Vaginismus

What is vaginismus?

Vaginismus is the ongoing difficulty getting something into the vagina, while you do want to. The GP guideline describes it as “persistent problems in getting a penis, finger, speculum, or anything else into the vagina, despite the woman’s explicit wish.” The pelvic floor muscles tense up during this without you steering it.

What vaginismus looks like in practice

Usually not as one dramatic moment, but as a list of things that quietly don’t work. The guideline names in one breath a penis, a finger, a speculum “or anything else,” and that is exactly the experience: it’s rarely only about sex.

A woman with primary vaginismus has often never managed to get a tampon in. The smear test is put off three times and then cancelled. The first time with a partner runs aground at the entrance, and not out of unwillingness, because she wanted it. What she remembers is that her body did something she wasn’t part of.

The second form runs differently. Nothing is wrong for years, and then a period with pain arrives. A yeast infection, a childbirth, or a lining that has grown thinner after menopause. People carry on, because it should be possible. The guideline describes that mechanism literally: continuing intercourse when it hurts can lead to secondary vaginismus. The body learns that something is coming that hurts, and closes the door in advance.

How the mechanism works

Relaxation comes after arousal, not before it. Thuisarts.nl sets that order down in three sentences: “For sex without pain you have to be sexually aroused. Arousal makes your vagina wet. Your pelvic floor is already relaxed or relaxes now.” Skip that build-up and penetration chafes, and chafing hurts.

After that it feeds itself. Thuisarts describes the circle like this:

1. You’ve had pain once and become afraid of the next time.
2. “Out of the fear, the muscles in your pelvic floor tense up. This happens on its own, without you wanting it.”
3. Getting aroused therefore takes longer and the vagina becomes wet less quickly.
4. Anyone who starts anyway, before that has happened, has pain again right away.
5. The tension in those muscles increases and the fear grows.

Under that circle, on the same page, stands a sentence that is rarely passed on. “It doesn’t mean your desire for sex is ‘broken.’ You can still get aroused, but it takes longer.” That is not a line of comfort. It is what the GPs write about it.

Primary and secondary vaginismus

The difference sits in the question of whether it has always been there. With primary vaginismus, penetration has never worked. With secondary vaginismus, it worked before and developed later.

That distinction is not academic, because the guideline hangs two different routes on it. With primary vaginismus, the referral is to a sexologist. With secondary vaginismus that mainly seems to follow from longer-standing pain during sex, the policy is the same as for that pain complaint itself, and the attention goes first to the cause of it.

The line between the two is less sharp than the words suggest. The standard itself adds that the distinction between vaginismus and dyspareunia, the pain during sex, is “often not or hardly possible to make.” They blur into each other. Vaginismus can give pain for someone who carries on anyway, and pain can cause vaginismus for someone who carries on too long.

How common vaginismus is in the Netherlands

Far more often in the questionnaire than in the consulting room, and that difference is the most interesting number on this page.

In a random sample of eight thousand Dutch people, 5.2 percent of women reported having vaginismus at least regularly; 4.7 percent were actually bothered by it. For dyspareunia that was 4.9 percent. In total, almost half of women had at least one sexual complaint.

And at the GP? There the incidence of vaginismus is 0.03 per 1000 patients per year. Work that out to a standard practice of 2350 patients and you arrive at roughly one new woman every fourteen years. The whole group of sexual complaints together brings that practice just over two new patients a year.

The standard names where that gap comes from itself. “The probably most important cause is the threshold patients feel about going to the GP with their complaints. Shame (toward the doctor, but possibly also toward the partner) plays a role, alongside a lack of confidence in a solution.”

Measured more broadly: Thuisarts.nl holds that about 20 of 100 women sometimes have pain during sex and 5 of 100 often. Among women younger than 25, that last number is 11 of 100.

What research says about the approach

The evidence is thinner than you’d hope, and on one point strikingly strong.

The Cochrane review Interventions for vaginismus by Melnik, Hawton, and McGuire looked at five studies, of which four with 282 women in total gave usable data. The outcome, in their own words: “There was not enough evidence to say if systematic desensitisation worked better than another treatment.” They add that a clinically relevant effect is therefore not ruled out, only not demonstrated.

