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What Is Vaginismus?

Vaginismus is a medical condition characterized by the involuntary contraction or spasm of the muscles surrounding the vagina, making penetration painful or impossible. This condition affects a person-with-a-vagina’s ability to engage in activities involving vaginal penetration, such as sexual intercourse, insertion of tampons, and even medical examinations. The severity of vaginismus can vary, with some women experiencing mild discomfort and others finding any form of penetration extremely painful. But here’s the good news: it’s very treatable!


Let’s dive into some background:


There are two primary classifications of vaginismus:

  1. Primary Vaginismus:

    1. This form occurs when a woman has never been able to engage in vaginal penetration. Even attempts at penetration, such as during sexual intercourse or medical examinations, are met with involuntary muscle spasms. These muscle spasms are painful.

    2. The onset of primary vaginismus is often associated with anxiety or fear related to the anticipated pain of penetration.

  2. Secondary Vaginismus:

    1. Secondary vaginismus develops after a period of normal sexual function. A woman who previously did not experience any issues with penetration may suddenly develop symptoms of vaginismus.

    2. Causes of secondary vaginismus can include trauma (physical or psychological), childbirth, gynecological procedures, surgery, infections, or other medical conditions.


Causes:

The causes of vaginismus are complex and can be both physical and psychological. Some common factors include:


  1. Psychological Factors:

    1. Anxiety and fear related to sexual activity, or just anxiety and stress in general!

    2. Past traumatic experiences, such as sexual abuse or assault.

    3. Cultural or religious beliefs that contribute to feelings of guilt or shame about sex.

  2. Physical Factors:

    1. Infections or medical conditions affecting the genital area.

    2. Injury or trauma to the pelvic region.

    3. Post-surgical complications.


Symptoms:

The main symptom of vaginismus is the involuntary contraction of the pelvic floor muscles, making penetration difficult or impossible.

  1. Let’s compare this to muscle tightness in the neck or the jaw. If you wake up with a stiff neck, it doesn’t feel very good to try to force it to where it doesn’t want to go. If you have been clenching your jaw and then you try to open wide for a big yawn, it doesn’t feel very good to open that far.

    1. The same thing happens with the pelvic floor muscles: if they are tight or spasming and then they are forced to stretch or open to accept a tampon, toy, speculum, penis, or anything else, they’re not going to be very happy! This will cause pain and discomfort.

    2. Other symptoms may include anxiety or fear related to attempts at penetration, avoidance of sexual activity, and strained relationships. You may also have avoided your gynecological exams, and you may use pads instead of tampons during your period.


Diagnosis:

Diagnosing vaginismus involves a thorough medical and psychological evaluation. A pelvic floor physical therapist may conduct a pelvic floor exam, take a detailed medical history, and explore any contributing factors.

  • In order to assess the pelvic floor muscles for tightness and treat them, the gold standard is an internal pelvic floor muscle examination. This may be via the vagina or the rectum, depending on the person, the situation, and the symptoms.

  • However! An internal examination is never necessary on the first visit or ever! You may understandably be nervous about this type of examination given the fact that you’re in physical therapy for pain with penetration to begin with! Let’s talk about what this exam looks like.

  • A pelvic floor muscle examination is always a gentle process without any speculums and with plenty of lubrication. You’ll be comfy on a heated table with plenty of pillows to support you. Your physical therapist will frequently check in with you for consent to start and to continue the exam, and you are in charge the entire time. You even have the option of bringing someone along to help you feel more comfortable: maybe a partner, maybe a friend!

  • Your physical therapist will use a gloved and lubricated digit to gently palpate the pelvic floor muscles of the external and internal pelvic floor. You will feel gentle pressure as your physical therapist identifies tightness, trigger points, or knots in the muscles. Just like any other muscle, the pelvic floor can get knots too! The exam usually lasts 3-5 minutes and gives you and your PT helpful information to identify if the muscles are tight, where they are tight, and how to treat them.

  • If you are not comfortable with an internal examination, there are still plenty of ways to treat vaginismus! This includes assessment of the areas surrounding the pelvic floor such as the abdominal, inner thigh, and glute muscles. Everything is connected, so there’s a good chance those muscles are also tight.


Treatment:

Treatment for vaginismus often involves a multidisciplinary approach:


  1. Pelvic Floor Physical Therapy:

    1. Involves exercises to relax and lengthen the pelvic floor muscles.

    2. This may involve internal pelvic floor muscle release work with your physical therapist, as well as instruction on how to perform internal pelvic floor muscle release work at home on your own. It’s always best to understand your own body!

