Siya was 35 when she first came to see me. She had been married for seven years and she had not been able to have intercourse. She had seen gynecologists and obstetricians before me. Two of them told her, “Take a glass of wine, all is good.” A few told her to use a numbing gel. Some told her, “First time can be painful, bear with it.” One of them did mention it being vaginismus and suggested pelvic floor physiotherapy. Each of them consulted their knowledge and previous experiences to come to the above conclusions. None of them had a reason to treat this particular symptom as an alarming sign of possible vaginismus.
Within the first ten minutes of our session, it was clear what was happening. After the patient consented to a physical examination, I made my way to her thighs with my gloved hands, and she closed them as a reflex. I could see her clenching her glutes, raising her shoulders, grazing her jaws, and a frown on her forehead. I didn’t need further explanation. Vaginismus is a reflexive tightening of the pelvic floor that makes penetration, tampon and menstrual cup insertion, and gynecological examinations difficult and painful. It is both psychological and physical. For some, the psychology outweighs the physical part, and vice versa.
Why it stays hidden
Part of the problem is structural. Vaginismus gets very little dedicated time in medical school and residency training. A thorough gynecological exam can rule out an infection, endometriosis, or a structural abnormality and still not arrive at the diagnosis of vaginismus. It sits in a gap between specialties rather than squarely inside any one of them.
Part of the problem is cultural. Patients often carry years of shame before they say anything out loud. I have had patients tell me they thought they were “broken,” that something was “wrong with their body,” that they assumed every woman quietly tolerated pain during sex and simply didn’t talk about it. Several had been with a partner, some partners being supportive, some otherwise, but almost everyone having no name for their “broken” body.
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A major problem may arise from their body and mind trapped in an emotional cage. Several women come to me with doubts about their own body. As a pelvic floor therapist, discussing history falls under my jurisdiction. Having a conversation, or simply listening to them, opens up a few little secluded corners of their life. “I remember my teacher mentioning it would be painful.” “My mom told me if I am a good girl, I should not talk about it.” “My friend mentioned it was painful.” “I heard the news that she was raped by two men and died after a few days.” “I was beaten by my parents.” And these are just the surface thoughts floating on deep waters. This is how the good girl circles back and forth, feeling restricted.
The result: Women see multiple providers, over multiple years, before anyone identifies what’s actually happening, because the system doesn’t yet route them to the right path.
A second story
Arya, another patient of mine, came in eight months postpartum. She hadn’t attempted intercourse since delivery, not because of low desire, but because the first attempt had been so painful she associated any attempt with panic. She’d had a standard six-week postpartum check, which confirmed she had healed structurally and was clear to resume normal activity. That checkup wasn’t designed to test how the muscles were actually functioning under load. That’s a different kind of assessment, one that pelvic floor physiotherapists are specifically trained to do.
We worked over ten weeks: educating her about her anatomy, manual therapy, breathing, pelvic floor relaxation, hip opening, down-training exercises to teach her nervous system that the area could be safe again, and graded exposure with dilators at a pace she controlled. Understanding why her body was doing this took as much pressure off her as the physical treatment did. By the end, she wasn’t just able to have intercourse again. She said the bigger shift was no longer feeling like her body had betrayed her.
What needs to change
Vaginismus deserves the same diagnostic rigor we’d give any other gynecological condition. This means:
- Normalizing the conversation enough that patients feel safe raising it in the first place.
- Giving clinicians outside pelvic health more exposure to what vaginismus looks like, so it’s easier to recognize and route appropriately.
- Planning a holistic approach toward vaginismus: psychologist, pelvic floor physiotherapist, sex therapist, gynecologist, and partner support if required.
- Making an earlier referral to the above specialists an option, not a last resort reached after years of frustration.
Vaginismus is treatable. The tragedy isn’t the condition itself. It’s how long women live with it before someone finally looks.
This essay is cited in the KevinMD record on women’s health.
Riti Shah is a pelvic floor physical therapist in India.
