Vaginismus Treatments and solutions: The Somatic Sexology Approach
If you’re experiencing pain during sex, you may have heard the term ‘vaginismus’ – but you might be wondering, what actually is vaginismus, why does it occur, and – most importantly – can it be treated?
In this blog, we’ll unpack the underlying causes of vaginismus and explore how somatic sexology can provide effective and lasting relief from this condition.
What is Vaginismus?
Vaginismus is a condition where the muscles around the vaginal opening tighten involuntarily – in other words, it happens automatically without you intending it to.
This can make it difficult or even impossible to insert anything into the vagina, whether that's during sex, when using tampons, or during a gynecological exam. When insertion is attempted, you might experience pain, discomfort, or a burning sensation. It's as though your body is trying to protect itself.
While muscles tightening is a physical symptom, vaginismus commonly stems from psychological causes. It’s rooted in the mind even though it shows up in the body. As a result, vaginismums can deeply impact your emotional well-being, self-image, and intimate relationships.
Fortunately, unlike many other sexual health challenges, vaginismus responds remarkably well to treatment.
What Causes Vaginismus?
Vaginismus is rarely caused by just one thing – instead, it’s a culmination of several factors, such as anticipating pain, relationship dynamics, past experiences, cultural messages about sex, or medical issues. At its core, vaginismus is often connected to fear, not feeling safe, and not feeling in control of your body and what's going to happen to it.
Understanding what's driving your body's protective response is an important step toward healing. Here are some of the common causes that contribute to vaginismus:
Fear of Pain
Fear of pain is one of the most common causes of vaginismus. The fear might stem from a previous painful experience – perhaps the first time you tried to use a tampon, a difficult gynecological exam, a painful sexual encounter, or sexual trauma.
But here's what's interesting: this fear can exist even if you've never experienced pain before. Maybe you heard someone say that sex or insertion "always hurts the first time” – that expectation of pain can become embedded in your mind and body, so that you do experience pain in those situations.
Relationship Dynamics
Sometimes vaginismus is a response to what's happening in your relationship. Your body might be responding to dynamics or patterns that don't feel safe, comfortable or pleasurable, even if you can't always name what's wrong. Often, a partner has something to do with it, not necessarily because they're doing anything intentionally harmful, but because of how interactions unfold between you. This might include:
A partner who moves too quickly or is less attuned to you during sex.
Feeling pressured to have sex before you're ready.
Poor communication about needs and boundaries.
Emotional distance or unresolved conflict.
Mismatched levels of desire.
Accumulated resentment or lack of feeling safe.
This is exactly why including your partner in treatment can be so valuable. They're part of the picture, and they can also be part of the healing.
Personal History & Psychological Factors
Your past experiences and current mental health play a significant role. Contributing factors can include:
Struggles with body image or feeling disconnected from your body.
A history of sexual, emotional, or physical abuse or trauma.
Current mental health challenges like depression or anxiety.
Major life stressors such as job loss, grief, or significant life transitions.
General feelings of shame or discomfort around sexuality.
Cultural & Religious Influences
The messages you received growing up about sex and sexuality matter. The messages you received growing up about sex and sexuality matter. These messages can become embedded in your body's automatic responses. For some women, vaginismus develops in the context of:
Limited or absent sex education.
Cultural or religious teachings that frame sex as sinful, shameful, forbidden, or dangerous.
Internalised beliefs that sexuality is wrong or that "good" women don't enjoy sex, often combined with the expectation that your body should instantly be ready for sex the moment you're with the right person.
Conflicting feelings between personal desires and family or community expectations.
Unrealistic expectations of sexual interactions learnt through pornography.
Medical and Physical Factors
In some cases, vaginismus can stem from physical causes. This might be an ongoing issue like recurring infections, contracting a sexually transmitted disease, or a painful medical procedure.
Even if the original medical issue has healed or resolved, vaginismus can persist. Your body may have learned to guard against pain that's no longer there.
Pelvic floor dysfunction or overactive pelvic muscles.
Vaginal dryness (from hormonal changes, medications, or other causes).
Infections like recurrent UTIs or yeast infections.
Birth injuries or trauma from childbirth.
Previous gynecological surgeries or medical procedures.
Painful conditions like endometriosis or vulvodynia.
Can Vaginismus Be Treated?
Yes, absolutely. And the prognosis is actually very encouraging.
Research shows that with appropriate treatment and commitment to the process, success rates range from 75% to nearly 100%.
