, both conditions are treatable. In fact, vaginal atrophy and vaginismus may need to be addressed simultaneously, as it is difficult to resolve one without managing the other”.⁷

• Pelvic floor physical therapy: A specialist can teach you exercises to help relax your pelvic muscles and decrease pain…
• Talk therapy: A psychologist or sex therapist can help you navigate the thoughts and fears you may have about sex or penetration…
• Vaginal dilator therapy: Vaginal dilators are tube-shaped devices of various sizes that help you get used to penetration. Your provider will explain the therapy in detail. You do it at home…”.⁸

You can ask to be seen by a female doctor, and you can bring someone you trust along for support.

Before the examination, you can discuss ways to make it as comfortable as possible for you.

The examination is usually very quick. Your doctor will take a quick look to rule out other conditions, like an infection.

If your doctor thinks you have vaginismus, you may be referred to a specialist, such as a sex therapist”.⁹