  2. Counseling or Sex Therapy:

    1. Addresses psychological factors contributing to vaginismus.

    2. Couples therapy may be beneficial to improve communication and understanding.

    3. High quality recommendations for therapists provided

  3. Desensitization Exercises:

    1. Gradual exposure to vaginal penetration through the use of dilators, the pelvic wand, or other techniques to reduce anxiety and muscle spasms.

  4. Medical Interventions:

    1. In some cases, medications or medical procedures may be recommended to address underlying physical issues. This may include trigger point injections, topical medication, suppositories, and more.

Vaginismus is a treatable condition, and many women find relief through a combination of physical therapy, counseling, and support. Seeking professional help is crucial to understanding the underlying factors and developing an individualized treatment plan that addresses both the physical and psychological aspects of vaginismus.


To Sum It Up:

Pelvic floor physical therapy is a specialized and effective approach for addressing vaginismus, a condition characterized by involuntary muscle spasms in the pelvic floor muscles that can cause pain and difficulty with vaginal penetration. This form of physical therapy focuses specifically on the muscles, ligaments, and connective tissues in the pelvic region, aiming to improve their function and alleviate symptoms associated with vaginismus. Here's a more concise explanation of how pelvic floor physical therapy treats vaginismus:


  1. Comprehensive Assessment:

    1. The therapy process begins with a thorough assessment of the individual's pelvic floor musculature. This may involve both external and internal examinations to evaluate the strength, flexibility, and coordination of the pelvic floor muscles.

    2. Posture and musculoskeletal alignment are also assessed to identify any contributing factors to pelvic floor dysfunction.

  2. Education on Anatomy and Function:

    1. Patients are educated about the anatomy and function of the pelvic floor muscles. Understanding the role these muscles play in sexual function and the development of vaginismus is crucial for effective treatment.

    2. Therapists provide information on how pelvic floor dysfunction can occur and contribute to conditions like vaginismus.

  3. Relaxation Techniques:

    1. Manual therapy techniques, such as massage, myofascial release, and stretching, are employed to release muscle tension and address trigger points in the pelvic floor.

    2. Biofeedback may be used to provide real-time feedback on muscle tension levels, helping individuals learn to consciously relax their pelvic floor muscles.

  4. Strengthening Exercises (Probably Not Kegels!):

    1. Pelvic floor exercises, commonly known as Kegels, are tailored to address specific muscle imbalances. Strengthening exercises may be prescribed to enhance overall pelvic floor function in those that have weakness.

    2. However, people that have pelvic floor muscle tightness are usually not going to benefit from kegels. In fact, it may make their pain worse. If the muscles are already too contracted and spasming, let’s not contract those muscles more!

    3. Functional training exercises that mimic real-life activities help individuals develop a more coordinated and responsive pelvic floor.

    4. This may include strengthening the muscles around the pelvic floor such as the glutes, abdominals, inner thighs, and more. If those muscles aren’t strong enough to do their job, the pelvic floor may be tight to compensate for the lack of strength in those collaborative muscle groups.

  5. Behavioral and Cognitive Strategies:

    1. Desensitization techniques are employed to gradually expose individuals to pelvic floor triggers, such as the introduction of a finger or dilator. This process helps them become more comfortable with penetration over time.

    2. Cognitive-behavioral strategies are utilized to address fears, negative thoughts, and anxiety related to penetration. Changing thought patterns and beliefs is crucial for overcoming the psychological aspects of vaginismus.

  6. Home Exercise Program:

    1. Patients are typically provided with a home exercise program, including dilator training. Dilators of varying sizes are used at home to gradually stretch and relax the pelvic floor muscles.

    2. Self-care techniques and exercises are taught to empower individuals to continue their progress between therapy sessions.

  7. Communication and Support:

    1. Partner involvement is often encouraged, with therapists providing strategies for effective communication and support. Partners may attend therapy sessions to gain a better understanding of the condition and contribute to the treatment process.


Pelvic floor physical therapy for vaginismus is a holistic and collaborative approach. Success in treating vaginismus through physical therapy requires consistent effort from the individual, open communication with the therapist, and, when applicable, the involvement and support of the partner. This comprehensive approach addresses both the physical and psychological aspects of vaginismus, helping individuals achieve improved pelvic floor function and a better quality of life.




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