The actual definition of vaginismus from the Diagnositc & Statistical Manual IV-TR is "involuntary contraction of the musculature of the outer third of the vagina interfering with intercourse, causing distress and interpersonal difficulty." Because of considerable confusion and criticism, this definition is in the process of being revised. The current definition does not address the fact that there may be anatomical abnormalities preventing penetration, or that there have been varying degrees of muscle contraction found.
Since they are often experienced together, vaginismus is often lumped together with dyspareunia (sexual pain) but actually only refers to the specific contraction or spasm that prevents penetration. Since attempts at penetration with vaginismus usually results in pain, it can be difficult, if not impossible, to separate the two in most cases. But technically they are two different issues and one can exist without the other.
The causes of vaginismus can be physical (infections, abnormalities with the hymen, vaginal atrophy, endometriosis, increased tone of pelvic floor muscles, vaginal lesions, vestibular pain) or psychological (fear of pregnancy, anxiety about sexual anatomy, fear of pain or bleeding, misunderstanding of the sex act, etc.). Every woman having difficulty with penetration should have a complete exam by a gynecologist to rule out and/or treat any physical causes. What is almost universal in women with vaginismus is the creation of a vicious cycle that goes from difficulty with penetration with or without pain, to negative thoughts about it, to increased anxiety or fear, to avoidance and hypervigilance, to guarding and muscle contraction. This cycle continues to reinforce itself and becomes increasingly distressing for the individual and the couple.
Because this vicious negative cycle complicates treatment and reinforces fear, the sooner that a woman receives treatment for vaginismus, the better. Treatment addresses both the physical and psychological contributors to difficulty with penetration. First, proper education about anatomy and the act of sex helps eliminate misunderstandings and gives a woman a greater sense of control. Working with a sex therapist to address the anxieties of penetration serve to help break the negative cycle. Although women who have experienced sexual abuse in their past do not have a significantly higher rate of vaginismus, these women should work carefully and progressively with a therapist.
Dilators are almost always used as part of the treatment for vaginismus. Progressively wider and larger dilators are used by a woman at home to provide physical stretching of the entrance of the vagina. In using dilators, women also become increasingly comfortable with the sensation of penetration. This helps decrease anxiety, reassuring a woman that she can experience penetration under her control and without pain. Therapists work not only with the individual, but also with the couple so that the partner can gain understanding of the condition and be helpful once penetration is to be attempted.If you have a holistic view of health, you can see how vaginismus is one way that a woman's body communicates to her that something related to her sexuality needs attention, either physically, psychologically or both. Therapy that addresses specific fears and anxieties related to vaginismus is the most successful. If your body is not letting you have sex due to vaginismus, don't delay in seeking treatment.