The Misunderstood Vagina

There’s a cultural narrative about what constitutes an “ideal” vagina, which is both pervasive and problematic. The subtle insinuations of this “ideal” were prevalent as I grew up. It was shocking for me to discover, as a pelvic floor therapist, that some women were given an extra, unnecessary stitch post-childbirth. This stitch is colloquially termed the “husband stitch.” Thankfully, this practice has become much less common.

Key Takeaways

• Vaginismus is a condition where certain pelvic floor muscles, especially those near the vaginal opening, involuntarily contract when faced with the possibility of penetration. This can occur during a medical examination, use of menstrual products, or sexual activity
• The direct cause of vaginismus remains elusive, but a notable correlation exists between the condition and experiences of abuse, trauma, or anxiety. Though evidence on the topic is not entirely clear-cut, it’s worth considering
• The standard treatment for vaginismus has historically been a dilator protocol. However, a holistic approach considering mental health, movement (including — gasp! — strength work), and other factors can be far more effective

Vaginismus Explained

To illustrate vaginismus, think of your hand: make an open circle with your thumb and index finger – let’s call this a relaxed vagina. Then, tightly close that circle – this represents the involuntary muscle contractions of vaginismus.

The DSM-5 categorizes vaginismus under genito-pelvic pain/penetration disorder (GPPPD), which also covers painful intercourse (dyspareunia). GPPD affects 10-28% of individuals with vaginas. The hallmark of vaginismus is that often, penetration becomes an impossibility.

Sexual health and intimacy extend beyond just penetration. However, for many, not having the choice of penetration can be profoundly distressing, impacting their self-identity and creating a nexus of fear, anxiety, and shame.

As for its root cause, vaginismus is largely understood as both a psychological and physical condition. While certain beliefs might result in physical dysfunction, it’s essential to consider other potential causes. For instance, many of my patients diagnosed with conditions like endometriosis or lichen sclerosus also present with vaginismus. While psychological factors play a role, many of these patients have endured medical traumas or were ignored by the healthcare system for extended periods.

Another significant factor to consider is the history of abuse. Research has found a significant correlation between instances of emotional and sexual abuse and vaginismus diagnoses. Additionally, traumatic experiences, such as adverse childbirth experiences, can contribute to the condition’s onset.

The Road to Recovery

Earlier in my career, vaginismus treatment seemed straightforward: manual therapy and dilators. As I gained experience, I recognized the broader complexities of the condition. It’s imperative to offer trauma-informed care, prioritizing the individual’s sense of safety and security.

From an orthopedic perspective, I’ve observed that those with vaginismus often have tight diaphragms and abdominal walls, suggesting they might not be breathing optimally. This observation was just the tip of the iceberg in better understanding that treating vaginismus requires an integrated approach.

While dilators can be helpful, they shouldn’t be the sole focus of treatment. Pinning one’s progress and self-worth on the size of a dilator can be counterproductive, especially for a condition so closely linked with anxiety and self-perception. Instead, assessing and working on glute strength, thoracic and hip rotation, postural and breath patterns, and overall nervous system regulation are the secret sauce to a sustainable recovery.

A Holistic Approach to Treatment

For anyone on a journey to address vaginismus or pelvic pain, always remember: there’s hope. Start with the basics: focus on your breath, engage in gentle movements, and prioritize feeling safe in your body. Should you need guidance or support, seek out a professional who understands the multifaceted nature of pelvic health.

Vaginismus and pelvic pain are complex, but surmountable. Surround yourself with a supportive team, approach the issue with patience, and remember, you’re not doomed. I’m rooting for you. 

Cait Van Damm is an occupational therapist specializing in pelvic floor and chronic pain. She has extensive training in yoga and craniosacral therapy, as well as internal and external evaluation of the pelvis, back, and hips. I am a body positive therapist. I believe in supporting all people across the gender spectrum and use trauma-informed care.