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While drafting a (still unfinished) reply to Real Sex 101 I googled vaginismus to make sure I had the spelling and definition right and discovered that the Wikipedia page assumes anyone with a vagina is a woman. Below is a draft corrected version but I've never edited Wikipedia before and HATE proofreading so am a bit hesitant to post it. I haven't done any major edits beyond ungendering the language, what do people think? It's pretty clunky in places, though not all of that is my fault :)
'''Vaginismus''', sometimes anglicized '''vaginism''' is the German name for a condition which affects a person's ability to engage in any form of [[vagina]]l penetration, including [[sexual intercourse]], insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a reflex of the [[pubococcygeus muscle]], which is sometimes referred to as the "PC muscle". The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration—including [[sexual intercourse]]—painful or impossible.
Someone suffering from vaginismus does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus and the pain during penetration, including sexual penetration, varies from person to person.
==Primary vaginismus==
A person is said to have primary vaginismus when they have never been able to have penetrative sex or experience vaginal penetration without pain. It is commonly discovered in [[Adolescence|teenagers]] and adults in their early twenties, as this is when many young people in the Western world attempt to use [[tampon]]s, have penetrative sex, or undergo a [[Pap test|Pap smear]]. People with vaginismus may be unaware of the condition until they attempt vaginal penetration, and may find it confusing. They may believe that vaginal penetration should naturally be easy, or may be unaware of the reasons for their condition.Pacik, PT Botox Treatment for Vaginismus Plast Reconst Surg vol 124: 455e-456e Dec. 2009
A few of the main factors which may contribute to primary vaginismus include:
* a condition called [[vaginal vestibulair syndrome]] more or less synonimous to [[focal vaginitis]] a so called subclinical inflammation. No pain is perceived, until some form of penetration is tried.
* [[urinary tract infection]]s or vaginal [[Candidiasis|yeast infections]].
* [[sexual abuse]], [[rape]], or attempted sexual abuse
* knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
* [[domestic violence]] or conflict in the early home environment
* having been taught that sex is immoral, vulgar, or demoralizing
* fear of pain associated with penetration, particularly the popular misconception of 'breaking' the [[hymen]] upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
* being sexualized or told about sex in violent or inappropriately graphic terms before an age at which one is comfortable with such information {{Citation needed|date=November 2010}}
* any physically invasive trauma
* generalized anxiety
* stress
Occasionally, primary vaginismus is [[idiopathic]].{{cite web | Sandra Risa Leiblum, Ph.D. | title =Vaginismus | work =Sexual Pain Disorders - Vaginismus | url=http://www.health.am/sex/more/sexual_pain_disorders_vaginismus/ | year = 2006 | publisher=Armenian Medical Network | accessdate=2008-01-07}}
Vaginismus has been classified by Lamont{{cite journal | last1 = Lamont | first1 = JA | title = Vaginismus | journal = American journal of obstetrics and gynecology | volume = 131 | issue = 6 | pages = 633–6 | year = 1978 | pmid = 686049 }} according to the severity of the condition. He describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor which can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus (also known as grade 4 vaginismus), the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, going unconscious, wanting to jump off the table or attacking the doctor.Pacik, PT., Cole JB. When Sex Seems Impossible. Stories of Vaginismus and How You Can Achieve Intimacy. Odyne Publishing pp 40-47, 2010 The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists.
However, it does not allow for a language with which someone with vaginismus might be able to verbalise their concerns, pain or problems. A patient with a lot of trust in the doctor might be classified as 1 but experience severe pain. A patient with less trust or who is or has been subjected to harsh examination, might be classified as 4 or 5.
Though spasm of the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified 2 additional involved spastic muscles in treated patients under sedation. These include the entry muscle
(bulbocavernosum) and the mid vaginal muscle (puborectalis). This accounts for the common complaint that patients often say when trying to have intercourse "It's like hitting a brick wall".Pacik, PT Botox Treatment for Vaginismus Plast Reconst Surg vol 124: 455e-456e Dec. 2009
== Secondary vaginismus ==
Secondary vaginismus occurs when someone who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a [[yeast infection]] or trauma during [[childbirth]], or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.{{Citation needed|date=July 2008}}
== Prevalence ==
The prevalence of vaginismus has been reported to be 6% in two widely divergent cultures, Morocco and Sweden. The prevalence of manifest [[dyspareunia]] has been reported as low as 2% in elderly British cis women, yet as high as 18–20% in British and Australian studies.{{cite journal | doi=10.1111/j.1743-6109.2004.10106.x | author=Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD | title = Epidemiology/Risk Factors of Sexual Dysfunction| work = Epidemiology/Risk Factors of Sexual Dysfunction | url=http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1743-6109.2004.10106.x | pmid=16422981 | publisher=Journal of Sexual Medicine | pages=35 | issue=1 | volume=1 | journal=The Journal of Sexual Medicine | accessdate=2008-01-08 | year=2004}}
By another study vaginismus rates of between 12% and 17% have been reported in people presenting to sex therapy clinics (Spector and Carey 1990). National Health and Sexual Life Survey, which used random sampling and structured interviewing, found that between 10% and 15% of women reported having experienced pain during intercourse during the last 6 months (Laumann et al. 1994).
