• Emily Reul, PT, DPT

Vaginismus

Hi friends! Have you ever heard of vaginismus? Maybe you, or a loved one, have experienced difficulty and pain with vaginal penetration—this may be vaginismus. This week we are going to talk about what vaginismus is and how it can be treated.


Vaginismus is difficulty for an individual to allow vaginal entry of a penis, a finger, or any other object, despite their interest to do so (Bo, 2015). While many times we talk about vaginismus when it comes to vaginal penetration with sexual intercourse, vaginismus can also make it difficult or impossible to do things like insert a tampon or have a gynecological exam with a provider.


Vaginismus is caused by an involuntary contraction of the pelvic floor muscles which makes the opening to the vagina more narrow. It’s important to recognize that this contraction of the muscles happens without the individuals control. This can make it painful and difficult to penetrate and sometimes even impossible. It may feel like you are hitting a brick wall when trying to insert something vaginally.


Vaginismus occurs in about 1% of pre-menopausal women (Bo, 2015). Sometimes we don’t know what has caused it, but other times it occurs after a particular event (like childbirth). It is often associated with fear and anticipation of pain with any attempts for insertion.


To treat vaginismus, there are several different treatment approaches. Many times, it takes a combination of these treatments to get rid of symptoms.

Pelvic floor physical therapy is a great option for treating vaginismus. A pelvic floor physical therapist will perform an evaluation to individualize your treatment plan. Your evaluation likely won’t include an internal exam for the first few sessions because, well, it hurts and that’s why you’re there!


Your therapist may perform manual therapy techniques to help relax the pelvic floor muscles and surrounding tissues (like the hips, back, and butt). They may also teach you down training techniques to help decrease stress and calm your nervous system. They will likely teach you how to relax your pelvic floor muscles voluntarily.


Dilator training may be a part of your treatment plan. Dilators can be a great way to progressively stretch the vaginal and perineal tissues, but more importantly, it is a way to teach the pelvic floor muscles to relax (instead of tighten) when an object is introduced for penetration. Dilators come in several different sizes and often come in sets that get progressively larger—some start as small as a pencil! Some of our favorite brands of dilators are Intimate Rose and Soul Source.


Depending on your individual needs, you therapist may use modalities for pain relief like ice, heat, and electrical stimulation.


Vaginismus can be an overwhelming condition that greatly impacts quality of life, but there is hope! With the proper treatment and resources, it is possible to return to pain-free vaginal penetration, whatever the purpose may be.


Here are some great resources to learn more about your pelvic floor and pain: