Podcast
Vaginismus, Sexual Pain, Trauma & Treatment
A conversation with Dr. Babb on vaginismus, sexual pain, trauma, and the treatment of severe disease.
Female Sexual Medicine
Vaginismus
Dr. Babb has spent years studying, defining, teaching, and treating vaginismus.
His work spans published research, clinical classification, physician and patient education, and advanced treatment, including the development of the Haven Procedure, which allows 95–97% of patients who undergo it to achieve penetration.
Patient education
Understanding vaginismus
What is vaginismus?
Vaginismus is an involuntary response associated with attempted or anticipated vaginal penetration. The muscles of the pelvic floor may contract or guard automatically, making penetration painful, difficult, or impossible.
The important word is involuntary.
You can want to have intercourse. You can feel safe with your partner. You can understand that a pelvic examination is medically necessary. You can consciously tell yourself to relax.
And your pelvic floor can still contract.
That disconnect between what you want your body to do and what it actually does is one of the defining, and most frustrating, features of vaginismus.
Over time, the response can become reinforced. Previous difficulty with penetration creates anticipation of what will happen the next time. The body begins preparing for penetration before it occurs, and the pelvic floor response may begin earlier or become stronger. Eventually, simply trying harder may accomplish very little.
What does vaginismus feel like?
Vaginismus does not feel exactly the same for everyone, but certain experiences are common.
You may experience:
- intercourse that feels as though you, or your partner, is “hitting a wall”;
- penetration that begins but becomes too painful or difficult to continue;
- an inability to have penetrative intercourse;
- difficulty or inability to insert a tampon;
- the ability to use a tampon but not tolerate intercourse;
- pelvic examinations that are extremely difficult, painful, or impossible;
- your legs closing or your body pulling away automatically during an attempted examination;
- anxiety that begins well before penetration because you already know what is going to happen; or
- a desire for penetration while your body responds as though it needs to prevent it.
For some people, the response is primarily a feeling of muscular contraction. For others, significant pain accompanies the contraction. In severe vaginismus, the response can extend beyond the pelvic floor and include trembling, sweating, hyperventilation, crying, nausea, vomiting, or fainting.
Wanting your body to relax and being able to make it relax are not always the same thing.
Why does vaginismus happen?
There is no single explanation that applies to everyone.
Pain, anticipation, previous experiences with penetration, anxiety surrounding penetration, and the nervous system's learned response can interact differently from one person to another.
Understanding what continues to reinforce the response can be just as important as identifying what started it.
Are there different types of vaginismus?
Vaginismus can present very differently from one person to another.
You may be able to use a tampon but not have intercourse. You may tolerate a finger or small dilator but be unable to progress beyond it. Penetration may begin before the pelvic floor contracts, or attempted penetration may not be possible at all.
Vaginismus that has always been present is often described as primary or lifelong vaginismus. Vaginismus that develops after a period of previously comfortable penetration is called secondary or acquired vaginismus.
The severity of the response can also vary considerably.
Research & classification
Understanding the severity of vaginismus
The original Lamont classification described four grades of vaginismus based on pelvic floor contraction and the patient's response to attempted examination.
The Lamont-Pacik Classification
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01
Lamont Grade 1
Pelvic floor spasm occurs during examination but can be relieved with reassurance, allowing the examination to proceed.
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02
Lamont Grade 2
Pelvic floor spasm persists throughout the examination despite reassurance.
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03
Lamont Grade 3
Pelvic floor spasm is accompanied by an involuntary attempt to avoid the examination, including elevation of the buttocks away from the examination table.
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04
Lamont Grade 4
Pelvic floor spasm is accompanied by more pronounced avoidance, including elevation of the buttocks, retreat from the examination, and tightly closing the thighs.
Dr. Babb's work defining Grade 5 vaginismus
Some patients with severe vaginismus experience reactions that extend well beyond pelvic floor contraction and physical avoidance. These responses were not adequately represented by the original four-grade Lamont classification.
Dr. Babb worked with Dr. Peter Pacik and colleagues to study these patients in a case series involving more than 500 patients. Their research formally defined Lamont-Pacik Grade 5 vaginismus.
