It is common, it is treatable far more often than people expect, and it is one of the least raised symptoms in gynaecology — frequently because women have been told at some point that everything looks normal, and concluded that the problem must be them.
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This is the question that narrows everything else, and it is worth deciding your answer before the appointment.
At the entrance, on first contact or on entry: points towards the vulval skin, the vestibule, dryness, or a pelvic floor that is holding too tight.
Deep inside, on deeper penetration or in particular positions: points towards the pelvis — endometriosis, ovarian or uterine causes, adhesions, or bowel-related pain.
Both, or a feeling that nothing can get in at all: often involves the pelvic floor muscles rather than the tissue itself.
Afterwards rather than during, with burning or urinary symptoms: points somewhere different again, often the bladder or urethra.
One examination distinguishes them, and it is a short one.
Vaginismus is an involuntary tightening of the pelvic floor muscles. It is not something you are doing on purpose, and being told to relax has never once solved it.
It frequently becomes self-reinforcing: pain leads to anticipation, anticipation leads to guarding, guarding leads to more pain. That loop is the thing being treated, and it is treatable.
The same muscles being overactive can also cause urinary urgency and discomfort with tampons or examinations. Where the pelvic floor is overactive, strengthening exercises make it worse rather than better — which is why this needs assessing rather than a generic instruction to do more Kegels.
Treatment is graded, works with the muscles rather than against them, and happens at a pace you set.
Scar tissue from tearing or an episiotomy can stay tender or tight well past the point where the skin has healed, and it is often assessed as “healed” because it looks healed.
Breastfeeding keeps oestrogen low, which keeps the tissue thinner and drier for as long as feeding continues. That is a common and treatable contributor, and many women are not told to expect it.
Pain that is still there at six months is not something to keep waiting out. Waiting is reasonable at six weeks; at six months it is worth being looked at.
The pelvic floor is frequently involved too, in either direction — weak, or holding tight in response to pain.
Falling oestrogen thins and dries the vaginal lining and reduces its elasticity. Discomfort with sex is one of the most common consequences and one of the least mentioned.
Unlike hot flushes it does not settle by itself with time, so waiting it out generally does not work.
The established treatments here are the unglamorous ones: moisturisers and lubricants for comfort, and local vaginal oestrogen, which acts on the tissue rather than the sensation. Whether local oestrogen is appropriate for you, including after breast cancer, is a conversation with a doctor who knows your history.
Results vary between individuals.
Worth an appointment: pain that is new, pain that is getting worse, pain that has stopped you having sex at all, or pain you have simply had for long enough.
Worth being seen sooner: pain with abnormal bleeding, bleeding after sex, unusual discharge, fever, or pain that also occurs outside sex.
The assessment is a history and an examination, and the examination is explained first and stops whenever you say. If an internal examination is not possible on the day, that is itself useful information rather than a failed appointment — it is often the finding.
You will be told what was found and which options apply. Nothing is decided in the room if you would rather think about it.
Consultation ฿1,500–3,000 depending on complexity, plus the ฿300 clinic service fee.
No residency, referral or Thai insurance is needed, and an assessment fits comfortably inside a short stay.
You will see a female specialist. Consultations are conducted in English or Thai.
Where it hurts narrows it down, and one examination usually establishes which cause it is. The examination is explained first and stops whenever you say. Message us on LINE.
This page is general information, not a diagnosis or a treatment recommendation. Suitability for any treatment is decided individually after assessment, and results vary between individuals. Pain with abnormal bleeding, bleeding after sex, unusual discharge or fever should be assessed sooner. Consultations are conducted in English or Thai. THE FIT CLINIC — 8th Floor, EM Tower, EMSPHERE, BTS Phrom Phong, Bangkok. Open daily 10:00–19:00.