What is vaginismus?
The definition of vaginismus is the involuntary contraction of the pelvic floor on attempted penetration. How this might present is a woman who is unable to have penetrative sex, unable to have a pap smear, or unable to use tampons - because as much as she tries to, she is unable to prevent her muscles going into spasm when something is attempted to be inserted into the vagina.
Women will often describe the sensation of it being like 'hitting up against a brick wall'.
Why might someone have ended up with vaginismus?
For some reason, a woman with vaginismus is experiencing her body going into 'protective mode', with her pelvic floor muscle attempting to prevent penetration to stop her from being hurt or injured. There may or may not actually be pain on attempted penetration, but almost always there is something in the woman's past that has been an instigator of her body thinking that it needs to protect her.
While this is not an exhaustive list, some examples may include the following:
- A history of trauma (physical and/or psychological), often to do with sex, birth, tampons, pap smears or something else related to the pelvic area.
- A history of chronic thrush, UTI's or something else that has caused repetitive discomfort in the vulval area
- A belief (present or in the past) that sex and sexual intimacy is forbidden, dirty, dangerous, or for some other reason should be avoided
- A history of bladder or bowel urgency, leading to chronic pelvic floor tension from trying to hold on all the time to prevent an accident
- An exercise history involving a sport that encourages the core muscles to be held on constantly, for example gymnastics, ballet or horse riding.
As you can see, some of these things may be a 'primary cause', where the muscles were tight to begin with. But vaginismus can also develop secondarily - where penetration has been possible, but has caused pain (for example due to thrush, or after childbirth, or for many other reasons), and then it has set off a 'Pain - Fear - Tension Cycle'. The body remembers that penetration was painful last time, and has a fear around the pain occurring again, and the pelvic floor muscle tenses up to try to protect from this perceived threat.
What are the other signs and symptoms that can be associated with vaginismus other than the inability to achieve penetration?
While the inability to have penetrative intercourse, or to have a pap smear, or to use tampons, can be the main symptoms of vaginismus, there are other secondary symptoms that may also be associated with this.
For example, the pelvic floor muscles becoming chronically tense could lead to a difficulty starting a wee or a poo, or could lead to incomplete bladder or bowel emptying. Good bladder and bowel function depends on the ability of the pelvic floor to be able to relax when the brain has decided it's time to go to the toilet.
Another sign or symptom of a chronically tense pelvic floor could be pain in surrounding areas, for example the deep buttock region, or the lower abdominal region.
How might a physiotherapist help a woman with vaginismus?
A physiotherapist's main role in the treatment of vaginismus is to teach the woman about where her pelvic floor muscles are, how to contract them on cue, and most importantly how to relax them on cue. Doing regular exercises for these muscles can improve her awareness and control.
Another common aspect of physiotherapist management of vaginismus is providing an opportunity for graduated and safe exposure to penetration. A gradually more challenging stretch can be given to the pelvic floor during vaginal examinations, or with vaginal dilators (see image below), and by being very careful to keep these experiences to a non-noxious level of pain, the woman's brain can slowly understand that vaginal penetration is not dangerous, and not something they need to be protected from.
A physiotherapist may also implement strategies like hip opening/stretching exercise sequences, hold/relax techniques for the muscles around the pelvis, visualisation exercises, diaphragmatic breathing exercises, TENS or vibration to the area for desensitisation, and mindfulness/relaxation sequences.
How to seek help for vaginismus
The Women's Health Physiotherapists at FitRight HQ are able to help patients with assessment and management of vaginismus as outlined above.
You can book a Women's Health Physiotherapy appointment here.
Please note that while physiotherapists can help with the physical aspects of vaginismus, holistic management almost always will involve concurrently treating the psychological/emotional aspects of vaginimus, and ruling out or managing any medical aspects of they woman's pelvic health that might be contributing to this.
At FitRight HQ, we have a holistic team who can help with these aspects too:
You can book a Women's Health GP appointment here.
You may choose to start your journey with one of the above practitioners and then be led by them with regards to when to implement the other 'puzzle pieces' of your management.
