Vaginismus: Understanding Pain with Penetration and the Role of the Pelvic Floor
- Dr Natalie Hutchins
- 3 days ago
- 3 min read
By Dr Natalie Hutchins
Pain with vaginal penetration is common, distressing, and frequently misunderstood. Many women experience years of difficulty using tampons, undergoing pelvic examinations, or having penetrative sex before receiving a clear explanation or being told that “nothing is wrong”.
Vaginismus is one of the pelvic floor conditions that can cause penetration pain. While the terminology has evolved, the experience is real, physical, and highly treatable with the right support.
What is vaginismus?
Vaginismus describes involuntary tightening or guarding of the pelvic floor muscles around the vaginal opening, making penetration painful or impossible. This response is not conscious or deliberate; it is a protective reflex driven by the nervous system.
Women may experience difficulty or pain with:
tampon use
vaginal penetration during sex
pelvic examinations or smear tests
Vaginismus can be:
primary (lifelong): present from first attempts at penetration
secondary (acquired): developing later, often after pain, trauma, childbirth, surgery, hormonal change or conditions such as endometriosis and adenomyosis
Updated medical terminology: Genito-Pelvic Pain/Penetration Disorder (GPPPD)
In modern medical classification, vaginismus is no longer listed as a standalone diagnosis and instead the term: Genito-Pelvic Pain/Penetration Disorder (GPPPD) is used.
This diagnosis recognises that penetration pain is multifactorial, involving an interaction between muscles, pain processing, and emotional and nervous system responses, rather than a single cause.
Diagnostic features of GPPPD
A diagnosis of GPPPD may include one or more of the following, present for at least six months and causing distress:
difficulty with vaginal penetration
pain during penetration attempts
fear or anticipation of pain
involuntary pelvic floor muscle tightening during penetration
Importantly, this diagnosis does not imply the pain is psychological or “in the mind”. It reflects real changes in muscle tone, pain sensitivity, and nervous system signalling.
What does GPPPD/vaginismus feel like?
Women may describe:
burning, stinging, or tearing sensations
a feeling of “hitting a wall” at the vaginal entrance
involuntary closing or clenching
anxiety or panic around penetration
difficulty relaxing the body despite wanting penetration
Symptoms can vary in severity and may fluctuate over time.
What causes vaginismus / GPPPD?
The condition is usually multifactorial, involving interactions between:
pelvic floor muscle overactivity
pain sensitisation
fear-avoidance responses
previous painful experiences (medical, sexual, or obstetric)
hormonal changes affecting vaginal tissues
underlying pelvic pain conditions such as endometriosis
This is best understood as a protective reflex rather than a dysfunction or failure of the body.
The role of the pelvic floor
In vaginismus, the pelvic floor muscles are typically overactive, tight, or poorly coordinated, rather than weak.
For this reason:
strengthening exercises alone may worsen symptoms
proper assessment is essential before treatment
treatment focuses first on relaxation, control, and desensitisation
How is vaginismus treated?
Treatment usually includes:
· Pelvic health physiotherapy
Focused on pelvic floor relaxation, coordination, manual techniques, breathing strategies, and gradual exposure where appropriate.
· Education and pain science
Understanding how pain and muscle guarding develop often reduces fear and improves outcomes.
· Gradual exposure and vaginal trainers
Used carefully and progressively, often alongside physiotherapy guidance.
· Psychological or sex therapy support
Particularly helpful when fear, anxiety, or past experiences contribute to symptoms.
Multidisciplinary care is associated with the best outcomes.
Prognosis
With appropriate assessment and treatment, most women experience significant improvement or full resolution of symptoms. Early intervention reduces the risk of symptoms becoming entrenched.
Vaginismus is common, treatable, and not something women need to “push through” or accept.
Further resources
References
Reissing ED et al. J Sex Med. 2004.
American Psychiatric Association. DSM-5-TR. 2022.
Bergeron S et al. Clin J Pain. 2010.
Fitzgerald MP et al. Obstet Gynecol. 2003.
