What is Vaginismus & What Causes Vaginismus?
Before we get into causes, let’s just define vaginismus.
The definition and diagnostic criteria of vaginismus is not as black and white as you may think, and it is actually something not consistently agreed upon.
As you can imagine, it was misunderstood early on and then not heavily researched. More recently though, more research has come about.
Vaginismus is a clinical syndrome where there is difficulty or pain with vaginal insertion, so much so that it can seem nearly impossible to insert anything vaginally. You may often read that there is an involuntary spasm of the vaginal walls - both the spasm and the involuntary piece of this sentence can be debated, but this can cause occlusion of the vagina, leading to difficulty with insertion. It has overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration.
Read more in the references at the bottom of this post.
There are two main types:
Primary (Lifelong) – Insertion has been difficult or feels impossible since you’re able to remember. This is often first noticed with attempts to insert a tampon, inability to get a pap smear at the gyno, or attempts at intercourse (which could have even been a finger) being unsuccessful.
Secondary (Acquired) – You were able to engage in insertion successfully and without pain at one point in life, then there was an onset of the inability to engage in insertion.
There’s also a third type - Situational Vaginismus — This is when there’s certain situations where vaginismus symptoms come up for you, and others where it does not. For example - maybe you can insert a tampon, but you are unable to insert a finger during intimacy.
What can cause vaginismus:
Again, more research is needed. This is not an exhaustive list. Just because you don’t identify with one of the following causes doesn’t mean you don’t have vaginismus. Also, just because one of the below happens, doesn’t mean you automatically will have vaginismus.
Sexual Trauma or Abuse
A history of sexual trauma can create a protective response in the muscles that has not yet gone away even if you know or feel you are in a safe situation.
Physical and verbal abuse can also feed into this response, even if the physical abuse was elsewhere. When that threat and fear was present, the muscles likely contracted. If that was chronic and/or if the response was not processed, the body can hold onto that threat response. When attempting to engage in insertion, this response may create pain or further guarding.
Shame around Sex or Genitals
Whether from society, media, certain religious or conservative upbringings, or family messaging, negative views around sex, sexuality, or genitals can be prevalent. It is very common for vaginismus to occur in these scenarios. If your body believes that sex is wrong or that nothing should be inserted, then it can respond accordingly to “protect” yourself within that belief. So if you’re told that you should not have sex, that it’s dangerous, or wrong, then the vagina can contract when intercourse is attempted. This shame can even come from something someone said to you one time when you were young and that belief stuck with you.
This shame can be around the act of sex itself, sexuality and who you are attracted to, or your genitals themselves.
Lack of Education
This can come with the religious or conservative upbringing or other scenarios where there is just no to limited education or discussion around sex or genitals.
When we don’t understand something, we can experience a fear of the unknown. It’s also possible something is attempted without having this understanding, leading things to not work or be painful, and then the body now remembers that pain and holds that response (especially when the body didn’t understand why it happened). Also, if something is specifically “hush hush” and not talked about intentionally, then it gets tied to feelings of shame, embarrassment, or thinking it’s wrong.Chronic Anxiety, Stress, Fear
When the body is under frequent stress, anxiety, and fear, the muscles can clench. When this is chronic, the muscles clenching response can also become chronic. This tension can create discomfort or feed into the brain’s pain response with insertion, or make it difficult to insert anything at all. Once that happens, there can be a continued trained response based on that pain, leading to more anxiety or fear, leading to more tension/guarding, and so on.
Physical Trauma or Injury to the Vagina
This could be from injury during birth and delivery, a surgery around the vagina or vulva, or physical injury to these tissues. This can create scar tissue causing pain and discomfort. After experiencing pain, especially with insertion, the brain can remember that and feel fearful of continued insertion leading to closing of the vaginal walls. The scar tissue itself can also create more tension. Especially when the injury is carried with more psychosomatic memory, there might be an emotional sensitivity to these areas being touched.
Medical Influences
Influences such as endometriosis, local infections, hymen or congenital abnormalities, radiation therapy, fibroids, pelvic congestion, or other medical influences can contribute to pelvic muscle tension and pain/sensitivity. Sometimes these are an initial cause, but just because any of these medical influences have been or continue to be present, doesn’t mean you can’t treat your vaginismus.
You could have multiple of these causes, but they can be more like risk factors. You may have experienced one of them, but that doesn’t mean it’s why you now present with vaginismus. Your cause could also be unknown.
It’s important to rule out medical influences, especially something that should be treated or medically addressed. For example, if you have an infection, you’re going to want that addressed!
However, so many of you are told everything looks “normal”, so they’re not sure what to do for you. Even if you don’t know an exact cause, knowing in general what factors could be contributing for you can help you address it and understand it. For example, if you know your symptoms stem from shame around sex, then doing work around addressing that shame or taking it into consideration during treatment strategies will help you better see success.
—> How To Help Your Vaginismus
—> Our Treatment Path for Vaginismus
References:
Crowley, T., Goldmeier, D., & Hiller, J. (2009). Diagnosing and managing vaginismus. BMJ, 338, b2284. https://doi.org/10.1136/bmj.b2284
Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Women’s Health. 2010 Sep;6(5):705-19.
Physiopedia. (n.d.). Vaginismus. Retrieved October 9, 2025, from https://www.physio-pedia.com/Vaginismus?utm_campaign=ongoing_internal&utm_medium=search&utm_source=physiopedia
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By Anxious Pelvis | Pelvic Floor Occupational Therapy in Denver, CO & Virtual Coaching Worldwide
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