After that came Dutch research that did give a clear result. Moniek ter Kuile and colleagues, in a randomized study from 2013, divided seventy women with lifelong vaginismus and their partners by lot into guided exposure or a waiting list. The treatment consisted of at most three two-hour sessions, within one week, in a university hospital, with the woman doing the exercises herself in the presence of her partner and a female therapist. Afterward, 31 of the 35 women in the treatment group reported having had intercourse, against 4 of the 35 in the control group.

The GP guideline draws this conclusion from it: there are indications that behavioral therapy under a therapist’s guidance works, and with confirmed primary vaginismus a woman can be referred directly for exposure under a sexologist’s guidance. With a caveat the standard adds itself, and one you want to know in advance: that specific treatment is “not (yet) available in many places.” What is right for you, your GP decides with you, and not this page.

Why the word vaginismus is disappearing

Because the two big classification systems have both rebuilt the concept, each in their own way.

The DSM-5 merged vaginismus and dyspareunia into one diagnosis, genito-pelvic pain or penetration disorder, partly because they are sometimes hard to tell apart. The ICD-11 of the World Health Organization did it slightly differently. According to the working group that revised that chapter, there is sexual pain-penetration disorder there, which does include vaginismus, but leaves dyspareunia and vulvodynia out of it and places them in the chapter on the urinary tract and genitals.

On the Dutch patient pages you see the result. Thuisarts.nl has an extensive page about pain during sex, with the pelvic floor, the fear circle, and the research in it, and doesn’t use the word vaginismus a single time. The GP guideline still keeps the concept, with the argument that the policy differs in the cases where you can make a distinction.

If you see a doctor who doesn’t use the word, that says nothing about your complaint. Describe what happens, and the conversation comes out of it on its own.

What people get wrong about vaginismus

“It’s because you don’t really want it.” The definition in the guideline contains, word for word, “despite the woman’s explicit wish.” Wanting is exactly what is there.

“Pain during sex just comes with the territory.” Thuisarts.nl waves it away in two sentences: “People sometimes think pain ‘comes with it.’ That’s not true.”

“It goes away after childbirth.” That is not stated, and the guideline even names the misunderstanding separately. Vaginismus is not an indication for a caesarean and does not disappear spontaneously through childbirth. The birth itself can be handled in primary care with vaginismus.

“Vaginismus is the same as pain during sex.” They overlap strongly and, according to the standard, are often impossible to tell apart, but they are two concepts. The DSM-5 threw them onto one pile, the ICD-11 did not.

“If you just persist, you get used to it.” In the guideline, persisting is not a route to recovery but one of the ways secondary vaginismus develops.

What you can do with this

• Describe what doesn’t work, even if you don’t want to say the word vaginismus. “Nothing will go in” is enough information for a GP to keep asking.
• Ask for a female doctor if you find that more comfortable. Thuisarts.nl names that explicitly as something you can ask when you make the appointment.
• Read in advance what the exam involves. Thuisarts describes step by step what the GP does, and that you can say at any moment you want to stop.
• Ask which referral fits your form. The guideline steers toward a sexologist with primary vaginismus and toward a pelvic floor physiotherapist with signs of pelvic floor trouble.
• Assume you’re not the first, however much the number in general practice suggests otherwise. That number measures the threshold, not the complaint.
• Don’t expect treatment from this page. Here is what the concept means and what research says about it. What is going on with you and what can be done about it belongs with your GP.

More reading on vaginismus

Within this glossary, the sexual response cycle explains why arousal comes before relaxation and not the other way around, dilator describes the aid used in increasing sizes in pelvic floor therapy, and menopause covers the other common reason penetration starts to hurt.

Beyond this site, Thuisarts.nl on pain during sex is the best starting point, because it’s the patient version of the guideline your GP uses and describes the consulting-room exam step by step. Anyone who wants to read the underpinning finds it in the NHG-Standaard Seksuele klachten. And anyone who wants to know how thin the treatment evidence is internationally reads the Cochrane review on vaginismus.

Where this fits on this site

I don’t treat vaginismus. That is not modesty, it’s the order: pain during penetration belongs first with your GP, and from there with a pelvic floor physiotherapist or a sexologist, and a date with me replaces none of that. What a date can be is an evening where penetration is not the goal and there is all the time in the world, and how that looks is on intimate togetherness.