The most recent study-based estimates of vaginismus range from 5% to 47% of people presenting for sex therapy or complaining of sexual problems, with significant differences across cultures (see Reissing et al. 1999; Nusbaum 2000; Oktay 2003). It seems likely that society's expectations of women's sexuality may particularly impact on these sufferers.{{cite web | title =Critical literature Review on Vaginismus| work =Critical literature Review on Vaginismus | url=http://www.vaginismus-awareness-network.org/lit_review.html | publisher=Vaginismus Awareness Network | accessdate=2008-01-08}}
== Treatment ==
There are a variety of factors that can contribute to vaginismus. These may be [[psychology|psychological]] or [[Physiology|physiological]], and the treatment required can depend on the reason that the person has developed the condition. As each case is different, an individualized approach to treatment is useful. The condition will not necessarily become more severe if left untreated, unless the person with vaginismus is continuing to attempt penetration, despite feeling pain. Some people may choose to refrain from seeking treatment for their condition.
According to the [[Cochrane Collaboration]] review of the scientific literature, "In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies."Interventions for vaginismus, The Cochrane Database of Systematic Reviews 2007 [http://www.cochrane.org/reviews/en/ab001760.html] Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90–95% and even 100%. For an example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see Reissing's literature review (links below). A Dutch study showed that many patients were subsequently able to be penetrated, but far fewer actually enjoyed being penetrated. Ph. Weyenborg et. al. Results for systematic desensitization with vaginismus 20o4-2008
===Psychological treatment===
According to Ward and Ogden's qualitative study on the experience of vaginismus for women (1994), the three most common contributing factors to vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature).
Vaginismus patients are twice as likely to have a history of childhood sexual interference and held less positive attitudes about their sexuality whereas no correlation was noted for lack of sexual knowledge or physical abuse.Reissing ED, Binik YM, Khalifé S, Cohen D, Amsel R.( 2003) Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther.29:47-59.
For some people with vaginismus, especially those with primary vaginismus, it is important to address the psychological aspects of the problem as well as the actual muscle spasm. Someone with vaginismus may choose to address the issue on their own terms, or they may avail the help of a therapist. Some, especially those with secondary vaginismus, may rely on a physical rather than psychological treatment and also be successful. There are emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and [[clinical depression|depression]].
As vaginismus includes a reflex, vaginismus should not be viewed as an behavior problem; so behavior therapies are problematic. Therapies that include the body and deeper brain structures (like [[EMDR]]) appear to be the more logical therapeutic choice.
===Physical treatment===
Treatment of [[vaginal vestibulair syndrome]] cq. [[focal vigaginitis]] most times start with soothing cream with a pH of 4.
If that does not work, than some anti inflammatory topical drugs are used.
Also an diet low on oxalate is advised.
[[File:Dilatorsfortreatingvaginismus.jpg |thumb|Dilators for Treating Vaginismus]]
Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and [[desensitization]] with [[speculum (medical)|vaginal dilators]]. Dilating involves inserting objects, usually [[phallus|phallic]] in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the patient progresses.
===== '''Botox™ Vaginismus Treatment''' =====
In cases of vaginismus where more traditional treatments have not been successful, Botox™ is now used. [[Botox]]™ offers an option that allows those who deeply fear penetration to the point where dilators are "too scary" to move ahead despite this fear{{cite web | title =Botox™ Vaginismus Treatment| work =Literature on Vaginismus Treatment| url=http://www.centerforfemalesexuality.com/vaginismus-botox.html | publisher=Medical Center for Female Sexuality| accessdate=2010-12-13}}.
