Vaginismus develops due to psychological and organic causes.

Statistically, 90% of the reason for vaginismus is attributable to psychological anxieties and 10% to organic causes (non-psychological).
Therefore, before starting any treatment, it must be carefully determined by a gynecological examination whether the reason for painful sexual intercourse is vaginismus or if there are other causes. In this way the best course of treatment can be selected.

Psychological Causes

90% of all vaginismus cases are due to psychological causes.

Vaginismus is accepted as an “anxiety disorder”. In reality, it is a defense mechanism of the body. The problem resides in the person’s subconscious.

Vaginismus may develop as a result of various psychological causes:

The cause of vaginismus might be prior unpleasant sexual experiences or fears that have been engraved in the subconscious.

Among the psychological causes are those that have been embedded in the subconscious, such as fears left over from childhood, living in a very strict social structure, severe moral rules and/or taboos, guilt, shame, sin and prejudices and misinformation about the first sexual experience and sexuality and fear in the subconscious about the penis entering the body.

Strict teachings about sexuality and the idea that “the hymen is a structure that is very crucial and by all means must be protected” taught to young girls throughout their childhoods, are among the most important causes for vaginismus specially in Moslem countries.

Many negative inculcations can be further exacerbated by such admonishments as “cover your crotch girl, it is shameful”, “be careful, do not hit that part while riding your bike”, “close your legs”, and “stay away from men, they will do you harm” – this type of reinforcement is among the important factors that cause sexual problems in later ages.

Moreover, the unpleasant experiences and memories from childhood (abuse or rapes, domestic violence, harsh parental behavior) may also cause vaginismus.

Especially in Western countries, certain sexual abuse or rape experienced in the past is considered as the most frequent cause for vaginismus, whereas in Moslem countries, sexual taboos, cultural and religious reasons are more prominent.

People who have not had any earlier incident of vaginismus may come to experience it as a result of unpleasant experiences (birth, miscarriage, abortion, or inappropriate gynecological examinations). (This is known as secondary vaginismus)

The ignorance of couples about sexuality, misconceptions and beliefs about the first sexual intercourse, combined with fear and panic, may cause vaginismus. (Cognitive vaginismus)

Sometimes, in people who had had vaginismus earlier but had not been fully treated, recurrences may occur. (Recurrence of the problem)

As stated previously, most of the time, in vaginismus patients, fears/anxieties about sexuality and sexual intercourse lie deep in the subconscious and the contraction of the PC muscles acts like a defense mechanism that protects the woman from an experience of which she is genuinely frightened.

In order to overcome these unnecessary fears set in the subconscious, appropriate psychological support must be provided to establish the spiritual conditions to relax and comfort the man and the woman.

In many women, none of these causes might be evident. (The causes of which are indeterminable and indiscernible vaginismus)
Suleyman Eserdag MD, Gynecologist and sexual therapist asks all the patients who have applied to his center (Hera Clinic) for vaginismus treatment this question: “Can you think of anything that you experienced earlier that makes you think that this particular event might have caused this problem?” Most of the time, the answer to this question is “No, I can’t”. However, although we seem to have forgotten most of the events we have experienced, these events have actually settled in our subconscious and been stored as seeds of fear and anxieties; yet, in many cases, the surfacing of the problem is delayed up to the first night of the beginning of a couple’s married life.

Fortunately, it is not necessary to find the underlying cause or causes to solve the problem of vaginismus. The important thing is to establish the “restructuring of the pelvic muscle memory” and to overcome unnecessary and false fears about sexuality.

Organic (Non psychologic) Causes

In 10% of cases, vaginismus might not arise because of a psychological problem but can be the result of an underlying organic pathology.

Among the organic causes of vaginismus are

Vulvar Vestibulitis Syndrome, PIH (Pelvic inflammatory disease), Bartholin Abscess and Cyst, Vaginal Fungal Infection (Candida Vaginitis), and Congenital Anatomic Disabilities: Short and blind vagina, septum on the vagina wall (cloak), hymen structured wide and thick.
The organic causes of vaginismus can be treated by a gynecologist with medicine or simple operations. In this way, without the need for psychological treatment, the problem can be overcome.

The point that must not be forgotten is that vaginismus can first be diagnosed by a gynecologist after a gynecological examination.
Who is at risk of vaginismus?

Personality background

Women who are especially childish, dependent upon their families and have not completed their psychological setup in a healthy way, make up the greatest at risk group. Amongst this group the possibility of vaginismus increases especially in people of high social status and/or economic means. (For example: Among vaginismus patients who are treated at the Hera Clinic, almost 90% are at least high school or university graduates.) This is interesting data.

