A guide to navigating vaginismus: In pursuit of healing and pleasure

Rather unexpectedly, I owe every morning-after glow and satisfied smirk to a condition that once brought me sharp, searing pain—and underlined the crucial nature of conversation. My meager sex education in high school—receiving The Talk in all its glory, and an in-depth guide to handjobs from a friend who identified as an “expert”—wasn’t enough, as it turns out. Grasping the language of my body required more attention and discussion. 

It was that first attempt at a tampon insertion, and with it a feeling akin to a knife piercing between my legs, that suggested my coming of age would look different than I had anticipated. A fantasy that involved some acne-ridden boy with hair he had to constantly shake to the side and his twin bed while his parents were out—if I was lucky! We don’t always know what’s best for us when we’re seventeen, especially when it comes to self-talk. The only words I had for my inability to insert a tampon, let alone a finger, were: Something is wrong with you and it’s your fault. 

After five years of pain and shame, a pelvic floor therapist interrupted my brain’s looping theory by finally naming my condition: primary vaginismus. The terminology was an acknowledgement; one that helped me immediately feel less alone, less to blame, and that would guide me toward answers to a growing set of questions.  

What is vaginismus? 

As explained by pelvic floor physical therapist, Dr. Abby Smith, PT, DPT, “Vaginismus is the involuntary contraction or spasm of the pelvic floor muscles when something enters the vaginal canal. It can be triggered by physical contact, but even simply envisioning contact can produce a reaction.” 

According to a 2025 study, around 5-7% of people with vaginas are reportedly affected worldwide. However, Dr. Smith suggests that the numbers may be difficult to account for: “I’d argue it’s higher due to underreporting; we also see that if providers aren’t asking about sexual health, it doesn’t get shared.”

Vaginismus can also constitute a spectrum of experience, categorized as “primary” or “secondary” vaginismus, depending on when symptoms first appeared. Defined by Dr. Smith, “Primary vaginismus is when a person has always experienced involuntary contractions related to vaginal penetration (e.g. during sex, when inserting tampons, or during medical examinations).” 

Meanwhile, secondary vaginismus occurs when somebody was able to have pain-free vaginal penetration in the past, but then develops difficulties with it—often thought to be triggered by environmental factors or experiences. According to Dr. Smith, these triggers might include things like traumatic childbirth; sexual assault; trauma, guilt, and shame around sexual experiences; or hormonal changes which impact the vagina and make penetration painful. Still, these examples aren’t exhaustive, and each individual’s experience will be entirely unique. “One of the most complex things about [vaginismus] is how multifactorial it is,” Dr. Smith adds. 

Learning the language of my body

As the years went on, I could fantasise lying next to someone in a dorm room, but the tension began as soon as I so much as felt the fuzzy fibers of a tampon or the heat of a hand—even my own—in the vicinity of my inner thighs. For others, vaginismus's effects can be provoked by the thought of touch anywhere near the lower body, according to Dr. Smith. Therefore, acknowledging how the mind interprets pain plays an enormous role in the treatment of vaginismus.

“The pelvic floor gets direct intervention from the autonomic nervous system, which is your involuntary nervous system,” Dr. Smith explains. The autonomic nervous system is broken up into the parasympathetic nervous system (which is responsible for what people refer to as "rest and digest"), and the sympathetic nervous system (responsible for "fight or flight"). These two structures work together to support and regulate nervous system balance.

Dr. Smith continues, “Life is pretty go-go-go for most people, and that can lead to this sympathetic nervous system being ‘on’ all the time. So if that’s on all the time, your pelvic floor is holding more tension and it’s discoordinated from the breath system—these things can trickle down.” 

