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Understanding Vaginismus: Causes and Treatment Options

As a pelvic floor physical therapist I talk a lot about the pelvis. But when talking about the pelvic floor I am not simply referring to the actual pelvis bone, but the extensive network of the 36 muscles and more than 10 ligaments and fascia that play a central role in our everyday lives.

Unlike other muscles, fascia, and ligaments throughout your body, your pelvic floor is, for the most part, invisible. You’ll never know it’s there, and probably don’t think about it functioning … unless something is wrong. 

Today’s topic illuminates this perfectly. In today’s blog post, we are chatting all things vaginismus, exploring what it is, what causes it, and the treatment options for vaginismus, a common but often misunderstood condition affecting women’s health.

What is Vaginismus?  

First, lets dive into what Vaginismus is. If you know someone who has a vagina, chances are they – or someone they know and love – suffer from this invisible pelvic floor disorder.

  • Vaginismus is an involuntary spasm of the muscles within the vagina upon penetration, or upon perceived *threat* of penetration– resulting in an inability to have penetrative sex as well as an inability to insert a tampon or have a pelvic exam/digital insertion.  
  • Vaginismus is a drastically under-reported pelvic floor disorder that many people with vaginas experience, and unfortunately, no reliable numbers exist that accurately convey its prevalence. 
  • Vaginismus is more common than you think.

Put simply, we don’t know the exact number of people who suffer from this pelvic floor dysfunction condition because many people are ashamed of having it – even though it is not their fault. Many people don’t feel safe or supported in sharing their condition with their medical provider, so they suffer in silence. 

What Does Vaginismus Look Like?  

Now that we know what Vaginismus is, lets explore what it looks like. It is very reasonable to assume that most people are unaware of the many muscles that comprise their vagina, so we have included a visual below to help us understand the scope of what Vaginismus entails. 

Pic source

In the side view above, the left shows a typical vaginal opening flanked by pelvic floor musculature on either side of the opening. The opening is sufficiently sized so that penetration is feasible. 

On the right side, the Vaginismus vaginal opening is much narrower, making penetration virtually impossible, due to the pelvic floor musculature on either side of the opening spasming

Pic source

The above picture shows this in a different way, so we can better visualize the exact pelvic floor musculature that is responsible for the vaginal opening and narrowing, the transverse perineal muscles. 

Upon penetration, or mere *threat* of penetration, these muscles involuntarily spasm and contract, making the opening extremely narrow and preventing any type of penetration or insertion.

Because these muscles aren’t easily visible, many people don’t always know or understand what is happening when they are experiencing symptoms. They say it feels like something is “hitting a wall.” 

Having a visual is helpful to understand exactly what is happening in your body so you can make an informed decision about how to treat it. 

Causes of Vaginismus

Now that we are well-versed in what vaginismus is and what it looks like, it’s helpful to explore what causes vaginismus. 

Vaginismus has a multi-factorial etiology –in other words, many causes. Some causes are physical or medical, while others are more psychological or psycho-social in nature. And for some, it’s a combination of everything

Causes for vaginismus may include but aren’t limited to the following: 

  • Previous medical conditions or surgeries: Multiple urinary tract infections (UTIs), sexually transmitted diseases (STDs), and yeast infections could result in a higher risk for developing vaginismus. If you’ve had surgery to the genital or pelvic area, that may also result in vaginismus. 
  • Hormonal changes concurrent with aging: As our bodies age and our hormones fluctuate due to childbirth, menopause, or using hormonal contraceptives, our risk of developing vaginismus changes over time as well. 
  • Perineal scarring or tearing: After giving birth vaginally, some people develop vaginismus, likely due to perineal tearing and scarring.
  • Trauma: People who have experienced sexual trauma or sexual abuse during their life have an increased risk of developing vaginismus. 
  • Anxiety and Fear: People who suffer from anxiety or fear or other high emotive states around sex and penetrative intercourse may have an increased risk of developing vaginismus.
  • Cultural and Religious Influences: Cultural and religious factors can create negative attitudes towards sex and also play a role in the development of vaginismus.

In addition to the aforementioned causes, it’s important to differentiate between primary and secondary vaginismus. 

