Vaginismus
Condition Overview
Vaginismus is a condition where a patient experiences pain due to pelvic floor muscle spasming with the insertion of something into the vagina. This can occur during sexual activity, pelvic exams, or insertion of a tampon or menstrual cup.
Vaginismus can cause mild discomfort to severe pain. This condition can lead to fear of pain or fear of penetration which can lead to self-limiting avoidance of activities and increased pain.
There are two types of vaginismus (primary and secondary):
Primary Vaginisumus
Primary occurs when the patient has discomfort or pain every single time she has attempted to introduce something into the vagina.
Secondary Vaginisumus
Secondary vaginismus is when a patient has previously experienced intercourse or pelvic exam without pain, but is now having pain.
Patients who have Vaginismus often report a sensation that their partner is “hitting a wall” when attempting penetrative intercourse.
Causes
There is not one direct cause known to primary vaginismus; however, physical, psychological, and sexual issues can be a factor. For example, if you have a vaginal septum (a partition that divides the vagina into two parts instead of one hole) this can make it physically impossible for something to enter the vagina.
Secondary vaginismus can occur due to anxiety disorders, prior sexual trauma, childbirth injuries (perineal tears), surgeries, fear of sex or vaginal penetration.
Symptoms of Vaginismus
Pain during vaginal insertion and inability to have sex or pelvic exam due to pelvic floor muscle spasms and pain.
Feeling your partner is “hitting a wall”
People who experience vaginismus alone will not have unprovoked pain - meaning this pain is not there unless something is attempted to be inserted into the vaginal opening.
What Can Physical Therapy Do?
It may be important to have a multi-disciplinary approach to treating vaginismus since there is a physical and usually a mental component playing a role on symptoms you feel. One part of that team should be a pelvic floor physical therapist.
In pelvic health therapy we will discuss your symptoms and go over each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to diagnose your symptoms appropriately. With your consent we will perform an external and internal pelvic floor muscle assessment. We will assess your abdominal wall, low back/hips, adductors, and superficial and deeper pelvic floor muscles. We will determine your muscle function, strength, endurance, and coordination.
If you cannot tolerate an internal vaginal assessment we always stop at your tolerance and never push you to handle more than you can. We move at a slow pace to ensure we are not generating a larger pain response which can slow progress down.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics!
Manual treatment can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization.We also may include dilator or pelvic wand training in order to teach these muscles how to relax and lengthen.
We will likely avoid kegels for the time being to ensure we are not worsening muscle spasms and therefore symptoms. We will most likely focus on downtraining/pelvic floor stretches and then progress as able with each session.
If you are experiencing pain with tampon insertion, pelvic exams, or sexual activity you should seek treatment!