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05
Lamont-Pacik Grade 5
The most severe presentation can include profound involuntary physical reactions to anticipated or attempted examination, including trembling, sweating, hyperventilation, crying, nausea, vomiting, or fainting.
Dr. Babb contributed to the data analysis, writing, and submission of the research and served as corresponding author of the study, published in Sexual Medicine.
Published research
Case Series: Redefining Severe Grade 5 Vaginismus
Read “Case Series: Redefining Severe Grade 5 Vaginismus” (opens in a new tab, academic.oup.com)
Diagnosis and evaluation
You don't have to prove you have vaginismus by enduring an examination.
For someone with vaginismus, seeking gynecologic care can seem overwhelming.
Maybe you've never been able to complete a pelvic examination. Maybe you've been told to relax your legs, take a deep breath, or tolerate just a little more. Maybe you've avoided examinations altogether because you already know how your body is going to respond.
Many patients have also had their experience minimized, sometimes by the very clinicians they went to for help. They have been told to “just relax,” “drink some wine,” or “try wiggling your toes” during penetration. Some have been reassured that everything looks normal even though intercourse remains impossible.
Advice like this can leave patients wondering why something that sounds so simple remains completely beyond their control.
Vaginismus deserves a clinical evaluation that takes the involuntary nature of the response seriously.
Dr. Babb begins with your history: what happens when penetration is attempted, whether penetration has ever been possible, what types of penetration you can tolerate, when the problem began, what happens during pelvic examinations, what treatments you have already tried, and what you ultimately want to be able to do.
For many patients, that history provides an enormous amount of useful clinical information.
When an examination is helpful, it should be approached according to what you can tolerate and what information is actually necessary.
The objective is to understand what your body is doing without forcing it through an examination.
An examination should provide information, not become another experience you have to survive.
Treating vaginismus
Treatment should match the person, not simply the diagnosis.
Vaginismus can be successfully treated, including in people who have never been able to have penetrative intercourse and those who have struggled with the condition for years.
The appropriate approach depends on the severity of your symptoms, what you can currently tolerate, what you have already tried, and what you want treatment to accomplish.
- Pelvic floor physical therapy
- Working with a pelvic floor physical therapist can help you recognize pelvic floor activity, reduce guarding, improve voluntary control, and gradually become more comfortable with penetration.
- Progressive dilation
- Vaginal dilators allow penetration to be introduced gradually and progressively. Dilation is most useful when it is structured around your current abilities rather than treated as something you simply need to force yourself through.
- Sexual or psychological support
- For some people, fear, anticipation, previous experiences, trauma, or relationship factors have become part of the vaginismus response. Addressing those factors can be an important component of treatment when they are present.
- Medication and targeted treatment
- Selected patients may benefit from medication or other targeted treatment used alongside rehabilitation.
- Advanced procedural treatment
- For people with severe vaginismus, or those who have been unable to progress with more conservative treatment, procedural treatment of the pelvic floor can create an opportunity to move beyond a barrier that has previously been impossible to overcome.
Treatment should be selected according to the individual patient, the severity of the response, previous treatment, and the goals of care.
When more is needed
When physical therapy and dilators haven't been enough
Many patients who come to Dr. Babb have already tried treatment, sometimes a great deal of it.
You may have spent months in pelvic floor physical therapy. You may own several sets of dilators. You may have tried counseling, medications, breathing exercises, relaxation techniques, lubricants, numbing creams, or repeated attempts at penetration.
You may have made progress but reached a point beyond which you simply cannot go. Or nothing may have worked at all.
That does not mean your vaginismus cannot be successfully treated.
Sometimes the severity of the involuntary muscular response has been underestimated. Sometimes the treatment strategy needs to change. Reducing both muscular guarding and pain can create an opportunity for progress that was previously unavailable.
For patients who reach this point, Dr. Babb may consider advanced procedural treatment.
Advanced procedural treatment
The Haven Procedure
An advanced procedural approach to vaginismus treatment.