Primary Vaginismus

Folks who have primary vaginismus report that they have never been able to endure vaginal penetration

People who experience primary vaginismus discovered that they cannot experience vaginal penetration under any of the following circumstances, including but not limited to the following common scenarios: 

  • When trying to use a tampon, 
  • When a practitioner is trying to administer a pelvic exam by using a speculum or gloved finger
  • When they are trying to have penetrative intercourse.  

Secondary Vaginismus

In contrast, people who have secondary vaginismus report that earlier in their lives, they were able to endure or experience vaginal penetration. Later in life, though, they are no longer able to experience vaginal penetration and report experiencing the involuntary vaginal muscle spasming sensations

Something happened between these two phases in the person’s life resulting in secondary vaginismus. 

Vaginismus and Pelvic Floor Physical Therapy

For so long, mainstream medicine, and the medical establishment in general, has been dismissive of anything pertaining to or labeled as “women’s health.” This has led many people to minimize their pain, disregard their symptoms, and tragically, not advocate for themselves. Instead, many women live a life beset by pain and discomfort because they feel they have no choice. 

For a long time, unfortunately, people who experienced vaginismus were told by their providers that their pain “was in their head,” that they should simply “use more lube” to rectify their penetrative or intercourse pain, or worse yet, that their pain was unimportant

With the emergence of pelvic floor physical therapy there are now medical providers who are experts in the functioning of all aspects of the pelvic floor, including the muscles that constitute the vagina. 

Pelvic floor physical therapists understand that while it may be “common,” it 👏 is 👏 not 👏 normal 👏 to experience pain with  vaginal penetration at any stage in life. Just because something is “common” does not mean it is “normal.”

Pelvic Floor Physical Therapy and Vaginismus – How Pelvic Floor Physical Therapy Can Help

If you’re experiencing vaginismus, consider connecting with a doctor of physical therapy who specializes in the pelvic floor

A pelvic floor physical therapist will assess your unique circumstance and presentation, consider your symptoms and lived history, and recommend a personalized treatment plan. 

As part of a pelvic floor physical therapy treatment plan for vaginismus, your pelvic floor physical therapist will assess: 

  1. Stress Nervous System –  The pelvic floor is the only group of muscles that has direct nervous input from the stress nerves. Therefore, the more stress you have, the more your pelvic floor will respond. Optimize Pelvic Health has assessment strategies and provides techniques to improve your relaxation response which will decrease pelvic floor symptoms.
  2. Organs – Optimize Pelvic Health’s techniques allow our doctors to assess how your pelvic floor is being impacted by your organs. When an organ is stressed, the muscles around it function as organ protectors. When this happens the muscle may limit its function in other areas which will limit your overall strength and flexibility. 
  3. Nerves – Have you ever stretched and stretched without feeling a release in the muscle? The reason the muscle is not releasing is due to tension on your nerves in your connective tissue. When there is tension surrounding a nerve, the muscles will not contract effectively. At Optimize Pelvic Health, we assess how the nerves influence the tightness you feel, and how this impacts your pelvic floor dysfunction.
  4. Whole Body – At Optimize Pelvic Health, we assess different body regions such as the foot, mid back and jaw which can contribute to pelvic floor symptoms. Assessing how different body regions affect the pelvic floor will allow for full recovery of your symptoms.

Additionally, we perform internal pelvic floor treatment along with stretches and/or exercises to achieve optimal recovery from vaginismus.

Connect with a Pelvic Floor Physical Therapist to Address Your Vaginismus Concerns Today

If you are experiencing vaginismus, consider connecting with a doctor of physical therapy who specializes in the pelvic floor

For so long, people have assumed that pain with vaginal penetration was normal and even acceptable. This is simply untrue

Pelvic floor physical therapists are experts in all aspects of the pelvic floor, and your pelvic floor physical therapist will consider your unique circumstances, symptoms, and lived history to tailor a treatment plan customized for you

There is no one-size-fits-all approach because vaginismus is different for everyone. 

Working with you, as a partner, a pelvic floor physical therapist can help determine the best course of treatment for your vaginismus and help you begin to heal. 

You – and your health! – are worth it. 

You don’t need to live in pain and discomfort for the rest of your life. 

You *can* enjoy vaginal penetration. 

We invite you to reach out today so that we can begin your healing journey together. 

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