Vaginismus refers to a painful condition with both physiologic and psychologic causes that prevents vaginal penetration and can cause severe distress to the woman who suffers from it.

Classically, vaginismus is defined as an uncontrollable contraction of the vaginal muscles that prevents any penetration into the vagina either by her partner’s penis or tampon or even a speculum during gynecologic exam. Women can develop a strong fear of intercourse and have problems with sexual intimacy. Many patients are referred to us for fertility concerns because of inability to have intercourse.

It is not known how many women suffer from vaginismus, as many can be married for many years without either engaging in intercourse or seeking care from a physician. Often, treatment has been directed towards the psychological fear of intercourse and systemic anti-anxiety medications are often prescribed for these women.

Our practice has a specialized program for patients suffering from vaginismus and we do not believe in the philosophy of simply giving women enough drugs to tolerate having intercourse, but would rather try to treat both physical as well as the psychological triggers of vaginismus and allow women to engage in a satisfying and normal sexual lifestyle.

Vaginismus is distinct from other pain conditions of the vagina that do not involve an involuntary contraction of the muscle as the primary initial physical response and this distinction is importantly made by a physician.

Evaluation and Treatment of Vaginismus

The initial evaluation for vaginismus in our office entails a thorough history and a number of sexual health questionnaires to better understand the condition. Specific aspects of the history include prior sexual experiences, concomitant medical problems, prior surgery, and current relationship status.

The physical exam often does not include any vaginal penetration as we do not wish to exacerbate the problem at the first visit, but would rather focus on looking for any dermatologic conditions that can be causing pain or any inflamed glands or inflamed vaginal tissue that may suggest a different diagnosis.

Vaginismus is classically classified as either primary or secondary.

Primary vaginismus occurs in women who have never been able to have intercourse or vaginal penetration and secondary vaginismus occurs in women who have intercourse in the past, but are unable to subsequently. The causes of secondary vaginismus often relate to some type of psychological or physical trauma which could include surgery.

Treatment of vaginismus involves a significant commitment by the patient and the treating provider. In our office, it is a combination of a physician, clinical nurse specialist, pelvic floor physical therapist, and a sex therapist. We have found that using the combination of these professionals as a team approach has afforded us the high degree of success. We define success not only as the ability to achieve penetration, but also the ability to begin enjoying intercourse and sexual intimacy.  We also will address fertility concerns as the patient’s age dictates.

Medical treatment can include antispasmodic medications, intravaginal medicated suppositories, and avoidance of external hormones.

Physical therapy will often involve a very slow progression of dilator use along with exercises to help relax the muscles in a sequential fashion to allow vaginal manipulation. Sex therapy is crucial to help understand how sexual pain and vaginismus can impact relationships, self-esteem, and overall well being. Therapy often surrounds improving one’s self-perception as well as understanding how to control sensations during sexual contact.

The most important aspect of treatment is a strong commitment from the patient to stick with the program. As this condition often haunts women for years, treatment often takes months and can involve many different avenues.

In some cases, we will consider the use of Botox, an injectable agent that can paralyze muscles in patients with vaginismus. The type of patient that is appropriate for Botox is one that has committed to an ongoing course of treatment and has made some progress and is able to use dilators on occasion. Using Botox as an initial treatment has a high degree of failure and disappointment in the patient. This injection can be given in the office, but is most commonly given in the operating room where a Pap smear or vaginal exam, often the first one the women has received, can be performed.  

Information and products for treatment can be available at or through the International Society for the Study of Women’s Sexual Health.

Contact Us


Round Rock Location

970 Hester's Crossing Road
Suite 101
Round Rock,TX 78681

Phone 512-238-0762
Fax 512-341-7370


Lakeline Location

12505 Hymeadow Drive
Suite 2C
Austin, TX 78750

Phone 512-238-0762
Fax 512-341-7370 


South Austin Location

4534 Westgate Blvd
Suite 108
Austin, TX 78745

Phone 512-238-0762
Fax 512-341-7370