The use of Botox™ relaxes the muscle spasm for some months. After the procedure, the patient awakens having already achieved that which is usually the hardest first step, the insertion of the first dilator. The anesthesia works to ensure that their first experience with the dilator is not painful at all. {{cite web | title =Botox™ Vaginismus Treatment| work =Literature on Vaginismus Treatment| url=http://www.centerforfemalesexuality.com/vaginismus-botox.html | publisher=Medical Center for Female Sexuality| accessdate=2010-12-13}}
==Sexuality==
If someone suspects they have vaginismus, sexual penetration is likely to remain painful or truly impossible until their vaginismus is addressed. This is a highly frustrating condition, as a lot of people, including doctors, may comment on their motives. Having vaginismus does not mean that the person does not want intercourse or does not love their partner. People with vaginismus may be able to engage in a variety of other sexual activities, as long as penetration is avoided. The sexual partners of people with vaginismus may come to believe that they do not want to engage in penetrative sex at all, though this may not be true. There is currently no indication that vaginismus reduces sexual drive or arousal and as such it is likely that many people with vaginismus wish to engage in penetrative sex to the same degree as those unaffected by it, but are deterred by the pain and emotional distress that comes with each attempt. Psychological pressure to "perform" sexually or become aroused quickly with a partner can be deteriorating.
===Masturbation===
Many people do not realize that it is common for people with vaginas to experience pain or discomfort upon attempting sexual penetration without being sufficiently aroused. Most people with vaginas acknowledge [[sexual arousal]] as vital to achieving comfortable penetration.
One of the problems which may accompany vaginismus is that the person with vaginismus may be extremely hesitant to engage in penetrative sexual activity with others, due to a fear of pain associated with any kind of vaginal penetration. Solo masturbation, with penetration, can alleviate this fear.
[[Orgasm]] need not be the only goal of masturbation. It may also serve to increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the [[vulva]], as well as in the [[vaginal lubrication]] produced. As a person becomes more aware of their individual sexual response, they can learn which sensations are best for bringing themselves to a state of arousal. They will then be better equipped to teach their partner which sensations feel best for them.
===Emotional experiences===
Frustration literally means disappointment. A person who is willing to have penetrative vaginal intercourse and finds that their vagina fires off a reflex that makes intercourse impossible, is likely to have all sorts of emotions ranging from amazement to grief to embarrassment.
Many people with vaginas have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. A sense of uselessness associated with vaginismus may increase these negative associations.
These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Feelings of extreme shame, inadequacy or fear of being "defective" can be deeply troubling. If multiple attempts to penetrate are made before treating vaginismus, it may lead to fear of sexual intercourse, and worsen the amount of pain experienced with each subsequent attempt. Relaxation, patience and self-acceptance are vital to a pleasurable experience.
'''Vaginismus''', sometimes anglicized '''vaginism''' is the German name for a condition which affects a person's ability to engage in any form of [[vagina]]l penetration, including [[sexual intercourse]], insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a reflex of the [[pubococcygeus muscle]], which is sometimes referred to as the "PC muscle". The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration—including [[sexual intercourse]]—painful or impossible.
Someone suffering from vaginismus does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus and the pain during penetration, including sexual penetration, varies from person to person.
==Primary vaginismus==
A person is said to have primary vaginismus when they have never been able to have penetrative sex or experience vaginal penetration without pain. It is commonly discovered in [[Adolescence|teenagers]] and adults in their early twenties, as this is when many young people in the Western world attempt to use [[tampon]]s, have penetrative sex, or undergo a [[Pap test|Pap smear]]. People with vaginismus may be unaware of the condition until they attempt vaginal penetration, and may find it confusing. They may believe that vaginal penetration should naturally be easy, or may be unaware of the reasons for their condition.Pacik, PT Botox Treatment for Vaginismus Plast Reconst Surg vol 124: 455e-456e Dec. 2009
A few of the main factors which may contribute to primary vaginismus include:
* a condition called [[vaginal vestibulair syndrome]] more or less synonimous to [[focal vaginitis]] a so called subclinical inflammation. No pain is perceived, until some form of penetration is tried.
* [[urinary tract infection]]s or vaginal [[Candidiasis|yeast infections]].