Your level of engagement makes a real difference. The more you practice, the more progress you'll experience. The bottom line is this: vaginismus is one of the most treatable sexual health conditions.
How Somatic Sexology Can Treat Vaginismus
The somatic sexology approach offers something that pelvic floor physiotherapy often misses: the integration of arousal, pleasure and partnered dynamics.
While physio focuses on mechanically relaxing muscles (which is an important part of the work), somatic sexology acknowledges that your body needs to be aroused for penetration to feel welcoming rather than threatening. Why would your body want to open to something that doesn't include pleasure?
Rather than just sending you home with exercises, a qualified somatic sexologist can provide real-time guidance and support during the session, as well as creating a comprehensive treatment program that’s tailored to your specific situation, needs, and goals.
As a qualified somatic sexologist, I bring a deep understanding of arousal and actively integrate it into the therapeutic approach, so that you can understand how it works in your body, how partnered dynamics influence your responses, and how to regain a sense of safety, predictability, and control in the bedroom.
Effective treatment typically includes several components working together:
Working with Fear, Emotions, and Beliefs
Since vaginismus often has psychological roots, addressing these is fundamental to treatment. We look at all these elements together and gently work to shift them, building a more positive and safe experience around sex and your body. In a safe, predictable space where you're in full control of what's happening, we explore the underlying causes, process the fears, emotions, beliefs, anxieties and any past trauma, address relationship dynamics, and build new positive associations around sex and your body.
Mind-Body Relaxation Techniques
Learning to calm your nervous system and release tension is key. This includes building awareness of your PC muscles so that you can recognise when they're tensing versus relaxed, and practicing relaxation exercises so you can consciously relax even when your body wants to tense up.
This PC muscle awareness and relaxation work is much of what pelvic floor physiotherapy focuses on. These practices might include:
Relaxing, down-regulating, PC-opening breathing techniques
PC appropriate tuning exercise
Sexual Anatomy Education
Getting to know your anatomy can be a game-changer. When this area feels unfamiliar or intimidating, simply understanding what's where makes a huge difference.
Crucially, you'll learn how arousal causes physical changes in your body – the vaginal canal lengthens, tissues engorge, natural lubrication increases. Your body literally becomes more ready and receptive for insertion when aroused.
Together, you'll learn your body with a mindset of curiosity, mapping where you feel pleasure, identifying exactly where discomfort shows up. Most women are surprised to find that the pain isn't all over like many thought – it's usually localised to specific spots. Just knowing this can bring real relief, confidence, and a sense of curiosity.
Gain a Sense of Safety & Control
The sense of control, safety, and predictability is essential for vaginismus patients. These elements must be present first – only then can we begin to reprogram the nervous system through exposure exercises to positive experiences.
By practicing in this safe, controlled environment where you know what to expect and nothing surprising will happen, your body gradually learns to open and relax to penetration. This foundation of safety and predictability is especially important in partnered practice.
Insertion and Penetration Exercises
This is where everything comes together. The understanding and practice of pleasure and arousal combines with PC muscle relaxation practice, and we bring both of these into the practice of insertion. While dilators can be used, fingers are more recommended – either your own or your partner's – as they're warmer, more responsive, allow for better feedback, and are closer to what sex is going to be like.
The exposure practice integrates arousal with PC relaxation exercises, creating positive associations with penetration. With a sexological bodyworker, you can actually practice insertion techniques during the session itself, learning in real-time with immediate feedback and support.
Readiness Exercises for Couples
To successfully resolve vaginismus, couples need to work together. The partner is a big part of your healing journey. It doesn't matter how much you practice on your own – if your partner isn't attuned, responsive, and easy to communicate with, progress will be limited.
These exercises focus on improving attunement, communication, and slowness, teaching your partner how to support you in your healing process and helping you feel safer in the partnered sex experience.
Keeping both of you connected throughout the healing process is essential. Part of this is separating practice from play time, making sure you still have moments of closeness and intimacy, even if penetration isn't an option yet. Your partner's needs throughout this process are also considered and not forgotten about.
Ready Overcome Vaginismus?
You don't have to live with vaginismus. Healing is possible, and you deserve to have a fulfilling, pain-free intimate life. You can reclaim comfort, pleasure, and confidence in your body. If you're ready to start your process, reach out. I'm here to guide you through a personalized treatment approach that honors your unique experience and goals. Let's begin your journey together.