What is Vaginismus? A Comprehensive Guide
Written by Dr. Karah Charette, PT, DPT, RYT
Are you looking for vaginismus help?
Do you deal with vaginal pain and sexual dysfunction?
Often thought of as a women’s health issue, vaginismus can affect anyone with a vulva.
In this blog, you will learn what vaginismus is, the causes of it, and what can be done to treat it!
What is Vaginismus?
Vaginismus is often defined as an involuntary spasm or tightening of the pelvic floor muscles in response to any form of possible penetration. This can often cause penetration to be painful or even feel impossible to achieve. Vaginismus is important to address because you deserve to have painfree intercourse for connection, pleasure, and even potential family planning.
Vaginismus can also affect other areas of health beyond sexual function. This tightening of the pelvic floor muscles can also be a barrier to gynecological exams, tampon insertion, and/or menstrual cup insertion.
As with any physical condition, the research is showing it is becoming harder and harder to fully separate the physical from the mental and emotional. So while physical therapists tend to focus on muscles and fascia, the reality is the nervous system dictates why those muscles or fascia might be tight or holding in the first place. It is for this reason that a purely biomechanical approach towards vaginismus will not be enough to help fully treat it.
If you have been told you just need to “stretch” and “put dilators in while watching TV”, this type of treatment plan will not be successful. Vaginismus is now being studied under the category of a potential phobia-like behavior from the body. If the components of fear, trauma, and stress are not addressed, stretching and dilators may not ever be possible let alone useful.
When addressing any dysfunction from a nervous system informed place, mindfulness and consciousness must be involved. Vaginimus requires a full bio-psycho-social approach in order to create meaningful and sustainable changes. Felt and perceived safety in this part of the body is the number one goal.
The Causes of Vaginismus
Some cases of vaginismus may appear from a more acute physiological cause such as a traumatic birthing experience or even a surgery that occurred in the pelvic, hip, back, or abdominal areas. Recurrent infections such as yeast infections, UTIs, or a history of STIs can also create more inflammation, irritation, and therefore holding patterns at the pelvic floor muscles. Similarly, chronic pelvic pain and inflammatory conditions such as endometriosis and interstitial cystitis can create muscular tension and fascial holding patterns at the pelvic floor due to longstanding pain and inflammation in the pelvic area.
As stated earlier, the binary of the body and mind does not exist. So whether something starts more in the mind and then manifests into physical symptoms, or something starts as physiological and then affects the nervous system, the two systems are always dancing together. For that reason, vaginismus can also be a very real physiological experience that is driven by deeper states of trauma, stress, anxiety, and fear. Especially if there is a history of sexual trauma, abuse, or negative associations with sex, the pelvic floor muscles can have even more reason to want to stay tight and in a protective state. For some people, this can manifest also in relationships with poor communication, lack of safety, or relationships that have a heavy emphasis on strongly religious and/or conservative beliefs about sexuality. In these cases, the best line of care is both somatic pelvic floor physical therapy and somatic psychotherapy. Together, the bodymind can be held and witnessed so there is space to reintegrate and create new meanings, experiences, and stories with this powerful part of your body.
Common Symptoms of Vaginismus
How might you know if you have vaginismus? One way you might feel symptoms manifest is through involuntary muscle spasms during penetration. You may also feel pain with penetration even if you can achieve it, whether that is during intercourse or during a pelvic exam or pap smear. Oftentimes people with vaginismus who can achieve some penetration experience pain as well as a feeling like a ring of muscles squeezing at the opening, preventing further penetration. These muscles can also continue to feel tight and sore even after the penetration has stopped.
It is possible that alongside symptoms with sexual dysfunction, you may also have a history of constipation and/or straining. You may also have issues with urinary function including urgency, frequency, UTI like symptoms, feelings of retention, or even incontinence. These can all result from pelvic floor muscles being too tight, and vaginismus is usually associated with upregulated and non relaxing pelvic floor muscles.
Types of Vaginismus
Vaginismus can technically be classified into two different categories:
Primary Vaginismus is when the condition is present from the first sexual experience or pelvic exam.
Secondary Vaginismus is when the condition develops after a period of “normal” painfree penetration or after an injury or trauma.
