Vaginismus – An intimate problem that women find especially difficult to discuss

Vaginismus is not merely physical discomfort; it is a powerful defensive reaction of the body, during which the vaginal muscles contract reflexively. This process makes penetration difficult or entirely impossible. Although this condition often leads to feelings of despair, it is important to know: vaginismus is treatable

The solution lies not in ignoring the fear, but in managing it, restoring trust with your body, and achieving progress through safe, incremental steps

Categories of fears and therapeutic approaches

Behind vaginismus, there is often a complex chain of psychological and physiological factors. Let’s examine the primary fears and the strategies to overcome them:

1. Fear of losing control and power

For many women, penetration is perceived not as intimacy, but as a violation of boundaries or an act of submission. This is particularly common among strong and independent women.

• Reflex: Body blockage — "I am the one in control here."

• Strategy: Returning control to the patient. The patient manages the pace of the process themselves and can stop it at any time.

2. Anticipation of physical pain and danger

"Penetration will inevitably be followed by pain" — this subconscious belief triggers an instantaneous muscle contraction.

• Strategy: Micro-tasks and the gradual use of special medical dilators.

3. Fear of emotional injury and sexual failure

The fear of "failing" or being rejected by a partner intensifies anxiety.

• Strategy: Focusing on the process rather than an immediate result. Emotional regulation through Cognitive Behavioral Therapy (CBT).

4. Fear of trauma, violence, or pregnancy

Past trauma or an unconscious fear of pregnancy forces the body to go into "shelter" (survival) mode.

• Strategy: Neurosexological approaches, informational support regarding contraception, and creating a safe environment for processing trauma.

Sexual infantilism and its impact

Sexual infantilism refers to a lack of emotional maturity in the intimate sphere, where a couple finds it difficult to speak openly about sex. In such cases, a woman is left alone with her pain and fears. This is one of the most common issues, where partner involvement is of particular importance for a resolution.

• The solution: Partner involvement in therapy, learning communication skills, and sharing responsibility between partners.

Core principles of treatment

The goal of therapy is for the body to transition from "defense mode" to "trust mode."

1. No coercion: The process proceeds only in accordance with the patient's readiness.

2. Step-by-step progress: The nervous system must learn that intimacy does not represent a threat.

3. Integrated methods: A combination of CBT (Cognitive Behavioral Therapy) and neuro-physiological techniques.

Practical Exercise: Fear Control

We advise patients to use the "visualization" technique:

1. In a quiet environment, close your eyes and visualize intimate closeness.

2. Focus on the sensations and visualize the process at your own preferred, slow pace.

3. Describe in a journal: What scares you and what gives you a sense of safety? This helps you face your subconscious fears directly.

Vaginismus therapy is not just a medical manipulation — it is a journey toward discovering and trusting your own body. At the "4&8" Center of Sexology and Psychology, you will receive all the necessary tools to navigate this path.

Remember: Your involvement and daily small steps will inevitably lead you to the desired result.

Confidentiality is fully guaranteed.

Article Author: Eka Daraselia Gynecologist-Sexologist