Vaginismus is a condition where the pelvic floor muscles tighten or spasm when something tries to enter the vagina — like a tampon, during intercourse or during a pelvic exam. Many patients describe it as “trying to push through a closed door.” The exact cause isn’t always clear, but it can be linked to past medical or sexual trauma. Whatever the cause, vaginismus is real, common and treatable.

Symptoms of vaginismus

Symptoms can look different from person to person. As described above, the sensation may feel like “running into a brick wall.” Others feel sharp, burning, stinging or ripping pain.

Mental health can play a major role, says Nebraska Medicine pelvic physical therapist Sam Weber, DPT, PT. “My patients often report that symptoms are worse during times of stress or anxiety because the nervous system goes into a fight-or-flight response putting their bodies in a hyper-aware state. This begs the questions – does anxiety cause the pain, or does the pain create anxiety. Often, it’s both.”

How vaginismus is diagnosed

Most people who are diagnosed with vaginismus are seen first by an OB-GYN provider, since they’re most familiar with the condition. The OB-GYN can then refer the patient to a pelvic physical therapist for further evaluation and treatment.

Diagnosis generally involves:

• Talking through symptoms and medical history.

• A gentle pelvic exam (if tolerated).

• Ruling out other causes of pelvic pain.

Treatment options

The good news is that vaginismus is highly treatable. Many patients see significant improvement with the right combination of therapy, education and support.

Pelvic floor physical therapy

“Pelvic physical therapy is typically the first line of treatment,” says Weber. “As musculoskeletal experts, we’re trained to work with the pelvic floor muscles and tissues directly.”

A key part of treatment is vaginal dilator training. Dilators are smooth, cylindrical tools used to help the pelvic muscles gradually adapt to stretch and penetration. A pelvic health specialist teaches patients how to use them safely and comfortably. Over time, dilators can help:

• Improve tissue mobility.

• Increase blood flow.

• Desensitize the nervous system.

• Reduce pain with penetration.

Stretching, breathing exercises and relaxation techniques are also used to help the muscles release tension and to set patients up for success at home. “You can’t just insert a dilator and hope for the best,” Weber explains. “Therapy sessions should be pain-free, paced and progressive.” 

Partners are sometimes invited to join therapy sessions. This can help improve communication and, if desired, teach partners how to support stretching exercises or dilator work at home.

Addressing the mental health component

Because anxiety, fear and muscle tension often feed each other, many patients also benefit from working with a mental health provider. This might be a sex therapist or a general mental health provider who can help address the emotional side of vaginismus.

Medical management

Some patients may benefit from medical treatments alongside therapy, including:

• Topical lidocaine to decrease pain before penetration.

• Trigger-point injections to relax tight pelvic muscles.

• Botox injections for more severe muscle overactivity.

Nebraska Medicine OB-GYNs and pelvic pain specialists can provide these treatments. Botox is carefully dosed, so muscles relax without causing problems like urinary incontinence.

How long does treatment take?

There’s no one-size-fits-all timeline. Treatment depends on your goals — whether that’s inserting a tampon, tolerating a pelvic exam or having pain-free intercourse.

“In the beginning, there’s usually a lot of education,” Weber says. “I tend to see patients weekly at first. Over time, as they practice at home, we space visits out every other week.” Most patients need multiple sessions, but progress adds up steadily with consistent home exercises.

Why seeking treatment matters

Vaginismus can affect everyday life, relationships and health. Some patients try to push through the pain, especially when trying to conceive, but forcing penetration usually worsens symptoms. And for many, penetration isn’t possible at all without treatment.

Getting help is also important for preventive care. Pap smears require a speculum exam, which can be difficult with untreated vaginismus. People with hypertonic pelvic floor issues may also experience symptoms like urinary urgency, pelvic pain or recurrent UTIs.

Most importantly, vaginismus is a medical condition — not a sign of being shy, prudish or uninterested in sex. Shame and embarrassment can prevent people from seeking care, but treatment is effective, and there is real hope.

“I always remind my patients that there’s nothing wrong with them,” Weber says. “You can absolutely reach your goals. The path may look a little different for everyone, but improvement is always possible.”

If you’re experiencing symptoms of vaginismus, you deserve compassionate, evidence-based care. The condition is treatable, and you don’t have to face it alone.