What is Vaginismus?

Vaginismus is a condition that causes involuntary muscle contractions of the pelvic floor muscles surrounding the vaginal canal. This pelvic floor muscle dysfunction (PFMD) can impact one’s ability to enjoy intimacy, handle gynaecological exams, and/or tampon use by causing pain and/or discomfort in the vulva and vaginal region and within the pelvic floor muscles.  As reported by Healthy Women in 2021, vaginismus affects about 1-6% of women and vagina owners; however it is believed that many cases go unreported.

Vaginismus is separated into multiple categories and it is important to note that you can fall into more than one category.

Primary: Penetration has always been difficult ever since the first attempt

Secondary: Penetration has NOT always been difficult and could be due to several factors (as described below)

Global: Any kind of penetration is painful

Situational: Some penetrative situations such as tampon use is pain-free, whereas others are painful (intercourse, gynaecological exams)

Total: Penetration is not possible past the pubococcygeus muscle (mid-layer pelvic floor muscle)

Partial: Penetration is possible, but painful

Why Do I Have Vaginismus?

There can be a few reasons why you may experience vaginismus and it’s important to note that each person’s experience with vaginismus may be unique, and the cause may not always be clear.  Know that understanding the root behind your vaginismus is the most crucial part in your healing journey.

Vaginismus can be idiopathic (unknown cause), from an injury onto the pelvis (i.e. fall onto a tailbone, car accident), auto-immune conditions such as lichen sclerosus, neurological conditions such as Multiple Sclerosis or traumatic brain injury affecting nerve communication, and/or from a previous trauma history (verbal/physical/sexual/emotional abuse).

Once you have discovered the root cause of your vaginismus, this will dictate your plan of care moving forward in pelvic health therapy.  This is integral for developing which types of therapy and techniques will be the best fit for you.  It will also help you understand what a timeline will look like for you to reach your goals.

From an anatomical perspective, the muscle contractions are often an unconscious response to fear, anxiety, and/or discomfort related to sexual activity, intimacy or penetration. This can cause a cycle of pain and anxiety, as the pain during penetrative activities or intimacy can lead to increased fear and anxiety, which in turn can cause the pelvic floor muscles to tighten further.

Trauma-Induced Vaginismus

For those who have experienced sexual trauma, working with a pelvic health therapist and a mental health therapist to address the emotional and physical impact of the trauma is a critical part of the healing process.  Vaginismus that has risen from trauma should be considered when developing a plan of care, as there are many facets that can affect the outcomes of treatment.

When starting pelvic floor physical therapy, it’s common to feel a range of emotions, including nervousness, frustration, embarrassment, shame, and anxiety. However, it’s important to remember that these feelings are okay and you are validated in how you feel. The therapist(s) of your choosing are there to support you through the healing process and you should be able to trust and feel safe with them.  

How do I treat Vaginismus?

Pelvic floor therapy is a form of treatment that is specifically designed to address pelvic floor dysfunction, including vaginismus. The goal of pelvic health therapy is to help individuals gain better control of their pelvic muscles and reduce pain during penetration. This can include desensitization therapy, manual therapy interventions, dilator therapy, in some cases hormonal therapy

One approach to treating vaginismus is through manual therapy interventions, which involves a pelvic health therapist using their hands to manipulate and mobilize the muscles and tissues in the vulva and pelvic floor. This can include mobilization of soft tissue (muscles, tendons, ligaments, fascia), stretching the muscles surrounding the pelvic floor (abdominals, adductors, buttocks, etc), utilizing downtraining techniques to calm the nervous system.  Pelvic health therapy can often include other practitioners such as mental health therapists, acupuncturists, OB/GYNs and practitioners that specialize in trauma-informed movement.

Another approach is the use of dilators, which are small, cylinder-shaped tools that are inserted into the vagina to gradually stretch and desensitize the area. In addition, a pelvic wand is another tool that can be used during therapy to help identify and release trigger points in the pelvic muscles that could be contributing to pelvic floor muscle tension.

Will pelvic health therapy hurt?

The experience of pelvic health therapy will vary depending on the individual, but it’s common to experience some discomfort or pain during the early stages of treatment. Over time, as the muscles become more relaxed and flexible, this discomfort should subside and eventually be pain-free. 

Will I ever be able to have sex or wear a tampon?

Vaginismus can be a distressing and frustrating condition, but it is a treatable condition and many people are able to overcome it with appropriate care.

With the help of pelvic floor physical therapy, relaxation techniques, gradual desensitization exercises, and/or hormonal therapy, many people with vaginismus are able to successfully have pain-free intercourse, enjoy intimacy, use tampons, and manage gynaecological exams.

Overcoming vaginismus is a process that requires patience, understanding and effort from both the patient and the pelvic health provider. With a consistent and targeted treatment plan, many people with vaginismus are able to achieve their goals.

It’s important to seek help from a physician and a pelvic floor physical therapist if you experience pain with sex, pain with insertion, or tight pelvic floor muscles. While it can be difficult to talk about these issues, it’s important to remember that they are common and treatable. With the right treatment, you can regain control of your pelvic muscles and enjoy a fulfilling sex life.

Dr. Allea PT, DPT is the owner of Daybreak Physical Therapy and Pelvic Wellness.  She has experience treating highly complex pelvic floor dysfunctions and takes a holistic and multi-faceted approach when treating her patients, to help them reach their goals.