Does your vagina feel like it’s hitting a brick wall when you have sex? Do you have difficulty inserting objects like tampons?

If it seems like your vaginal entrance has closed off or sex has become a pain – a pelvic pain, that is – there is a term you may want to familiarise yourself with.

No, you’re vagina isn’t broken, nor is it depressed (throwback to Charlotte in that episode of Sex and The City). You might in fact, have vaginismus.

Disclaimer: This article is designed to be informative, and not to replace medical advice from your GP or health professional.

Vagina-what?

Vaginismus (pronounced va-juh-niss-muhz) is a medical condition in which the muscles of the vagina tighten or spasm, making penetrative sex of a vagina difficult. Some experience a slight discomfort, but for others the pain is greater, often described as an intense burning or stinging sensation.

And it’s more common than you think.

“Many people with vulvas experience painful penetrative sex at some point in their lives,” says Kassandra Mourikis, a sexologist and sex therapist based in Melbourne.

In fact, around 20% of cis women have experienced some form of vaginismus within their lifetime. And that number is likely to be even greater.

“Given that most of these studies are outdated, are limited in their sample populations, exclude people with vulvas that aren’t cis women or that some people find the experience embarrassing or sensitive, the rates of painful sex including vaginismus might be far higher,” says Kassandra.

It’s not just sex that is affected – those with vaginismus often cannot use tampons or menstrual cups, and sex toys are out of the question – even a trip to the gyno is difficult.

So what causes vaginismus?

Vaginismus can be caused by a skin infection or irritation, or even recurrent thrush. But, perhaps more commonly, it presents itself from fear or anxiety, or a protective and survival response to a traumatic experience.

“Vaginismus is a very real condition that reflects the mind-body connection, sometimes referred to as psychosomatic,” explains Kassandra. “The mind and body are intrinsically linked and our bodies want to protect us.”

When we encounter any sort of stressor – either real or perceived – that leaves us feeling afraid, anxious or ashamed, the muscles in our body may brace, tense or contract to either fight or flee that stressor.

“When people don’t realise this is happening or when they ignore it, push past it or continue to attempt penetration despite these warnings, sex can often be painful,” says Kassandra.

Penetrating against tight pelvic floors can reinforce the fear response “leading to avoidance of sex – which in turn intensifies this fear.” This is called the cycle of pain and it perpetuates vaginismus.

Where does this fear or anxiety around penetrative sex come from?

“People have been told to expect that sex will hurt, that ‘a little pain is normal’, or they might have experienced sexual violence or trauma,” says Kassandra.

In some cases, a religious or sex-negative upbringing where they have been raised to believe that sex is wrong or immoral can result in tensing or bracing of the body. Stress is another factor that can cause muscles in the pelvic floor to spasm. Likewise, being distracted or not present in the moment might also result in pain during penetration.

Kassandra says it’s important to know that your pain is real, it’s valid and you deserve support.

“People with vulvas who experience it typically have their pain dismissed or denied, told that it’s in their head, that they should have a wine and try to relax. This is incredibly dangerous and worsens outcomes for people with vaginismus because support becomes inaccessible.”

The good news is it is a treatable medical condition – pain-free sex is possible

Lauren Muratore, Director of Integrated Sex & Relationship Therapy in Melbourne, says vaginismus can stem from negative thought patterns such as not feeling good enough to please their partner, preemtping that sex will not be enjoyable and painful, and the feeling that sex is a chore. She teaches women to get out of their heads and into their bodies.

“Concentrating on pleasure, in whatever capacity this looks like, is super important. Many women have an ideal of how they should perform sexually without even knowing their own body.”

One way to overcome vaginismus is to explore other forms of outercourse (sex that happens outside your body – think everything you might label as “foreplay“) and non-painful intercourse (for example oral sex).

“The use of dilators in conjunction with mindfulness, not to mention also focusing on self pleasure rather than just experimentation, can work well together,” Lauren says. “Reframing the sexual script and concentrating on pleasure rather than the expectation of penetration can help wonders.”

Kassandra agrees. “It’s important to remember that sexual intimacy is incredibly diverse and sex doesn’t have to look a certain way for it to be real sex.

“You have every right to define sex and pleasure for yourself. If penis-in-vagina sex isn’t available right now or if you don’t enjoy it, it doesn’t mean you can’t have a pleasurable sex life.”

If you have a sexual or romantic partner, let them know you need them on board.

“Vaginismus is rarely an individual problem and more often a relationship challenge,” says Kassandra.

Likewise, if your partner is the one with this condition, support them by learning about what it is they are dealing with, be flexible with what sex and pleasure looks like, reduce pressure and shift your perspective from adversaries (you vs them) to allies (you and them vs pain).

“Partners play a bigger role in sexual pain outcomes than they may realise.”

There are a range of sexual health professionals that can work with you to develop a program to meet your needs. Firstly, you should visit a gynecologist to make sure the pain is diagnosed correctly. A pelvic floor physiotherapist (yes, that is a thing) can also help to offer relaxation techniques and gradual vaginal training to address the physical aspects of vaginismus.

A sexologist, or sex therapist, can support you to address the emotional and mental elements of vaginismus, including helping you to understand what factors are contributing towards painful sex and the cycle of pain. Sex therapy may also involve unpacking beliefs and feelings about penetrative sex, addressing any negative perceptions and creating conditions of safety and control.

But Kassandra says it’s important to explore what acceptance means (note: it doesn’t mean giving up).

“As a culture, we’re so focused on cures and fixing ourselves, and completely curing or healing pain may not be entirely possible, especially if the pain is lifelong or has shifted into chronic pain. Some people with vulvas may not want to spend their lives and resources trying to get to a place of being pain-free.”

By learning to listen and pay attention to your body, exploring turn-ons and turn-offs, redefining sex for yourself and prioritising pleasure, you can work through vaginismus.

“If you’ve had pain, don’t give up. Search for a health professional; a gynaecologist, pelvic floor physiotherapist, sexual health physician or sexologist/sex therapist who specialises in sexual pain and get support because you don’t have to do this on your own.”