Clinical Review

Diagnosing and managing vaginismus

BMJ 2009; 338 doi: (Published 18 June 2009) Cite this as: BMJ 2009;338:b2284
  1. Tessa Crowley, associate specialist psychosexual medicine1,
  2. David Goldmeier, clinical lead Jane Wadsworth sexual function2,
  3. Janice Hiller, consultant psychologist3
  1. 1Bristol Sexual Health Service, Bristol BS2 0JD
  2. 2Imperial NHS Trust, St Mary’s Campus, London W2 1NY
  3. 3Department of Psychology, Goodmayes Hospital, Ilford, Essex IG3 8XJ
  1. Correspondence to: T Crowley tessa.crowley{at}

    Summary points

    • The conditions of vaginismus, vestibulodynia, and dyspareunia overlap

    • Diagnosis of vaginismus is based on a full psychosexual history

    • The degree of distress, anxiety, and self reported interference with penetration is more central to the diagnosis than is muscle tone

    • Genital examination is needed at some point to exclude organic pathology

    • Information on sexual function and pelvic anatomy should be given to all patients

    • Treatment comprising insertion of “vaginal trainers” of gradually increasing size is associated with the achievement of penetrative intercourse

    Recent consensus defined vaginismus as, “The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and or any object, despite the woman’s expressed wish to do so.”1 The definition also noted that affected women often avoid intercourse; experience involuntary pelvic muscle contraction; and anticipate, fear, or experience pain. However, it can be difficult to diagnose vaginismus. Women with total vaginismus are unable to tolerate penetration of their vagina by any object, but those with partial vaginismus tolerate penetration with difficulty and pain. The condition can be lifelong (primary) or it can occur after sexual function has been normal (secondary). It can also be situational, occurring only with certain partners or in particular circumstances, or it can be global, occurring independent of partner or circumstances. It is thus a clinical syndrome, not a definitive diagnosis, that consists of overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration.

    The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) categorises vaginismus as a sexual pain disorder along with dyspareunia. It describes vaginismus as occurring when “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina” interferes with intercourse.2 According to this definition, the experience of pain is not necessary for the diagnosis. …

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