Inability to have intercourse, or painful intercourse, may be due to a condition known as Vaginismus. This condition can also make inserting tampons and gynecologic exams difficult or even impossible. Vaginismus refers to the involuntary contraction of the pelvic floor muscles, the muscles in the vaginal area, in response to attempted penetration, effectively closing or significantly narrowing the vaginal opening. I stressed the word involuntary because many women feel they are to blame for this condition, and they are not. They simply have not yet gained the tools needed to overcome it. Many women with Vaginismus describe penetration as “hitting a wall.” Others simply describe the pain it causes to be unbearable. Fortunately, treatment for Vaginismus is usually very effective.
What Causes Vaginismus?
While there is no clear cause for Vaginismus, many believe that it is usually triggered by a sexual trauma, and therefore has a psychological component. However, not all women with Vaginismus report a history of sexual abuse or trauma. While there may in fact be a conscious or subconscious psychological cause, this condition is usually best addressed in a practical manner, as opposed to delving into deep psychological work. Many women get very frustrated by being told by providers that this condition is “in their head,” because they are often very eager to address it, and are looking for practical solutions. However, there are definitely many women that can benefit from psychotherapy in addition to the treatments outlined below.
At the Florida Center for Urogynecology, you will first be examined by one of our expert Physicians or Physician Assistants to determine if the cause of your symptoms is in fact Vaginismus (there are other causes for sexual pain that we address as well). Your provider may recommend medications such as muscle relaxants and numbing creams to make intercourse more comfortable. Sometimes pelvic floor Botox injections may help if other treatments do not work or only work partially. While medications may help, they are not a cure. The first-line treatment for Vaginismus is Pelvic Physical Therapy.
Pelvic Physical Therapy
Our Pelvic Physical Therapists work side by side with our medical providers to provide you with the very best treatment. At your first session, your therapist will perform an evaluation which includes a detailed history, an orthopedic exam, and a pelvic floor exam. The orthopedic exam is to determine any musculoskeletal issues that may be contributing to your symptoms. The pelvic floor exam is similar to a gynecologic exam, where, with your informed consent, the therapist will insert a gloved finger into the vagina. With more severe cases, finger insertion may not be possible on the first session, and that is alright. This exam provides the therapist with valuable information in order to help you. It is also the first step in starting your treatment.
Pelvic Physical Therapy Treatments for Vaginismus
- Vaginal Dilators: Your therapist will teach you and guide you on how to effectively use vaginal dilators. Vaginal dilators are a set of plastic or silicone inserts to help you gradually learn how to allow penetration. You will start with the largest size that is not too easy to insert, but is not painful. The goal is to eventually use the dilator that is about the same size as your partner. Some women are able to use the dilators without the guidance of a therapist, but many women plateau without additional help. Keep in mind, dilators are only part of the comprehensive treatment plan.
- Neuromuscular Re-Education: While vaginismus is an involuntary or reflexive response, you can learn how to override it. A good analogy is learning how to insert contact lenses. We are naturally wired to prevent things from entering our eyes in order to protect them. However, with practice, you can learn how to stop blinking in order to insert the contact lens. Your therapist will teach you how to effectively relax and lengthen your pelvic floor muscles in order to allow penetration.
- EMG Biofeedback: Biofeedback gives a visual of how well you are able to relax your pelvic floor muscles. This is done by placing a sensor into the vagina or stickers on the perineum, and connecting it to a computer monitor. This visual feedback can help you practice and learn how to relax your pelvic floor muscles more effectively.
- Manual Therapy: Hands-on techniques can help you relax your pelvic floor muscles more effectively. This may include alignment correction, massage to the abdominal, inner thigh and gluteal muscles, as well as internal myofascial release, trigger point release, and gentle stretching of the pelvic floor muscles.
- Therapeutic Exercise: In addition to dilators, your therapist will provide you with a comprehensive home exercise program that you will practice between sessions.
- Patient Education: Knowledge is power. Your therapist will help you understand your condition and your body, what you can do to ensure a full recovery, as well as the many resources that are available to you.
Vaginismus can be very distressing, with many women seeing multiple providers before getting the proper diagnosis and treatment. We hope you find this information to be a useful part of your healing journey. Remember, we are here to help.