Once again, according to our studies, in rural areas, vaginismus generally surfaces as a result of a lack of information and can be solved in relatively short, applied cognitive therapies.

The syndrome of being a “nice” girl

Women often encounter problems such as vaginismus, a lack of sexual desire, feeling disgusted by sexuality, sexual anxiety and the inability to have an orgasm if, in their childhood, they did not have any sexual education by their parents, and whose families even condemned sexuality, possibly going so far as to convey the message that the hymen is a region of the utmost importance that absolutely must be protected. This problem, which develops in girls brought up by such families and in these types of environments is very widespread in Turkish society, and is called the “syndrome of being a nice girl”.

In women who carry the features of nice girl syndrome, sexuality is a “job that is necessary only for their spouses”, meaning that sexuality is seen more as a “duty which is going to make their spouses happy”, rather than as an act that they will enjoy themselves.

Moreover, according to our observations at the Hera Clinic these women are disciplined, meticulous and perfectionist in character in their private lives.

Family structure

Children, whose family structure consists of the model of a dominant and disciplining father and a passive mother, are at risk of vaginismus in their later lives.

Fears of becoming pregnant

People who are traditionally or religiously educated, or women who are single and are trying sexuality with their boyfriends/fiancés but fear they will become pregnant afterwards have an abortion, may suffer from vaginismus.

Religious and moral pressures

In traditional environments where sexuality is only acceptable within strict confines and bound to rules and especially for people who had a religious education in their childhoods, there is the risk of vaginismus later in life. According to the researches we have conducted, Konya leads the list of cities from which patients coming from outside Istanbul have applied to Hera Women’s Health Center.

Sexual Myths (Exaggrations)

In people living with fears left over from their childhood, this disease more easily forms. Mostly the fears are the ones exaggerated by women who feel they are symbolically encountering great pain, disintegration and death because of a penis.

We call these kinds of erroneous and/or exaggerated beliefs and superstitions “sexual myths”. Erroneous and exaggerated thoughts written into the subconscious of these persons almost always pave the ground for vaginismus later in life.
Many rumors about sexuality change form as they are circulated by the public imagination, and myths that are not in the least bit true come into being.

Sexual myths most frequently told among the public (superstitions):

The idea that "my vagina is narrower than normal"

An idea like “My vagina is very small (or very narrow) that’s why I am not able to have sexual intercourse” is generally untrue, because the vagina has a very flexible composition; it can stretch enough to let the 10 cm-diameter head of a child pass through in child birth.

Despite the fact that these women have no structural anomalies, it is natural for them to think in this way. The emergence of vaginismus is generally irrelevant of the anatomic structure of the genitalia.

The idea that the first night is going to be painful and bloody

If the person is very relaxed on the first night, she might not bleed at all or bleed very little. At the same time, very little or no pain might be experienced. However, with persons who get tense and constrict themselves during the insertion of the penis, it is natural to have more than normal pain and bleeding due to abrasion.

The idea that the hymen pops in the first night

The hymen is not a structure that bursts, cracks or breaks. It is an approximately 2 mm thick extremely thin film located 2cm away from the vaginal entrance. During the first penetration, due to the small stretching and afterwards a few millimeters of tearing, sometimes a few drops of blood spill, yet most of the time it does not bleed at all.

Penis Captivus (interlocking) phenomenon

One of the most interesting sexual myths is that of the “penis captivus” phenomenon. In this myth, once the penis has entered the vagina during sexual intercourse, it cannot leave and gets stuck due to the contraction of the vaginal muscles.
This condition is a sexual paranoia and one of the greatest superstitions told by more than half of vaginismus patients, as if they have consensually agreed to tell the same story.

As a matter of fact, this special condition cannot occur in human beings though it is a very normal (physiological) condition in animals (especially dogs).

In the penis captivus phenomenon in animals, the male dog’s penis ejaculates after it enters the female dog’s vagina. In order for the sperm ejaculated into the vagina to fertilize the eggs in the female dog, it needs certain materials secreted from the prostate sac of the male dog. In this case the female dog, by tightening her vagina approximately for one hour, prevents the penis of the male dog from coming out, thus increasing her chances of pregnancy.

No such phenomenon is seen in human reproduction as it is not necessary. However, such stories and anecdotes are told among friends as jokes, thereby creating certain fears in the mind of the listener that may well set the stage for later problems.