What is the Definition of Vaginismus?
Vaginismus is a condition where there are involuntary (unwanted) contractions of the muscles of the vagina, which can cause pain and discomfort. These muscle spasms can happen at any time, but tend to come along when there is anticipated or actual penetration of the vagina, like during sexual activity, when inserting a tampon, or during a physical examination.
The term vaginismus has been around a very long time, but in the newest version of the Diagnostic and Statistical Manual (DSM-V), which is published by the American Psychological Association, vaginismus has been combined with dyspareunia (which is the name for having pain with sexual intercourse) into one diagnosis called “Genito-Pelvic Pain/Penetration Disorder” (or GPPPD). Vaginismus is common, with about 1-7% of women reporting experiencing vaginismus, and probably many more out there who haven’t sought any help for it.
So, What Causes Vaginismus?
There isn’t one singular cause for vaginismus, which is why it is tricky to treat. Some of the things that can cause it are:
- Anxiety
- Fear
- Trauma
- Negative sexual experiences
- Relationship difficulties
- Physical conditions like infections or endometriosis
- Structural issues like dryness or having a small vaginal opening
- Scarring or trauma from childbirth or surgeries
- Other physical and emotional causes
What are the Most Common Vaginismus Treatments?
Treating vaginismus is a complex process, and different treatments can work for different women depending on the causes of their issues. Here are some of the most effective treatments available today:
- Physical therapy: Pelvic floor physical therapy is the most commonly recommended treatment for vaginismus. An experienced and licensed physical therapist, specifically a specialized pelvic floor physical therapist, can create personalized treatment plans for women with vaginismus. The treatment usually involves a combination of manual therapy and exercises that help to calm your nervous system and body as well as to help you strengthen and learn to control your pelvic floor muscles so that you can also relax them.
- Vaginal dilators: For some women who deal with vaginismus during sexual activity, vaginal dilators can help to stretch the vaginal tissue gradually. Your pelvic physical therapist can help guide you through safely and comfortably using these.
- Cognitive behavioral therapy: CBT is a type of therapy that is used to treat many different issues. For vaginismus, CBT can be helpful for some women to help them to address and reframe anxiety, fear, or negative thoughts associated with situations that trigger their vaginismus.
- Sex therapy: A trained sex therapist can work to uncover and process any emotional or psychological factors that might be contributing to vaginismus.
- Mindfulness and relaxation techniques: Studies have shown that, for some women, mindfulness and relaxation techniques can help to reduce muscle tension and anxiety associated with vaginismus.
- Botulinum toxin injections: Usually reserved for more severe cases where other treatments have not helped, injections of botulinum toxin (brand name or generic variations of Botox®) into the hypertonic and tense pelvic floor muscles can temporarily reduce the involuntary muscle spasms caused by vaginismus by paralyzing or weakening the muscles. To maximize the benefit of pelvic floor botox, pelvic physical therapy afterwards is strongly indicated.
- Topical numbing or anesthetic products: For some women, topical numbing (anesthetic) creams can reduce pain and help with relaxation.
Pelvic Floor Physical Therapy for Vaginismus
Pelvic floor physical therapy (PT) is a highly specialized treatment that focuses on treating the muscles, ligaments, and other tissues around and inside the pelvis and vagina.
Here’s what you can expect at a pelvic floor PT session for vaginismus and what you can expect:
- Assessment and diagnosis: A pelvic floor PT will do a thorough evaluation by asking you some questions and performing a physical exam. This might include checking your pelvic area to see which areas are tense or in spasm.
- Exercises: Your PT will teach you several exercises that you will need to do at home to strengthen, relax, and/or stretch the area, depending on what your specific issues are.
- Education: This is your opportunity to learn more about the pelvic floor and all its components and ask any questions you have about vaginismus and how it relates to those components.
- Nervous System: Addressing any anxiety and stress that could be causing youto tense your pelvic floor muscles is an important part of helping people with vaginissmus.
Manual therapy: Your pelvic physical therapist should use manual techniques to help release tension and improve the mobility and flexibility of your pelvic floor tissues. This may sound scary, but it’s all done very carefully and only with your consent and at your level of comfort.
- Positioning and breathing techniques: Your PT may help you to identify positions that help your muscles to relax, and they may teach you some breathing techniques to help you to relax your muscles.
- Biofeedback: Biofeedback techniques use actual signals from your muscles to show you visually how well your muscles are contracting and relaxing. A small percentage of people find biofeedback helpful as a tool to help them gain a better sense of when they tensing versus relaxing their pelvic floor muscles. Biofeedback can be done with a handheld device that you can see while an inserted probe or surface sensors take readings while you do your exercises.
Does Pelvic Floor Physical Therapy Work for Vaginismus?
The short answer is yes, for many women, especially when combined with home exercises and therapy, it does work. The length of treatment can vary from woman to woman, but many women see improvements within a few months of treatment.
Vaginismus can be a challenging condition, but with a treatment plan that includes an experienced pelvic floor physical therapy, you can be on the road to less pain and a better quality of life. If you or someone you love is struggling with vaginismus, reach out to a qualified healthcare professional like a pelvic floor physical therapist for expert advice and treatment today.