What’s more, anxiety over the pain can create a feedback loop, exacerbating the entire experience. This is why Dr. Smith recommends a holistic approach to treatment involving both the physical and the mental. It's helpful to think about—and discuss—one’s experience beyond the walls of a pelvic floor therapist’s office. In a manner of speaking, I was medically advised to explore what I was feeling in the bedroom; a thought that could break the brain of the average man I came across in my early twenties, the type whose concept of sex boiled down to: I simply put it in and you love it. They were not very sensitive to my condition, but I’d venture that’s a result less of cruelty than of narrow-mindedness, lack of imagination, and the oft-cis-straight male belief that sex is primarily about their orgasms. Vaginismus hasn’t just enlightened me in regards to people with vaginas, but to people living in all kinds of bodies. Anxiety and frustration are just as universal as desire and connection. 

Vaginismus treatment options

“There’s a psychosocial component to this,” Dr. Smith says. “It’s not just the [pelvic] muscles. [Vaginismus] is definitely understood to be a lot more complex and diverse, and I think the biggest [takeaway] is that’s how you have to treat this. It needs to be multidisciplinary, it’s not just one person or principle treatment that’s going to solve this and maintain it too.” 

To this end, Dr. Smith names several approaches that focus on steps, not leaps. These include physical graded desensitization techniques, which can be practiced solo, with a pelvic floor therapist, or with a partner. You can approach graded exposure in three main ways:

• Touch: Beginning with a hand on the lower inner thigh for an extended period of time, or placing two fingers next to the vulva, experiment with touching and noting how it feels.
• Dilators: Often made of medical-grade silicone, these flexible tools of varying length and width are meant to be inserted inside the vagina, and can be used to further test touch and feeling. 
• Breathwork: You can intentionally stimulate the calm nervous system by breathing deeply throughout any practice, to stay present and grounded.

Dr. Smith emphasizes the crucial combination of mental health therapy in conjunction with physical therapy: “You’re retraining the body’s connection to this area, working on interoception, which is your body’s ability to sense internal things going on, such as intestinal pain when your stomach hurts.” Therefore, routinely speaking with a professional can ease the mind through affirmations and talking out how you feel in intimate settings, whether with a counselor, psychologist, or sex therapist. 

AASECT-certified sex therapist Dr. Rosara Torrisi highlights the importance of self-kindness:  “If you don’t have compassion for your body, it’s really hard to have pleasure with this body,” she explains. Exploring my own treatment, whether alone or with another person, I assured myself, “I’m safe. I can go as slow as I’d like. I’m here to feel good, whatever that may be.” Other times, when in need of a quick boost, I simply reminded myself, “I’m hot.” 

This is not a lone endeavor

The natural progression of self-confidence gained through physical and mental health therapy ushered its way into my relationships. Simultaneous to my understanding that I was deserving of pleasure, I realized the burden of invisible pain wasn’t mine to carry alone. Relaying to my friends over coffee that “I fit half my pointer finger in!” was reminiscent of middle school sleepovers, speculating together in the dark about what exactly a blowjob was.

These kinds of conversations are meant to continue, adapting as we educate ourselves after sexual rendezvous and visits to the gynaecologist or pelvic floor therapist. Dr. Smith advocates for sharing information, as it can neutralize feelings of shame, and aids in “breaking that pain cycle, because it can really help those catastrophizing thoughts and the fear that we see with vaginismus.”

When it comes to discussions with a new partner, Dr. Torrisi encourages statements along the lines of: “I know my body likes this.” From oral sex to mutual masturbation to slow penetration, there are still orgasms to be had with vaginismus. “It’s a part of a whole consent conversation that should be happening anyway with sex or sexual activities, so it doesn't have to be something that somebody feels ashamed of having to negotiate just because of vaginismus,” said Dr. Torrisi.

After years of consistently verbalizing what I like and what I don’t, my body opened up. It’s not quite relief I feel, but appreciation for pleasure in all its forms. I don’t think of my own journey as one of overcoming—rather one of understanding my body’s needs, and its wants. Which I’m learning to be loud about, even if the neighbors hear. 

Read more about journeys with vaginismus, and discover how to communicate your desires in our Feeld guide. If you’re curious about exploring your connections with others—and with yourself—we’re waiting for you on Feeld.