Treatment for vaginismus will largely depend on what's causing it.
If there is an obvious physical cause, such as an infection or oversensitive nerves at the opening of the vagina (provoked vulvodynia), this may be treated with medication at the same time the vaginismus is treated.
If the cause is less obvious, you may be taught self-help techniques to try to resolve the problem.
A specialist in psychosexual medicine or sex therapy may offer you sex therapy in the form of counselling, brief dynamic psychoanalysis, or cognitive behavioural therapy (CBT).
These therapies can help to address any underlying psychological issues, such as fear or anxiety, tackle any irrational or incorrect beliefs that you have about sex and, if necessary, be used to educate you about sex.
Sex therapy is available privately. In many parts of the UK, it's no longer available through the NHS.
The specialist can also talk to you about techniques that can eventually stop your vagina closing involuntarily, such as using vaginal trainers and pelvic floor exercises.
Vaginal trainers can be used to help you relax the muscles in your vagina by gradually getting you used to having something inserted into it. These are a set of four smooth, plastic penis-shaped objects in different sizes, which can be used in the privacy of your own home.
The smallest trainer is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size and so on. It's important to go at your own pace, and it doesn't matter how long it takes – whether it's days, weeks, or months.
When you are able to tolerate the larger trainer without any pain or feelings of anxiety, you and your partner may want to try having sex.
Vaginal trainers are not used to "stretch" a vagina that is "too narrow". Women with vaginismus have normal-sized vaginas. The trainers are simply a method of teaching the vagina to accept penetration without automatically closing.
If you prefer, you can try using your fingers instead of vaginal trainers.
Relaxation and touching
You may also find that relaxation and exploration exercises help. Having a bath, massage and breathing exercises are good ways to relax while you get to know your body.
Your therapist may also teach you a technique called progressive relaxation. This involves tensing and relaxing different muscles in your body in a particular order. You can then practise tensing and relaxing your pelvic floor muscles before trying to insert your finger or a cone.
If you reach the stage where you can put your finger inside your vagina, you can try to insert a tampon, using lubricant if needed.
It's important to take things slowly and gently and, when you are ready for intercourse, make sure you are fully aroused before attempting penetration.
Pelvic floor exercises
A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily.
These exercises are usually recommended while using vaginal trainers.
Occasionally, a technique called biofeedback may be recommended. A small probe is inserted into your vagina, which monitors how well you are doing the exercises by giving you feedback as you do them. The probe senses when you squeeze your muscles and sends the information to a monitor.
However, biofeedback isn’t always available, and some practitioners don't consider this approach to be useful.
If you are in a relationship, you could try sensate focus. This is a type of sex therapy that you and your partner do together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman's breasts). The idea is to explore your bodies, knowing that you will not have sex.
After the agreed period of time, you gradually start touching each other's genital areas, which should eventually build up to penetrative sex.
Very few cases of vaginismus require surgery. However, it may be useful if a physical problem is causing pain during sex and is contributing to your vaginismus.
Endometriosis is a possible reason for surgery, as it can cause pain in the pelvis during sex.
Endometriosis causes small pieces of your womb lining to grow outside your womb. Surgery can be used to remove or destroy these areas of tissue. Read more about treating endometriosis.
Enlarging the vagina
Surgery is sometimes used to enlarge the vagina. This may be necessary if, for example, previous surgery has left scar tissue that either restricts or blocks your vagina, such as an episiotomy during childbirth.
A small operation can remove the scar tissue. It involves neatly cutting out the scar tissue and sewing together the clean-cut edges using small, dissolvable stitches. The operation can either be carried out under a local anaesthetic or a general anaesthetic.