* [[sexual abuse]], [[rape]], or attempted sexual abuse
* knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
* [[domestic violence]] or conflict in the early home environment
* having been taught that sex is immoral, vulgar, or demoralizing
* fear of pain associated with penetration, particularly the popular misconception of 'breaking' the [[hymen]] upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
* being sexualized or told about sex in violent or inappropriately graphic terms before an age at which one is comfortable with such information {{Citation needed|date=November 2010}}
* any physically invasive trauma
* generalized anxiety
* stress
Occasionally, primary vaginismus is [[idiopathic]].{{cite web | Sandra Risa Leiblum, Ph.D. | title =Vaginismus | work =Sexual Pain Disorders - Vaginismus | url=http://www.health.am/sex/more/sexual_pain_disorders_vaginismus/ | year = 2006 | publisher=Armenian Medical Network | accessdate=2008-01-07}}
Vaginismus has been classified by Lamont{{cite journal | last1 = Lamont | first1 = JA | title = Vaginismus | journal = American journal of obstetrics and gynecology | volume = 131 | issue = 6 | pages = 633–6 | year = 1978 | pmid = 686049 }} according to the severity of the condition. He describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor which can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus (also known as grade 4 vaginismus), the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, going unconscious, wanting to jump off the table or attacking the doctor.Pacik, PT., Cole JB. When Sex Seems Impossible. Stories of Vaginismus and How You Can Achieve Intimacy. Odyne Publishing pp 40-47, 2010 The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists.
However, it does not allow for a language with which someone with vaginismus might be able to verbalise their concerns, pain or problems. A patient with a lot of trust in the doctor might be classified as 1 but experience severe pain. A patient with less trust or who is or has been subjected to harsh examination, might be classified as 4 or 5.
Though spasm of the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified 2 additional involved spastic muscles in treated patients under sedation. These include the entry muscle
(bulbocavernosum) and the mid vaginal muscle (puborectalis). This accounts for the common complaint that patients often say when trying to have intercourse "It's like hitting a brick wall".Pacik, PT Botox Treatment for Vaginismus Plast Reconst Surg vol 124: 455e-456e Dec. 2009
== Secondary vaginismus ==
Secondary vaginismus occurs when someone who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a [[yeast infection]] or trauma during [[childbirth]], or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.{{Citation needed|date=July 2008}}
== Prevalence ==
The prevalence of vaginismus has been reported to be 6% in two widely divergent cultures, Morocco and Sweden. The prevalence of manifest [[dyspareunia]] has been reported as low as 2% in elderly British cis women, yet as high as 18–20% in British and Australian studies.{{cite journal | doi=10.1111/j.1743-6109.2004.10106.x | author=Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD | title = Epidemiology/Risk Factors of Sexual Dysfunction| work = Epidemiology/Risk Factors of Sexual Dysfunction | url=http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1743-6109.2004.10106.x | pmid=16422981 | publisher=Journal of Sexual Medicine | pages=35 | issue=1 | volume=1 | journal=The Journal of Sexual Medicine | accessdate=2008-01-08 | year=2004}}
By another study vaginismus rates of between 12% and 17% have been reported in people presenting to sex therapy clinics (Spector and Carey 1990). National Health and Sexual Life Survey, which used random sampling and structured interviewing, found that between 10% and 15% of women reported having experienced pain during intercourse during the last 6 months (Laumann et al. 1994).
The most recent study-based estimates of vaginismus range from 5% to 47% of people presenting for sex therapy or complaining of sexual problems, with significant differences across cultures (see Reissing et al. 1999; Nusbaum 2000; Oktay 2003). It seems likely that society's expectations of women's sexuality may particularly impact on these sufferers.{{cite web | title =Critical literature Review on Vaginismus| work =Critical literature Review on Vaginismus | url=http://www.vaginismus-awareness-network.org/lit_review.html | publisher=Vaginismus Awareness Network | accessdate=2008-01-08}}
== Treatment ==
There are a variety of factors that can contribute to vaginismus. These may be [[psychology|psychological]] or [[Physiology|physiological]], and the treatment required can depend on the reason that the person has developed the condition. As each case is different, an individualized approach to treatment is useful. The condition will not necessarily become more severe if left untreated, unless the person with vaginismus is continuing to attempt penetration, despite feeling pain. Some people may choose to refrain from seeking treatment for their condition.
According to the [[Cochrane Collaboration]] review of the scientific literature, "In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies."Interventions for vaginismus, The Cochrane Database of Systematic Reviews 2007 [http://www.cochrane.org/reviews/en/ab001760.html] Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90–95% and even 100%. For an example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see Reissing's literature review (links below). A Dutch study showed that many patients were subsequently able to be penetrated, but far fewer actually enjoyed being penetrated. Ph. Weyenborg et. al. Results for systematic desensitization with vaginismus 20o4-2008
===Psychological treatment===
According to Ward and Ogden's qualitative study on the experience of vaginismus for women (1994), the three most common contributing factors to vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature).
Vaginismus patients are twice as likely to have a history of childhood sexual interference and held less positive attitudes about their sexuality whereas no correlation was noted for lack of sexual knowledge or physical abuse.Reissing ED, Binik YM, Khalifé S, Cohen D, Amsel R.( 2003) Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther.29:47-59.