Both are treatable with quality somatic pelvic floor physical therapy.
The Impact of Vaginismus
The impact of vaginismus can be serious and severe. As mentioned earlier, the pelvic floor muscles affect not just sexual function, but also bowel and bladder function. Having chronic tension in these muscles can lead to urinary and/or bowel dysfunction down the road. The pelvic floor muscles are also an essential part of your core, so there can also be an impact on your hip and back health if they are not able to work optimally for you under load and during exercise.
Beyond purely physical health, vaginismus can also affect emotional well being. Vaginismus can lead to the avoidance of sexual activities and have a negative impact on physical intimacy. There can also be feelings of shame, frustration, guilt, or isolation when dealing with this. One important aspect to know is that vaginismus is more common than you think, it is just rarely talked about. Shame can be a breeding ground for further pain, and one of the most healing things you can do is communicate what you are going through and what you need with trusted loved ones and certified medical providers such as pelvic floor physical therapists.
How a Somatic Pelvic Floor Physical Therapist Can Help
One of the most important aspects in quality pelvic floor physical therapy to address vaginismus is that the therapy needs to go slow, be nervous system informed, and extremely tailored to the individual.
One major aspect often seen with people who deal with vaginismus is a loss of the sense of boundaries. If care does not take this into account, people can be re-traumatized or patterns of appeasement can be reinforced because oftentimes the physical therapist client relationship is shaped around the client being told what to do. For vaginismus (and truly all healing), the plan of care must be collaborative and a sense of agency for the client must be established. If you are passive in your healing, it will not change your nervous system responses. No amount of passive tissue stretch, massage, or dilator work can create real sustainable change without embodiment and integration.
At Bodyful, we customize the treatment plan based on your unique needs and experiences. Your beliefs and stories matter. We often start by giving many options for ways to begin to regulate the pelvic floor without just quickly moving to internal work or dilators. We are uniquely trained in visceral fascial mobilization work that allows us to gently assess and treat areas in the abdomen above the pelvis that still greatly affect the pelvic floor holding patterns.
De-sensitization training and techniques similar to exposure therapy have proven to be very helpful with vaginismus. Being able to start in areas of the body such as the respiratory diaphragm, abdomen, and even the glutes can be perceived as potentially safer areas to start with touch work, without overwhelming the nervous system. Retraining how the body responds to touch can be extremely therapeutic. Our focus on breath work and grounding techniques allows for the nervous system to regulate and create new neural pathways of safety with touch at a slow and titrated rate.
Eventually, the goal of achieving penetration can slowly be worked up to with the use of smaller sized dilators as well as the internal assessment and techniques the pelvic floor physical therapist is trained in. At Bodyful, we focus on integrative ways to work with the dilators and internal work, including coordination exercises of the pelvic floor, de-sensitization to sweeping and movement, and even practicing movement of your body during the dilator or internal work. All of these techniques have the goal of allowing this work to be more neurologically rich, helping your brain and body create new experiences of safety with penetration, pressure, and stretching at the pelvic floor.
Another aspect we invite into treatment at Bodyful is incorporating partners. If and when the time feels right, acknowledging that penetration for intercourse occurs in a relationship, it can feel helpful to allow a partner to be in the treatment room or even learn techniques alongside the therapist that can be tried at home. Translating dilator work to your partner means another nervous system is now involved. Finding creative ways to titrate into safety and curiosity with that experience is another vital aspect to fully treating vaginismus beyond just dilators.
How to Seek Help
If you are reading this and notice many of the symptoms and experiences named resonate with you, it may be time to reach out for professional help. Consulting with a pelvic floor specialist can be an important step in finally making sustainable change for vaginismus. Early treatment can actually mean less money and time spent in the long run. The earlier you are able to address your symptoms, the less likely you are to develop secondary pelvic floor dysfunction down the line. Not to mention, you get to connect more deeply with an important part of your body that may allow you to access deeper pleasure, joy, and safety!
Vaginismus is a treatable condition with the right support.
If you feel called to work with our somatic pelvic health approach at Bodyful, book a discovery call to learn more about vaginismus treatment. We offer Telehealth and in person visits. Our office is located in Oakland, CA. Somatic wellness sessions are available to anyone in or outside of CA.
