Painful Sex? Experts Say Vaginismus Is Treatable—Here’s How To Find Relief and Enjoy Intimacy Again

If you’ve noticed that sex has become painful lately, you might be experiencing a condition called vaginismus. It happens when the pelvic floor muscles tighten involuntarily, making penetration uncomfortable or even impossible. “Vaginismus is something I see in my practice and hear about frequently from women,” reveals triple-board certified ob-gyn Anna Cabeca, DO. “The encouraging thing is that it can be very treatable once we understand what’s happening.” Keep reading for expert advice on how to treat this frustrating condition so you can reclaim comfortable, joyful intimacy. (And don’t miss the condition’s buzzy pop-culture reference!)

What is vaginismus, and how does it feel?

The main vaginismus symptom is involuntary tightening of the vaginal muscles when penetration is attempted or even anticipated. “Women often describe it as their body clenching or tensing up, sometimes with pain at the vaginal opening,” says Dr. Cabeca. “It can range from mild discomfort to severe pain that makes intercourse feel genuinely blocked.”

“Women often describe it as hitting a wall, a burning or tearing sensation or the body ‘slamming shut’,” adds Vanessa Cushing, a certified sex therapist who treats the psychological, relational and emotional symptoms of vaginismus on a daily basis and personally experienced it herself.

It doesn’t just happen during sex. Some women also experience vaginismus when inserting tampons or undergoing a gynecologic exam.

“Vaginismus is known as ‘high-tone pelvic floor’,” explains Michael Ingber, MD, a urogynecologist and co-founder of LiviWell. This muscle tightening is involuntary. “A woman may very much want to have intercourse, but her pelvic floor muscles essentially react automatically.” This creates an additional challenge. He explains, “Fear or anticipation of pain can then lead to more muscle tightening, creating a cycle of pain and avoidance.”

What causes vaginismus?

Many cases of vaginismus are rooted in a specific event. “It can be triggered by all kinds of things: a yeast infection or UTI that makes sex painful so the body ‘learned’ to guard against it, childbirth, menopause and related hormonal changes, a medical procedure or sexual trauma,” suggests Cushing. “It means vaginismus isn’t just a trauma response. Sometimes the body’s protective reflex gets switched on by something as ordinary as a UTI, and then keeps firing long after the original cause is gone.”

How common is the condition?

Awareness of this women’s health condition has hit pop culture, thanks to the new novel Thighs Wide Shut by Hayley Fleming, who was diagnosed with the mysterious condition. The second-chance romance centers on a character grappling with vaginismus. But how common is it in the real world? Vaginismus affects up to seven percent of women, according to The Journal of Sexual Medicine. And BMC Public Health reports up to 21 percent of women experience painful sexual intercourse at some point in their life.

A gynecologist can diagnose you with vaginismus after taking a sexual health history and giving you an exam. Vaginismus is often categorized as part of a broader condition called genito-pelvic pain/penetration disorder.

How hormonal changes can contribute to vaginismus

Beyond the muscle response itself, hormonal factors with aging can also play a role. “It’s important to address anything else that may be contributing to pain or discomfort, including inflammation, vaginal dryness or hormonal changes,” says Dr. Cabeca. “In some women, particularly during perimenopause or menopause, local hormone therapy or vaginal moisturizers may be helpful when dryness or tissue changes are contributing to pain.”

How to treat vaginismus

The good news? Multiple effective treatments can help you find relief, from working with a pelvic floor physical therapist to learning how to practice diaphragmatic breathing.

Start physical therapy

“This is where pelvic floor physical therapy can become your best friend,” says Dr. Cabeca. “A skilled pelvic floor therapist can help you learn to relax those muscles, because some women actually need to relax the pelvic floor, not strengthen it.”

Dr. Ingber adds, “We often recommend ‘wands’, which are silicone, pyrex, glass or metal inserts that can help in relaxing these muscles. Pelvic floor therapists are excellent at directing women on how to use these wands, and where to use them.” This approach is effective: “For some women, a few visits with a pelvic floor therapist may completely resolve the problem.”

Use vaginal dilators

“Vaginal dilators may also be used gradually and gently, at your own pace,” says Dr. Cabeca. With this approach, you begin by inserting a very small tool in the vagina, then slowly progressing to larger sizes as your muscles learn to relax. “It’s about retraining your muscles.”

Try relaxation techniques

Dr. Ingber says, “Relaxation and breathing techniques can be helpful.” Cushing adds the goal is, “Treating the nervous system, not just the muscle.”

Consider medications

Vaginal relaxant suppositories (medications that help muscles release tension) or Botox injections of the pelvic muscles can also be used in certain cases.

Try talk therapy

The psychological component is equally important. to treat here Dr. Cabeca recommends, “Reducing anxiety, building confidence, learning to breathe through the sensation and sometimes working with a therapist or sex therapist when fear or anxiety is part of the cycle.”

Cushing adds, “Partners are often included in sessions, because vaginismus affects the relationship too, and shame or misunderstanding on either side can make things worse.”

Healing from vaginismus: It’s not your fault

In her therapy practice, Cushing has observed, “The most common turning point is when a patient stops seeing her body as broken and starts seeing the tightening as a protective reflex that can be retrained. That reframe alone often reduces the fear that fuels the cycle.”

“The women who do best are often the ones who stop blaming themselves and get curious instead,” adds Dr. Cabeca. “That shift from shame and fear toward understanding and compassion can be incredibly powerful.”

How fast can women get relief from vaginismus?

“It really depends on the woman and what’s driving it,” says Dr. Cabeca. “Some women see meaningful improvement within weeks; others need months of consistent, gentle work.”

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Dr. Ingber shares, “One woman told me she couldn’t have sex with her husband for 12 years, due to severe pain and discomfort. After 12 weeks of therapy, medical management and a minor procedure we did in the office, she had pain-free sex for the first time in over a decade.” His advice: “Seek a specialist to care for you, and there is almost always something we can do!”

And one Reddit user shared online, “I cured my vaginismus in four months.” She used pelvic floor physical therapy and says, “I went once a week, and it was a game-changer. Most insurance companies cover it, so definitely check!”

The bottom line

“The important thing for women experiencing vaginismus is that there is real reason for hope,” says Dr. Cabeca. “I’ve seen women go from genuine fear of intimacy to being able to have comfortable, pain-free sex. It takes patience and the right support, but significant improvement is absolutely possible.” Remember: Your body’s protective response can be retrained.