Coital Vaginismus: TCM Causes, Diet, and Herbal Treatments

Violent and persistent contractions of the muscles around the vagina during or before sexual intercourse are termed as coital vaginismus. It is a psychophysiological syndrome. The spasm may be confined to the area around the vaginal orifice, or involve contractions of all vaginal muscles, sometimes even including the inner thigh muscle groups. This condition does not occur at other times. When the patient attempts sexual intercourse or perceives that the man’s penis is about to be inserted, the vagina immediately spasms, making sexual intercourse impossible. Spasms may also occur when the patient perceives that other objects are about to enter the vagina; for example, a gynecological examination is sufficient to induce vaginismus. When spasm occurs during the first attempt at sexual intercourse, it is called primary vaginismus; when spasm occurs after successful sexual intercourse in the past, it is called secondary vaginismus; when spasm occurs due to changes in the sexual environment, it is called situational vaginismus, though this is extremely rare.

Women with coital vaginismus, although extremely fearful of sexual activity, still have sexual desire. Their vaginal lubrication and sexual response orgasm are normal, and they may feel happy and satisfied with non-coital sexual life. Therefore, patients often feel distressed because their normal sexual desire helps maintain them from engaging in normal sexual intercourse.

I. Causes of Vaginal Spasm During Sexual Intercourse

1. Mental and psychological factors

Vaginismus during sexual intercourse is mostly caused by mental and psychological factors, with organic causes being relatively rare. For instance, during the newlywed period, if the woman lacks a correct understanding of sexual life and is excessively fearful and nervous, or if she fears pregnancy from sexual intercourse after marriage, or if there is discord between the couple and the woman has an aversion to sexual life, vaginismus may occur, hindering sexual activity. It can also result from past mental trauma, such as rape, or from overly rough actions by the male during sexual intercourse, or if the woman’s hymen is relatively tough and the pain during hymen rupture triggers reflexive and defensive vaginismus.

Vaginismus during sexual intercourse may also be related to socio-psychological factors. Some foreign scholars believe that being influenced by orthodox religious concepts during childhood and adolescence, viewing sexual activity as obscene, evil, and lewd behavior, thus forming rigid and erroneous views, can also lead to this condition.

2.Organic lesions

A protective and reflexive vaginismus caused by female external genital or vaginal injury, atrophic vaginitis, pelvic lesions, ulceration of the vaginal orifice or labia majora, genital herpes, other infections, or gynecological tumors, which can also result in vulvar pain. Recurrent pain may also form a conditioned reflex, meaning that vaginismus may still occur even after the lesion has supports spontaneously or been supports.

3. TCM Understanding of the Etiology of Vaginismus During Sexual Intercourse

In traditional Chinese medicine, the female reproductive system is considered to be under the governance of the Chong and Ren meridians, which are in turn related to the Liver and Kidneys. The Liver governs the tendons. If the seven emotions cause internal injuries and emotional distress, repressed anger injures the Liver, leading to Liver Qi Stagnation and a failure of smooth flow; or if Liver qi becomes rebellious and its dispersing and descending functions are impaired, the meridians become obstructed and fail to receive nourishment, resulting in spasms and contractions of the tendons in the genital area. The Kidneys govern the anterior and posterior orifices. Excessive sexual activity injures the Kidneys, depleting true yin, causing deficiency of qi and blood, and exhausting the essence and blood of the Chong and Ren meridians. As a result, the tendons and meridians fail to receive nourishment, leading to spasms and contractions of the tendons in the genital area. Alternatively, damp-heat pathogens may flow to the lower jiao, causing redness and swelling of the external genitalia. Pain during sexual intercourse can trigger vaginal spasm.

II. Syndrome Differentiation and Dietary Therapy

1.Liver Qi Stagnation

Emotional distress leads to Liver Qi Stagnation, impairing the Liver’s function of dispersion and regulation, blocking the meridians, and causing spasms and convulsions of the genital muscles during sexual intercourse. This is accompanied by signs of imbalance such as chest oppression and sighing, distending pain in the hypochondriac region, restlessness and agitation, insomnia with dream-disturbed sleep, emotional tension, a white tongue coating, and a wiry pulse. The supports principle is to soothe the Liver and resolve depression. Shuanghe San can be taken.

Formula and Preparation Method: 50 grams each of Tangerine Seed (Citrus reticulata Blanco, Tangerine Seed) and Litchi Seed (Litchi chinensis Sonn, Litchi Seed), and 5 grams of Cicada Slough (Cryptotympana pustulata Fabricius, Cicada Slough). Grind into powder. Take 9 grams each time, dissolved in 40 grams of brown sugar mixed with boiling water to flush down the medicine. Take once in the morning and once in the evening daily for 1 month.

In the formula, tangerine seed (Jú Zǐ Hé) and litchi seed (Lì Zhī Hé) soothe the Liver and regulate qi, activate meridians and helps with occasional pain; combined with cicada slough (Chán Yī) to calm the Liver, dispel wind, and helps with occasional spasm. After taking it, the Liver qi becomes smooth, the blood vessels are unobstructed, and naturally the pain stops and the spasm is helps with occasional.

