The Gist: What is Vaginismus?
Other ways to describe this: pelvic pain, painful sex, my vagina is "too tight"
Vaginismus is the inability to penetrate the vagina due to pain and tissue overactivity. Penetration includes intercourse, pelvic exams, and tampon usage. Primary vaginismus is when the pain has always been present and secondary vaginismus develops later from a specific event like trauma, infection, or menopause. Women with secondary vaginismus do experience symptom-free sexual function prior to developing vaginismus.
The Anatomy of Vaginismus
The pelvic floor consists of three layers, the superficial, the middle, and the deep layer. The muscles sit in the base of the pelvic floor and encircle the vaginal opening.
Spasms or dysfunction in one or more of the pelvic floor muscle layers can decrease the size of the vaginal opening so that it makes vaginal penetration unbearably painful or impossible all together.
Who gets Vaginismus? When does it occur for women?
Vaginismus does not always have a direct cause. However, it can be related to a history of sexual trauma or abuse, other pelvic traumas (e.g., car accident, sports accident), or a multitude of emotional and stress related factors. Other pelvic floor muscle disorders like endometriosis can result in vaginismus as well.
Primary vaginismus is often diagnosed after a woman's first attempt at penetrative intercourse, whenever that may be, or the first time she tries to use a tampon or have a pelvic exam.
Secondary vaginismus develops after a more specific event like sexual trauma, a fall or accident, or an STI or other infection. Secondary vaginismus can also come about later in life after menopause. Estrogen levels decrease during and after menopause leading to decreased elasticity and lubrication of the vagina, which can make intercourse painful or impossible and lead to vaginismus.
The Origin Way: Physical therapy for Vaginismus
At Origin, we look at your entire history and take a comprehensive approach that includes not only addressing the pelvic floor but also the way you move, manage your stress, and even breathe. We find the driver of your symptoms and create a plan of care that is right for you. Your Physical Therapist will treat you at a pace that is comfortable for you.
A typical plan of care involves breathing and relaxation training, as well as mobility and lengthening exercises to improve your pelvic floor range of motion. Manual therapy techniques may also be used, but they will be used according to your plan of care. It may start with gentle soft tissue mobilizations to your inner thighs over your pants if that's where you are comfortable. You and your Physical Therapist will go at your pace, and no faster. Eventually, your Physical Therapist may do manual therapy techniques to your pelvic floor and introduce dilators or EMG, which is pain free visual or audio biofeedback about your pelvic floor muscle tone, as part of your plan of care.
How long does it take?
Because the pelvic floor may have been in spasm for years, it can take some time to downtrain and lengthen the pelvic floor. Every patient truly is different, but a typical course of treatment lasts anywhere from 4-12 months.
What to expect in the future
Once your Physical Therapy is complete, we recommend that you continue the prescribed lengthening and relaxation exercises because your symptoms could come back at some point in the future, particularly if your symptoms are due to an underlying condition. However, you will have the techniques, tools, and exercises to manage your symptoms or you can return to your Physical Therapist for support at any time.
Additional Reading and Sources
Rosenbaum T: Physiotherapy treatment of sexual pain disorders. J. Sex Marital Ther. 31, 329 - 340 (2005).
Reissing, Elke D, et al. "Pelvic Floor Physical Therapy for Lifelong Vaginismus: a Retrospective Chart Review and Interview Study." Journal of Sex & Marital Therapy, U.S. National Library of Medicine, 2013, www.ncbi.nlm.nih.gov/pubmed/23470141