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2017
Dr. Babb trains directly with Dr. Peter Pacik.
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2022
Dr. Babb develops the Haven Procedure.
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Current approach
Multi-level pelvic floor chemodenervation and targeted long-acting analgesia, with establishment of penetration and progressive dilation.
Dr. Babb first trained directly with Dr. Peter Pacik in advanced vaginismus treatment in 2017, joining a program that had drawn patients from five continents for specialized vaginismus care.
As Dr. Babb's clinical experience grew, so did his approach to procedural treatment. In 2022, he developed the Haven Procedure.
Earlier procedural approaches primarily concentrated botulinum toxin treatment in the muscles immediately surrounding the vaginal opening, followed by dilation under anesthesia. Dr. Babb expanded treatment across several pelvic floor muscle groups and incorporated targeted long-acting analgesia of the pelvic floor and pudendal nerves.
The Haven Procedure uses multi-level pelvic floor chemodenervation and targeted long-acting analgesia to reduce involuntary muscular resistance and pain while penetration and progressive dilation are first established.
This is especially important for patients whose repeated attempts at penetration have resulted in muscular guarding, pain, and increasing anticipatory fear. Reducing those physical barriers creates an opportunity to begin penetration and dilation under circumstances that were previously difficult or impossible.
95–97%
ultimately achieve penetration.
Among Dr. Babb's patients treated with the Haven Procedure, 95–97% ultimately achieve penetration, most commonly penetrative vaginal intercourse.
These results reflect Dr. Babb's clinical experience with patients who underwent the Haven Procedure and continued with the recommended dilation and rehabilitation afterward. Individual outcomes vary, and no treatment can guarantee a particular result.
Treatment outcomes
What does successful treatment mean?
Penetration is an important clinical outcome, but what successful treatment means in your life depends on why you sought treatment in the first place.
- If you've never been able to insert a tampon, success may begin there.
- If you've avoided gynecologic care, it may mean finally being able to complete an examination.
- If you want penetrative intercourse, it may mean being able to have intercourse for the first time or for the first time in years.
- If you're hoping to become pregnant, penetration may have another significance entirely.
Those goals matter.
Dr. Babb looks at successful treatment in terms of what you are able to do after treatment and whether you have reached the goals that brought you to care.
The purpose of treatment is to change what vaginismus allows you to do in your actual life.
Expertise
Dr. Babb's work in vaginismus
Dr. Babb's work in vaginismus extends from the medical literature to the treatment room. He has helped define how severe vaginismus is classified, developed an advanced procedural approach to its treatment, and cared for patients with presentations ranging from difficulty with penetration to severe Lamont-Pacik Grade 5 vaginismus.
His work includes published research, clinical classification, advanced procedural treatment, patient education, and physician education. Patients have traveled from across the United States, Canada, and India to seek his care.
For physicians and healthcare organizations, Dr. Babb also teaches the evaluation and management of vaginismus through clinical education, lectures, and procedural preceptorship.
Traveling for treatment
Traveling to Tulsa for vaginismus treatment
Specialized care may be worth traveling for.
Patients travel to Haven Center in Tulsa specifically for vaginismus evaluation and treatment.
If you live outside Oklahoma, the Haven team can help you understand what evaluation is needed, whether advanced treatment may be appropriate, how procedural treatment is scheduled, and what to expect afterward before you make travel arrangements.
When the Haven Procedure is recommended, care can be coordinated with the needs of traveling patients in mind. Treatment continues after you leave Tulsa. Dilation, rehabilitation, and follow-up remain important components of the Haven Protocol.
Where you live should not prevent you from finding care from someone who understands what you are experiencing.
For clinicians & healthcare organizations
Bringing vaginismus into clinical practice and medical education.
Dr. Babb teaches vaginismus within his broader work in female sexual medicine.
His educational work addresses recognition of the different presentations of vaginismus, assessment of severity, evaluation when a conventional examination cannot be tolerated, treatment selection, and the management of severe or treatment-resistant disease.
He works with physicians, residency programs, healthcare organizations, professional societies, and clinical teams through several educational formats.
