Have you or your partner ever experienced pain during intercourse or just the thought of intercourse? Has your daughter mentioned that her sexual encounter was very painful or avoids using a tampon due to pain? Are you peri-menopausal or menopausal, and suddenly noticing discomfort with penetration? Or maybe you are avoiding your PAP exam because the speculum is too painful. While it is common for people to have pain with physical intimacy and intercourse, it is definitely not normal.

There are many conditions that could cause pain with intercourse, vaginismus being one of them. Vaginismus is a condition characterized by involuntary spasming of the vaginal muscles with any attempted penetration or even the thought of penetration. Pain may vary from discomfort, stinging, soreness, burning, intense sharp pain to chronic constant pain in the area.

Vaginismus can be categorized as primary or secondary based on the cause for the pain. Primary vaginismus is a condition wherein a woman has never been able to have vaginal penetration and is unable to have sex, often discovered when first attempting to insert a tampon.

Secondary vaginismus can occur after a period of non-painful penetration. Pain may be elicited due to physical factors, trauma, infections, autoimmune conditions, hormonal changes, and/or emotional or psychological factors. Prolonged pain or symptoms left untreated can affect our quality of life and have a big impact on our overall health, mental health, as well as our relationships.

Having said all of this, sometimes the cause for vaginismus is unknown. Vaginismus is considered to be involuntary tightening caused by a protective mechanism of the brain. A few structures in the brain are associated with the formation of episodic memories, perception of sensory information and controlling bodily reactions – this is the limbic system.  When one attempts to have intercourse or even have the thought of intercourse, this system can sometimes create an internal alarm/flight or fright reaction causing a protective response of tightening pelvic floor muscles. This reflexive spasming of the vaginal muscles can cause pain. The good news is you can learn to change these messages from the limbic system with appropriate treatment.

When we anticipate pain, or experience fear or anxiety our body will go into protection mode. Our jaw muscles clench, our shoulders lift, our stomach muscles are braced and our pelvic floor muscles tighten, all ready to either fight or flee. This can affect function, including vaginal penetration. We will then naturally want to avoid pain, so we start to avoid touch, not wanting that to lead to anything further. Over time we may not even look each other in the eyes anymore, we avoid deep conversations and date nights – our relationships overall may become strained. 

The good news is, vaginismus can be fully resolved and treated with a multidisciplinary approach. Consider involving a gynaecologist, pelvic health physiotherapist and/or sex/relationship therapist to your team.  

Pelvic physiotherapy plays an important role in one’s path to recovery. There is a lot of education involved in understanding your pain and learning that there is hope in recovery. An internal assessment may not always be required or done when you visit your pelvic physiotherapist, and you will always have consent. A guided approach to teach you how to relax your pelvic floor and down-train your nervous system will first be initiated. This may be followed by manual therapy and dilator therapy, where you learn progressive steps to penetration, working toward your goals, and at your pace. Vaginal dilators are also commonly recommended after certain types of cancer treatments such as radiation and surgery. If you are postpartum, have received cancer treatment or are menopausal, learning about different lubricants can be helpful for these hormonal changes that affect our vaginal tissue.

Pain with intercourse is not your fault and is changeable. You do not have to live with pain! Talk to your doctor, and seek help by booking with a pelvic physiotherapist in your area. If you live in a remote area, much of this can also be guided virtually. Healthy Balance Physiotherapy & Wellness is located in the Oakville/Burlington area and our therapists are licensed to treat in Ontario. If you are experiencing pelvic pain, contact our office today. We would love to help you reach your goals.

Healthy Balance Physiotherapy & Wellness is a therapist owned and operated facility where the focus of care is a hands-on approach with individualized and goal-oriented treatment programs.