Vaginismus diagnosis is made mostly by history because most women with vaginismus, especially those with more severe vaginismus, are unable to tolerate a pelvic exam to demonstrate the spasm of the entry vaginal muscle (bulbospongiosum). Vaginismus diagnosis cannot be made under anesthesia because here too any vaginal spasm disappears.
The following symptoms are common in vaginismus:
- Inability to tolerate tampon insertion, often noted at a young age.
- A tampon getting stuck practically clinches the diagnosis. This is due to the tampon swelling with blood and the inability to remove the swollen part of the tampon through the spastic muscle located at the entrance to the vagina.
- Attempts at penetration (finger, GYN exam, intercourse) are either very painful or impossible due to the spasm of the entry muscle. Burning, which may last hours to days is often noted after penetration is attempted. The "burning" is due to forced stretching of the spastic muscle. Anytime a muscle (anywhere in the body) is stretched beyond its normal ability this results in a burning searing sensation.
- In less severe cases of vaginismus, some penetration may be possible, but intercourse is either impossible or very painful.
- The feeling by both the woman and the partner that there is a "wall" preventing penetration. This is due to spasm of the entry muscle of the vagina (known as the bulbospongiosum) and feels like a tightly closed fist. Because of this some women are concerned that they have no opening in the vagina.
- Unconsummated marriage.
- Avoidance of sex due to pain.
- Ongoing sexual pain of unknown origin.
- Secondary vaginismus: Ongoing sexual discomfort or penetration pain following childbirth, yeast/urinary infections, sexual transmitted diseases, hysterectomy, cancer, vaginal surgeries, rape, menopause or for no known reasons.
These symptoms help distinguish vaginismus from other common sexual pain disorders such as vulvodynia (pain involving the vulva) and vestibulodynia (pain in the area of the vestibule located inside the labia but outside the vagina).
Misdiagnosis of vulvodynia or vestibulodynia:
A common misdiagnosis of vaginismus is the diagnosis of vulvodynia and or vestibulodynia. Women who have severe vaginismus will react with considerable fear and anxiety to any touch in the pelvic area. Therefore, if the clinician touches the vulva, or does an examination with a cotton tipped applicator, the patient reacts by withdrawing and in severe cases of vaginismus will either not allow an exam or will want to jump off the examination table causing a misdiagnosis of vulvodynia or vestibulodynia.
More information can be read in my book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy” (Chapter 3 pages 17-24) and by watching the one-hour film about vaginismus.