Detailed definition
Vaginismus is characterized by involuntary contraction of the bulbocavernosus and pubococcygeus muscles in response to attempted vaginal penetration. It is now classified within "genito-pelvic pain/penetration disorder" in DSM-5. Primary vaginismus presents with lifelong inability to tolerate penetration; secondary vaginismus develops after a period of pain-free function, often triggered by a painful event (childbirth trauma, surgery, infection) or by escalating dyspareunia from another cause such as GSM. Diagnosis is clinical, supported by examination if tolerated. Treatment is multimodal: pelvic floor physical therapy with biofeedback, graded vaginal dilator therapy, addressing any underlying tissue cause (treating GSM with vaginal estrogen if relevant), and, often, sex therapy or cognitive behavioral therapy to address the anxiety component.
Why it matters in menopause
In postmenopausal women, secondary vaginismus often develops on top of unaddressed GSM — a woman who has had repeated painful sex develops protective muscle guarding, and even after vaginal estrogen heals the tissue, the muscle response persists until specifically retrained. Pelvic floor PT plus dilators alongside vaginal estrogen is the durable solution.
Related terms
Sources
External references: Wikipedia.