Clinician education and institutional training
Dr. Babb provides lectures, grand rounds, residency education, workshops, and customized educational programs in female sexual medicine, including vaginismus and complex sexual pain.
Courses and clinical education
Dr. Babb's educational work includes structured clinician education in female sexual medicine focused on translating evidence into practical clinical decision-making.
Procedural preceptorship
Physicians and other qualified healthcare professionals seeking practical experience with advanced procedural care can work directly with Dr. Babb through individualized clinical preceptorship.
Preceptorship can include patient selection, clinical decision-making, procedural principles, and post-procedure management for advanced vaginismus treatment and the Haven Procedure.
Books and resources
Dr. Babb is the author of A Practical Guide to Female Sexual Medicine and develops additional educational resources for clinicians seeking a deeper understanding of sexual medicine.
Vaginismus in the media
Vaginismus in the media
Dr. Babb has discussed vaginismus, sexual pain, and female sexual medicine through podcasts, interviews, and other media.
His work in this area allows him to speak about vaginismus from several perspectives, including the patient experience, clinical presentation, severe and Grade 5 vaginismus, pelvic floor physiology, and available treatments.
Selected media on vaginismus
Article
Vaginismus
Dr. Babb's own long-form discussion of vaginismus for a general readership.
Additional selected appearances
Media & press inquiries
Dr. Babb is available to journalists, editors, producers, podcast hosts, and other media professionals seeking clinical perspective on vaginismus and female sexual medicine.
Relevant topics include vaginismus, severe and Lamont-Pacik Grade 5 vaginismus, painful or impossible penetration, pelvic floor involvement in sexual function, diagnosis and treatment, and advanced procedural care.
Selected work on vaginismus
Published research & patient education
Dr. Babb's published work on the classification and treatment of severe vaginismus.
Published research
Sexual Medicine
Case Series: Redefining Severe Grade 5 Vaginismus
Dr. Babb served as corresponding author and contributed to the data analysis, writing, and submission of the study establishing Lamont-Pacik Grade 5 vaginismus.
Read the Published Study (opens in a new tab, academic.oup.com)
The Journal of Sexual Medicine
Psychosocial Predictors of Pain in Primary Vaginismus
View the Abstract on Oxford Academic (opens in a new tab, academic.oup.com)
Patient education
About the author
About Dr. Corey Babb
Corey R. Babb, DO, FACOOG, IF, MSCP is a board-certified gynecologist specializing in female sexual medicine and vulvovaginal disorders and the founder and medical director of Haven Center for Sexual Medicine and Vulvovaginal Disorders.
He has worked in vaginismus since 2017. His experience includes direct advanced clinical training, research into the classification of severe vaginismus, patient and clinician education, and advanced procedural treatment.
Dr. Babb served as corresponding author of the research establishing Lamont-Pacik Grade 5 vaginismus and developed the Haven Procedure in 2022.
Written by Corey R. Babb, DO, FACOOG, IF, MSCP.
Last reviewed: .
Frequently asked questions
Questions about vaginismus
Can vaginismus be successfully treated?
Yes. Vaginismus can be successfully treated, including in people with severe symptoms and those who have never been able to have penetrative intercourse.
Among Dr. Babb's patients treated with the Haven Procedure, 95–97% are ultimately able to achieve penetration.
Individual outcomes vary, and the appropriate treatment depends on your presentation, severity, previous treatment, and goals.
How do I know if I have vaginismus?
Common experiences include involuntary pelvic floor tightening with attempted penetration, feeling as though penetration is “hitting a wall,” painful or impossible intercourse, difficulty inserting tampons, and difficulty tolerating pelvic examinations.
Some people can tolerate certain forms of penetration but not others.
Can vaginismus make intercourse completely impossible?
Yes. With more severe vaginismus, penetrative intercourse may be completely impossible despite repeated attempts.
Can I have vaginismus if I can use tampons?
Yes. Vaginismus exists across a spectrum. Being able to tolerate a tampon does not mean intercourse or another form of penetration will necessarily be possible or comfortable.
Why can't I just relax?
