What is vaginismus?

Vaginismus is the clinical diagnosis to describe involuntary muscle spasms of the pelvic floor in anticipation of penetration. This is often accompanied by increased tension of the pelvic floor muscles, sometimes referred to as a hypertonic or overactive pelvic floor.

Oftentimes this causes penetration to be painful, especially in the beginning or upon movement. For some people, pain associated with vaginismus is mild. For others, it is unbearable. This could be experienced during intimacy, when inserting a tampon, or during medical pelvic exams. The muscle spasms do not have to occur across all 3 of those contexts to be considered vaginismus. For example, it is possible to experience pain with sex but not have trouble with a tampon. It truly depends on the individual person. 

Common statements from clients with vaginismus include:

• It feels like he’s hitting wall

• It feels like it just doesn’t fit

• I try all the things to relax but it just won’t go in

• Lube doesn’t seem to make a difference

• The pain is mainly with initial penetration

• Sometimes it feels like my partner isn’t at the right angle

• I also have difficulty inserting a tampon

• Tampons have never been comfortable

• Speculums at gynecology visits are super uncomfortable

• There are times that is seems to be worse than others

• If I don’t have sex for a long time, it feels like starting all over

• I notice sometimes it is hard to relax my legs too

How do I know if I have vaginismus?

When describing some of these symptoms to medical professionals, people may feel completely shut down after hearing things like:

“Have you tried a glass of wine to loosen up a little first?”

“You should try lube.”

“Your partner is probably too big for you.”

“Just relax.”

Sex should not hurt. Ever. If you feel like you have been dismissed when describing symptoms of pain with sex, you are not alone. It is rare, but slowly becoming more widespread, for a physician to identify vaginismus, explain it to you in a way you understand, and refer you to pelvic therapy for relief. The good news is, you do not have to wait to have a “diagnosis” before seeing a pelvic therapist. If you feel like you have symptoms of vaginismus after reading the beginning of this blog, then there is a good chance you probably do. After all, you know your body best.

Can pelvic floor therapy help with vaginismus?

Yes! 1,000 times over – yes! Pelvic therapy uses a biopsychosocial approach to address the root cause of vaginismus. They address the pelvic muscle spasms as well as any related cognitive components associated with symptoms. 

Pelvic therapy appointments for clients experiencing vaginismus may consist of hands-on manual therapies to decrease pelvic floor muscle tension or perhaps myofascial restriction or muscle tension outside of the pelvic floor, such as through your abdomen, back, inner thigh muscles, etc. Check out our other blog posts for a full description of what internal and external manual therapies entail. Mobility at and around the hips as well as through the entire body is often a part of these treatment sessions as well. 

Some people are surprised to find out that while stretching and lengthening tight muscles within and surrounding the pelvis is important, assessing and addressing muscular balance and strength is also of utmost importance for clients with vaginismus. This helps to ensure that your pelvic floor is not overcompensating for muscle weakness in another area, such as through your abdominals or core. 

Navigating other resources (books, blogs, podcasts, meditation, self-care care practices, etc.) to support clients with vaginismus is also helpful for establishing comfort with penetration and improving their sense of control over the situation. It can be very frustrating when dealing with these symptoms to want to “just relax” but feeling like you do not have the ability to truly do so. 

It is important to determine if there are other concerns going on contributing to your pelvic pain, such as something hormone related. Your pelvic therapist at Bloom Pelvic Therapy will help you navigate that avenue by connecting you with physicians that are experts in sexual pain if needed for further diagnostics and medication management. Your pelvic therapist will champion your care to make sure all areas and root causes for your pain are addressed so full relief is possible. 

What are dilators used for?

Dilators, sometimes referred to as vaginal trainers, may be a part of your home program to assist with decreasing anticipatory muscle spasms. Dilators can help with the ability of the vaginal walls to move freely without restriction from the surrounding musculature. They also can support the brain-body connection to decease the guarding response to penetration familiar to those with vaginismus. Dilators are a great tool for empowerment for clients to progress towards their goals between pelvic therapy treatment sessions.

Dilators recommended are sized specific to the individual person and made of a comfortable silicone material. The smallest dilator that may be recommended is smaller in width than your pinky finger, and they increase in size from there. Starting size recommendation is based on your initial state of pelvic muscle tension as well as your specific anatomy. The range of sizes and size that you will progress to depends on goals. If goal is for pain-free well woman exams, then there is the perfect size for that. If goal is for pain-free, pleasurable penetrative sex, then size may depend on your sexual partner(s).  

Not everyone is an appropriate candidate for dilators, so it is important to discuss with a pelvic therapist if they would be a good tool for you to use, as well as to receive individualized instruction for use. Rather than placing the dilator in and leaving it in for 10-20 minutes while watching TV or reading a book, we will provide you with a guide and instruction on how to optimize their use with simple vaginal stretch techniques. The stretches, time for use, frequency of use, etc., is tailored to where your tension is specifically. 

Some people prefer to incorporate dilators on their own at home, while others prefer their partner’s support. Some people prefer to trial their dilators for the first time in office to ensure they are using correctly, while others prefer to trial at home first after prescribed by their pelvic therapist and report back with any trouble shooting needed. It all depends on the person and their preference! Timing for progressions in size is another aspect individualized to the person and how they are responding. 

Penetration does not have to be painful!

Many people experiencing this go years before hearing the term “vaginismus” for the first time or until they are taken seriously. Do not settle for medical gaslighting. Find the relief you need and deserve, whether it is for not just pain-free, but pleasurable sex or maybe it is to be able to comfortably wear that tampon for a pool day in this summer heat. It is never too late to get started!  

For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”