This site also has a page that turns the question around and describes what a gigolo could add alongside pelvic floor physiotherapy and therapy, with the agreements that go with it: a gigolo in the treatment of vaginismus. That page takes a wider stance than this one; read them side by side.

Sources

• NHG-Standaard Seksuele klachten (eerste herziening), M87. NHG working group on sexual complaints, Huisarts en Wetenschap 58(11), 586-597, 2015. The guideline Dutch GPs base their policy on for sexual complaints. Provides the definition “persistent problems in getting a penis, finger, speculum, or anything else into the vagina, despite the woman’s explicit wish,” the finding that the distinction from dyspareunia is often not or hardly possible to make, the primary and secondary distinction, the point that continuing intercourse when it hurts can lead to secondary vaginismus, the prevalence of 5.2 percent (4.7 percent bothered) from the questionnaire research among eight thousand Dutch people, the incidence of 0.03 per 1000 patients per year in general practice, shame as the probably most important explanation for that difference, the referral to a sexologist with primary vaginismus and to a pelvic floor physiotherapist with pelvic floor trouble, the finding that vaginismus is not an indication for a caesarean and does not disappear spontaneously through childbirth, and the note that guided exposure is not yet available in many places. The official edition on richtlijnen.nhg.org blocks automated access; this is the full publication of the same standard in the society’s scientific journal.
• Ik heb pijn bij vrijen (vrouw). Thuisarts.nl, Dutch College of General Practitioners and Federation of Medical Specialists, last changed March 25, 2026. The patient version of the same guideline. Provides the order of arousal, wetness, and relaxation, the sentence “People sometimes think pain ‘comes with it.’ That’s not true,” the description of the fear circle with “Out of the fear, the muscles in your pelvic floor tense up. This happens on its own, without you wanting it,” the reassurance that the desire for sex is therefore not broken, the figures of about 20 of 100 women with pain during sex sometimes, 5 of 100 with pain often and 11 of 100 under 25, the option to ask for a female doctor when making the appointment, and the fact that the page nowhere uses the word vaginismus.
• Interventions for vaginismus. Tamara Melnik, Keith Hawton & Hugh McGuire, Cochrane Database of Systematic Reviews, CD001760 (DOI 10.1002/14651858.CD001760.pub2). The systematic review of treatments for vaginismus. Provides the size of the evidence, five studies of moderate to poor quality of which four with 282 women together gave data, and the verdict “There was not enough evidence to say if systematic desensitisation worked better than another treatment,” with the addition that a clinically relevant effect is therefore not ruled out.
• Therapist-aided exposure for women with lifelong vaginismus. A randomized waiting-list control trial of efficacy. Moniek M. ter Kuile, Reinhilde Melles, H. Ellen de Groot, Charlotte C. Tuijnman-Raasveld & Jacques J. D. M. van Lankveld, Journal of Consulting and Clinical Psychology 81(6), 1127-1136, 2013 (DOI 10.1037/a0034292). The Dutch randomized study the guideline draws on. Provides the setup with seventy women and their partners, the treatment of at most three two-hour sessions within one week, and the outcome that 31 of the 35 women (89 percent) reported intercourse afterward against 4 of the 35 (11 percent) in the control group.
• Disorders related to sexuality and gender identity in the ICD-11. Geoffrey M. Reed et al., World Psychiatry 15(3), 205-221, 2016 (DOI 10.1002/wps.20354). The report of the WHO working group that revised the chapter on sexuality in the ICD-11. Provides the place of vaginismus in the new classification: “In ICD-11, Sexual pain penetration disorder includes Vaginismus and excludes Dyspareunia and Vulvodynia, which are classified in the Genitourinary chapter.” The publisher site of World Psychiatry blocks automated access; this is the freely accessible copy in PubMed Central.

Related terms

Vaginismus is about what happens with the pelvic floor; the terms below are about what plays around it.

• Pelvic floor. The muscle group that stands too tense with vaginismus, with the anatomy and the other functions included.
• Sexual response cycle. Why arousal precedes relaxation and lubrication, and not the other way around.
• Dilator. The rod in increasing sizes from pelvic floor therapy, and why the medical and the BDSM use are two different things.
• Menopause. The other common reason penetration starts to hurt, with a very different mechanism under it.
• Libido. How desire and pain influence each other, and why less desire is a consequence here and not a cause.