One can also take Jinmei Decoction. Formula and preparation method: 10 grams of Radix Curcumae (Yujin), 10 grams of Semen Nelumbinis (Lianzi). Add water to decoct into a soup, then add 6 grams of Flos Rosae Rugosae (Meiguihua) and boil it just once. Add an appropriate amount of brown sugar and take it as a tea substitute.

In the formula, Curcumae Radix (Yujin) soothes the Liver and regulates qi, promotes blood circulation and helps with occasional pain. Rosae Rugosae Flos (Meiguihua) can enhance the effect of the formula in regulating qi and relieving depression. It is combined with Nelumbinis Semen (Lianzi) to nourish the Heart and calm the mind, eliminating tension. Drinking it regularly will naturally be effective.

2.Damp-heat pouring downward

Exposure to damp pathogens leads to their accumulation and transformation into heat, or excessive consumption of rich alcohol and heavy, greasy foods generates damp-heat, which flows to the lower energizer, causing redness and swelling of the external genitalia and resulting in spasmodic contraction of the muscles in the genital region during intercourse. This condition is often accompanied by signs of imbalance such as a sensation of fullness and dropping in the lower abdomen, dry mouth and throat, red and white vaginal discharge, scanty and dark urine, a red tongue with a yellow coating, and a wiry and rapid pulse. The supports approach should focus on clearing damp-heat, detoxifying, and relieving spasms. Dilong Jiejing Decoction can be administered.

Formula and Preparation Method: 10 g of Lumbricus (Pheretima aspergillum, earthworm), 30 g of fresh Luffa acutangula (loofah), 10 g of Eleocharis dulcis (water chestnut), 10 g of Lonicerae Japonicae Flos (honeysuckle flower), 10 g of Houttuyniae Herba (Heartleaf houttuynia herb). Decoct in water for oral administration. One dose per day for 1 week.

In the formula, Lumbricus (Di Long), water chestnut (Bo Qi), and fresh towel gourd (Xian Si Gua) clear heat, eliminate dampness, and helps with occasional spasm, while Lonicerae Japonicae Flos (Yin Hua) and Houttuyniae Herba (Yu Xing Cao) detoxify and reduce swelling. The combination of these herbs can supports sexual intercourse-related vulvar pain caused by downward flow of damp-heat.

One can also take the decoction of purslane and plantain. Formula and supports method: 60 to 120 grams of fresh purslane, 60 grams of fresh plantain, and 10 grams of cyperus rotundus. First, wash the purslane and plantain, then put them in a pot together with cyperus rotundus to decoct in water, and drink it frequently as a tea substitute.

In the formula, Plantago Herb (Plantago asiatica L.) promotes diuresis and helps with occasional stranguria, while Purslane Herb (Portulaca oleracea L.) clears heat, detoxifies, and reduces swelling. When used together, they can supports inflammation caused by urinary tract infections. The inclusion of Nutgrass Rhizome (Cyperus rotundus L.) aims to regulate qi and helps with occasional spasm.

In addition, one can also choose heat-clearing and dampness-eliminating diet therapy prescriptions to take.

3. Kidney Yin Deficiency

Deficiency of true yin in the Kidneys, insufficient qi and blood, and failure of the tendons and vessels to be nourished, resulting in vaginal dryness and spasmodic discomfort during sexual intercourse. Accompanied by signs of imbalance such as soreness in the lower back, night sweats, dry mouth and throat, red tongue tip, and a thin and rapid pulse. The supports principle is to nourish the Kidneys and replenish yin. Sangshen Tiandi Paste is recommended for consumption.

Formula and Preparation Method: 1000 grams of fresh mulberries (or 500 grams of dried mulberries), 300 grams each of Rehmanniae Radix (Sheng Di) and Asparagi Radix (Tian Dong). Wash them, add an appropriate amount of water, decoct to obtain the juice, then simmer over low heat until it becomes relatively thick and sticky. Add 500 grams of honey and condense into a paste. Take 1 tablespoon each time, dissolve it in boiling water and drink. Take it twice a day.

In the formula, mulberry fruit (Fructus Mori) can nourish yin and blood, while rehmannia root (Radix Rehmanniae) and asparagus root (Radix Asparagi) nourish yin and tonify the Kidney. Therefore, taking it can reduce deficient fire, enrich yin fluid, moisten the vagina during sexual intercourse, and stop spasms. One can also take Lycium barbarum and Polygonatum odoratum pudding.

In addition, one can also choose food therapy prescriptions that nourish yin and replenish essence for consumption.

III. External Folk and Proven Prescriptions

1. Cnidium monnieri (L.) Cusson (Fructus Cnidii) 15g, Zanthoxylum bungeanum Maxim. (Pericarpium Zanthoxyli) 10g, Aconitum carmichaelii Debx. (Radix Aconiti Lateralis Preparata) 15g, Citrus reticulata Blanco var. aurantium (L.) Osbeck (Pericarpium Citri Reticulatae Viride) 10g, Citrus reticulata Blanco (Pericarpium Citri Reticulatae) 10g, Saposhnikovia divaricata (Turcz.) Schischk. (Radix Saposhnikoviae) 10g. Decoct the herbs in water to make 300ml of decoction, let it cool, and use it to wash the external genitalia before sexual intercourse.

2. 15 grams of Hyoscyami Semen (Tianxianzi), 3 grams of Daturae Flos (Manduoluohua), decoct in water to make 300 milliliters, and use it to wash the external genitalia before sexual intercourse.