Managing Vaginismus with a Board Certified Pelvic Health Physical Therapist
Have you ever experienced the sensation of “hitting a wall” while trying to insert a finger, tampon, speculum, or penis into your vagina?
Has a doctor ever advised you to simply relax or have a glass of wine to ease the process of penetration? Are you frustrated that despite wanting to insert something into your vagina, your body responds with a firm "no"?
If you’ve answered yes to any of these questions, you’re in the right place. The “hitting a wall” sensation is a commonly reported symptom of vaginismus. Vaginismus is defined as the involuntary spasm of the outer third layer of the pelvic floor muscles during attempted vaginal penetration. This means that the feeling of “hitting a wall” is real and results from the tensing or tightening of the pelvic floor muscles.
Despite how common vaginismus is (with reports suggesting that between 5-17% of women experience it, though the number is likely higher due to underreporting), the exact cause of the automatic tensing is not completely understood. Several hypotheses suggest contributing factors such as:
Painful or traumatic sexual experiences that cause fear and anxiety about experiencing pain again
Painful or traumatic pelvic exams
Abuse or trauma
Negative feelings or beliefs about sexual experiences or female genitalia stemming from personal, familial, cultural, or religious beliefs
The Role of the Nervous System in Vaginismus
Our pelvic floor muscles receive about 30% of their innervation from the autonomic nervous system, which includes the “fight or flight” and “rest and digest” responses. This means that pelvic floor muscles are partially controlled by our emotions. When we experience a threat, our pelvic floor muscles react and tense up, similar to how a dog tucks its tail when it’s afraid. In humans, this reaction results in the tightening of the pelvic floor muscles.
This becomes problematic when there is no actual threat. Our bodies can hold onto memories of past negative experiences, leading to protective muscle guarding. The good news is that our bodies are adaptable and can learn to neutralize the perceived threat, allowing the muscles to relax during intimate moments, menstrual care, or pelvic exams.
Treating Vaginismus with Pelvic Floor Physical Therapy
Vaginismus is highly treatable, and Pelvic Floor Physical Therapy is a key component of treatment. PFPT involves working with a specialized physical therapist who can help you learn to control and relax your pelvic floor muscles. The therapy may include:
Education: Understanding how the pelvic floor muscles work and how they contribute to vaginismus.
Exercises: Performing exercises to strengthen and relax the pelvic floor muscles.
Manual Therapy: Hands-on techniques to release tight muscles and improve pelvic floor function.
Biofeedback: Using advanced techniques to monitor muscle activity and provide feedback to help you learn to control your muscles.
Dilator Therapy: Gradual insertion of dilators of increasing size to desensitize the pelvic floor muscles and reduce pain.
Multidisciplinary Approach
While Pelvic PT is crucial, treatment outcomes are significantly enhanced when combined with a multidisciplinary approach that includes psychotherapy. Addressing both the physical and emotional aspects of vaginismus can lead to more effective and long-lasting results. Psychotherapy can help in:
Addressing Fear and Anxiety: Understanding and overcoming the fear and anxiety associated with penetration.
Trauma Therapy: Working through past traumatic experiences that may be contributing to vaginismus.
Sexual Counseling: Improving communication with your partner and exploring new ways to experience intimacy without pain.
FAQs About Vaginismus and Pelvic Floor PT
1. What causes vaginismus? Vaginismus can be caused by a variety of factors, including childbirth, medical conditions, traumatic experiences, and negative beliefs about sex.
2. How common is vaginismus? It's estimated that 5-17% of women experience vaginismus, but the actual number may be higher due to underreporting.
3. Can vaginismus go away on its own? While some women may experience relief over time, many benefit from targeted treatment like PFPT and psychotherapy to address the underlying causes.
4. What can I expect during a PT session? During a PFPT session, your therapist will assess your pelvic floor muscles and guide you through exercises and techniques to relax and control these muscles.
5. How long does it take to treat vaginismus? The duration of treatment varies depending on the individual, but many women see significant improvement within a few months of consistent therapy.
Getting Started with Treatment
If you have more questions about vaginismus or are ready to begin your healing journey, don’t hesitate to reach out to a qualified pelvic floor physical therapy clinic like Chicago Pelvic Health. Treatment is highly personalized and can provide significant relief, helping you reclaim control over your body and improve your quality of life.
Written by Dr. Rebekah Wolinetz, PT, DPT, WCS, PRPC, Cert-DN, of Chicago Pelvic. Find all of our accounts here at Linktree.