The pelvic floor response associated with vaginismus is involuntary. Consciously wanting the muscles to relax does not necessarily prevent them from contracting when penetration is anticipated or attempted.
Is vaginismus psychological?
The pelvic floor response in vaginismus is physical and involuntary.
Psychological and emotional factors can contribute for some people. Pain, anticipation, previous experiences, and learned physical responses can also contribute. The combination is different for each person.
Do I need a pelvic examination to be diagnosed?
Not necessarily. A detailed history can provide substantial information about vaginismus.
When an examination is useful, it should be approached according to what you can tolerate and what information is actually needed.
Does pelvic floor physical therapy work for vaginismus?
Pelvic floor physical therapy is an important treatment for many people and may be sufficient for some.
Others continue to experience significant involuntary guarding despite physical therapy and may need additional treatment.
What if pelvic floor physical therapy hasn't worked?
Not improving with physical therapy does not mean you are out of options.
Dr. Babb evaluates the severity and characteristics of your vaginismus, what progress was possible with previous treatment, where that progress stopped, and whether a different or more advanced approach may be appropriate.
What if I can't progress with dilators?
Difficulty progressing with dilators is common among people with more significant vaginismus.
When progression repeatedly stops at the same point, it can be useful to understand why the pelvic floor response remains difficult to overcome and whether additional treatment could help.
How does Botox work for vaginismus?
Botulinum toxin temporarily reduces the ability of targeted muscles to contract as strongly.
In appropriately selected patients, this can reduce involuntary muscular resistance while penetration and progressive dilation are established.
What is the Haven Procedure?
The Haven Procedure is Dr. Babb's procedural approach to advanced vaginismus treatment.
It combines multi-level chemodenervation of the pelvic floor with targeted long-acting analgesia of the pelvic floor and pudendal nerves. Progressive dilation begins under anesthesia and continues afterward through the Haven Protocol.
Is Botox the Haven Procedure?
Botulinum toxin is an important component of the Haven Procedure, but the procedure also incorporates broader pelvic floor targeting, long-acting analgesia, and dilation under anesthesia.
What is the Haven Protocol?
The Haven Protocol is the complete treatment pathway surrounding the Haven Procedure.
It includes evaluation, procedural treatment, progressive dilation, structured post-procedure rehabilitation, continued clinical guidance, and additional rehabilitation when appropriate.
What is Grade 5 vaginismus?
Lamont-Pacik Grade 5 describes the most severe end of the vaginismus spectrum.
Patients may experience profound involuntary physical reactions to anticipated or attempted examination, including trembling, sweating, hyperventilation, crying, nausea, vomiting, or fainting.
Dr. Babb served as corresponding author of the published research that established Grade 5.
What if I've already had Botox for vaginismus?
Previous Botox treatment does not prevent you from being evaluated by Dr. Babb.
He can review what treatment you received, where the injections were performed, what happened afterward, and whether the Haven Procedure or another treatment approach may be appropriate.
Can I come to Haven if I've already been treated somewhere else?
Yes. Many people seeking specialized vaginismus treatment have already tried physical therapy, dilation, counseling, medication, procedural treatment, or combinations of these approaches.
Can I travel to Tulsa for treatment?
Yes. Patients travel to Haven Center in Tulsa for specialized vaginismus evaluation and treatment.
The Haven team can discuss anticipated timing, procedural logistics, travel considerations, and follow-up before treatment is scheduled.
Vaginismus has already taken enough from you.
Maybe it has affected intercourse. Maybe you've avoided pelvic examinations for years. Maybe you've wondered how you will become pregnant. Maybe it has affected a relationship, your confidence, or the way you think about your own body.
Or maybe you're simply exhausted from repeatedly trying something that everyone else seems to think should be easy.
You do not need to keep proving how hard you are trying.
There is a reason your body is responding this way. Understanding that response gives us somewhere better to start.
Even when vaginismus is severe, and even when penetration has never been possible, there may be considerably more that can be done.
Schedule a consultation with Dr. Babb to understand your vaginismus, how severe it is, and what treatment could look like for you.