Vaginismus: Symptoms, Causes & Treatments

Rian A. Maercks, M.D., P.A., American Board-Certified Plastic Surgeon, is an artist and a leading aesthetic, craniofacial, and reconstructive plastic surgeon, based in Miami, Florida. His private practice, The Maercks Institute, is located in the beautiful Design District and is fully equipped with a tastefully designed office and an AAAHC qualified operating room. Dr. Maercks has spoken on many panels and given numerous lectures, domestically and internationally, regarding his unique breast augmentation procedure, which has brought in a large number of patients from all over the world. 

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Vaginismus is a female sexual problem that many women deal with and suffer from, although they may not even realize it has a name. Vaginismus is the involuntary tightening of the pelvic floor muscles and subsequent muscle spasms. This can make any form of vaginal penetration difficult and painful, causing sexual intercourse to be frustrating, and in some cases, impossible.

Physical or psychological steps can be taken to resolve vaginismus and further treatment is often needed to relieve the symptoms to the point where sex and intimacy and no longer impossible but enjoyable. For some women, none of the usual causes are at play, and there is no clear reason for their vaginismus symptoms. Haute Beauty speaks with Dr. Rian Maercks to highlight the symptoms, possible causes, and treatments of vaginismus.

What are common symptoms of Vaginismus? 

Women with primary vaginismus have symptoms starting at a young age. They often notice a problem when trying to use a tampon or receive a pelvic exam. Secondary vaginismus can develop at any point in a woman’s life, even if she has had years of normal sexual function beforehand.

Vaginismus can be caused by both physical and psychological factors. Some of the most common causes of vaginismus include:

  • Medical conditions such as UTIs, STDs, pelvic inflammatory disease, or other
  • Fear of or anxiety about sexual intercourse
  • Pelvic surgery or other trauma to the pelvic area
  • Side effects from certain medications, causing pelvic pain
  • Normal or difficult vaginal deliveries during childbirth
  • C-sections 
  • Miscarriages
  • Vaginal dryness
  • Past trauma, such as rape, sexual or physical abuse, or assault
  • Menopause
  • Hormonal fluctuations
  • Anxiety and depression
  • Relationship problems

How can Vaginismus be treated?

Dr. Maercks understands the sensitivity and impact that female sexual dysfunction can have. Dr. Maercks offers two approaches to treating vaginismus, both surgical and non-surgical, depending on which procedure will benefit your unique situation and goals.

At the Maercks Institute, we offer a completely unique and different approach when it comes to care and treatment for vaginismus. Dr. Maercks will perform a specialized, in-depth evaluation for you to determine whether your condition is muscular and structural. Most offices are unable to do such evaluations due to inexperience with this issue, but Dr. Maercks’ experience allows him to give you this service and special care. From there, Dr. Maercks will decide which treatment will be the most effective due to your specific situation.

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The non-surgical approach

Botox is more than an injectable to smooth the lines and wrinkles in the face. Botox is made from a substance that relaxes the muscles. It can help treat chronic pain conditions because it prevents muscles from contracting--that’s why it resolves facial wrinkles. Using Botox to treat vaginismus has over a 90% success rate as a permanent solution to vaginismus.

On your first visit, we will perform a test to see if Botox is right for you. This allows us to go forward with Botox with the certainty of results, instead of the usual approach of giving the treatment in the hopes that it will work, while you wait for a week to find out if it does.

At the Maercks institute, the Botox approach to treating vaginismus is carefully individualized to target the muscle group for each patient, as there may be different contracted areas from person to person. Dr. Maercks begins by identifying the exact muscle group of the pelvic floor causing the issue.

Once this muscle group is isolated, Dr. Maercks will inject Botox into these pelvic floor muscles that are specifically responsible for the condition of vaginismus. The Botox relaxes and eases the muscles. Within 10 days of the treatment, a vaginal dilator can be used. Progressive dilation of the vagina is done, slowly helping the muscles dilate until they can allow expansion on their own. Once you feel comfortable, you can attempt sexual penetration.

The surgical approach 

Vaginismus surgical treatment is quick and effective. A procedure is done to address the hymen, called a “hymenectomy” operation. A hymenectomy is performed, and the procedure takes less than one hour. Incisions are made on a few different areas, allowing the vaginal canal a wider point of entry once the procedure and recovery are complete.

This procedure is usually done with local anesthesia. However, sedation anesthesia is available for patients who prefer it. Most patients resume their normal activities a few days after the surgery. Sexual intercourse is possible 3-4 weeks following the procedure.


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