For some people with vaginismus, especially those with primary vaginismus, it is important to address the psychological aspects of the problem as well as the actual muscle spasm. Someone with vaginismus may choose to address the issue on their own terms, or they may avail the help of a therapist. Some, especially those with secondary vaginismus, may rely on a physical rather than psychological treatment and also be successful. There are emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and [[clinical depression|depression]].
As vaginismus includes a reflex, vaginismus should not be viewed as an behavior problem; so behavior therapies are problematic. Therapies that include the body and deeper brain structures (like [[EMDR]]) appear to be the more logical therapeutic choice.
===Physical treatment===
Treatment of [[vaginal vestibulair syndrome]] cq. [[focal vigaginitis]] most times start with soothing cream with a pH of 4.
If that does not work, than some anti inflammatory topical drugs are used.
Also an diet low on oxalate is advised.
[[File:Dilatorsfortreatingvaginismus.jpg |thumb|Dilators for Treating Vaginismus]]
Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and [[desensitization]] with [[speculum (medical)|vaginal dilators]]. Dilating involves inserting objects, usually [[phallus|phallic]] in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the patient progresses.
===== '''Botox™ Vaginismus Treatment''' =====
In cases of vaginismus where more traditional treatments have not been successful, Botox™ is now used. [[Botox]]™ offers an option that allows those who deeply fear penetration to the point where dilators are "too scary" to move ahead despite this fear{{cite web | title =Botox™ Vaginismus Treatment| work =Literature on Vaginismus Treatment| url=http://www.centerforfemalesexuality.com/vaginismus-botox.html | publisher=Medical Center for Female Sexuality| accessdate=2010-12-13}}.
The use of Botox™ relaxes the muscle spasm for some months. After the procedure, the patient awakens having already achieved that which is usually the hardest first step, the insertion of the first dilator. The anesthesia works to ensure that their first experience with the dilator is not painful at all. {{cite web | title =Botox™ Vaginismus Treatment| work =Literature on Vaginismus Treatment| url=http://www.centerforfemalesexuality.com/vaginismus-botox.html | publisher=Medical Center for Female Sexuality| accessdate=2010-12-13}}
==Sexuality==
If someone suspects they have vaginismus, sexual penetration is likely to remain painful or truly impossible until their vaginismus is addressed. This is a highly frustrating condition, as a lot of people, including doctors, may comment on their motives. Having vaginismus does not mean that the person does not want intercourse or does not love their partner. People with vaginismus may be able to engage in a variety of other sexual activities, as long as penetration is avoided. The sexual partners of people with vaginismus may come to believe that they do not want to engage in penetrative sex at all, though this may not be true. There is currently no indication that vaginismus reduces sexual drive or arousal and as such it is likely that many people with vaginismus wish to engage in penetrative sex to the same degree as those unaffected by it, but are deterred by the pain and emotional distress that comes with each attempt. Psychological pressure to "perform" sexually or become aroused quickly with a partner can be deteriorating.
===Masturbation===
Many people do not realize that it is common for people with vaginas to experience pain or discomfort upon attempting sexual penetration without being sufficiently aroused. Most people with vaginas acknowledge [[sexual arousal]] as vital to achieving comfortable penetration.
One of the problems which may accompany vaginismus is that the person with vaginismus may be extremely hesitant to engage in penetrative sexual activity with others, due to a fear of pain associated with any kind of vaginal penetration. Solo masturbation, with penetration, can alleviate this fear.
[[Orgasm]] need not be the only goal of masturbation. It may also serve to increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the [[vulva]], as well as in the [[vaginal lubrication]] produced. As a person becomes more aware of their individual sexual response, they can learn which sensations are best for bringing themselves to a state of arousal. They will then be better equipped to teach their partner which sensations feel best for them.
===Emotional experiences===
Frustration literally means disappointment. A person who is willing to have penetrative vaginal intercourse and finds that their vagina fires off a reflex that makes intercourse impossible, is likely to have all sorts of emotions ranging from amazement to grief to embarrassment.
Many people with vaginas have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. A sense of uselessness associated with vaginismus may increase these negative associations.
These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Feelings of extreme shame, inadequacy or fear of being "defective" can be deeply troubling. If multiple attempts to penetrate are made before treating vaginismus, it may lead to fear of sexual intercourse, and worsen the amount of pain experienced with each subsequent attempt. Relaxation, patience and self-acceptance are vital to a pleasurable experience.