“Vagina, vagina, vagina.” If you are reading this you either have a vagina or you came from someone with a vagina. Our vaginas are often taboo, a topic that does not get the attention it deserves. Vagina is an anatomical term, it’s a medical term, and it’s an important part of our day-to-day functioning as women. If you’ve been following our blog, you know we take the pelvic floor and
When we frame the vagina as a medical term, it opens us up for a discussion about the things that may not be working as well as we want. One such challenge is pelvic pain. And vaginismus (along with the related dyspareunia) is one common cause of pelvic pain.
What is Vaginismus?
Vaginismus is an involuntary tightening of pelvic muscles (the perineal & levator ani muscles, specifically). Women experience vaginismus for different reasons and realize it with different activities. Some women say that when they use a tampon, it feels like the tampon is hitting a wall. Some women experience vaginismus when going for their gynecological exam, and the use of a speculum is extremely painful. For others, their husband is not able to insert his penis into the vagina, making penetrative intercourse nearly impossible due to pain.
Regardless of when you first noticed your vaginismus, it impacts your ability to engage in preferred activities, impacts your access to necessary healthcare, and may put a strain on your intimate relationships.
But you are not alone.
How Common is Vaginismus?
The numbers on vaginismus range quite dramatically, and because of the personal nature of pelvic pain, we think even the best estimates are too low. But I’m a pelvic floor physical therapist; I treat women from Oklahoma City for vaginismus every day. I am confident that you have someone close to you who is suffering, or has suffered, from vaginismus or another pelvic pain disorder.
You are not alone, but you have to ask for help. Fortunately, physical therapy is a common treatment for vaginismus in Oklahoma City and we probably already have a working relationship with your OB/Gyn.
Treatment for Vaginismus
Because we are taught not to talk about “our lady parts” vaginismus is often a silent condition, one that a lot of women in Oklahoma City suffer through needlessly. But the beautiful thing about our muscles is that they all work in the same way. Just as they tighten, they can be lengthened to release. And when you need treatment for vaginismus, you need that pelvic floor relaxation. The pelvic floor physical therapists at FYZICAL Oklahoma City are trained to teach you to relax and release the muscles of your pelvic floor.
The clinching of vaginal muscles is not unlike tightening the muscles of your hand. When you clinch the muscles of your hand, you make a fist; when you clinch the perineal and levator ani muscles, you close the opening of the vagina. Just like you can’t hold anything once your fist is closed, insertion into your vagina is painful, if not impossible, while your pelvic floor muscles are clinched.
We can voluntarily contract the muscles in our hand, and we can voluntarily relax those muscles as well. We can stop the contraction. We can open our hand to pick up our child, grab our purse, or clutch our significant other’s hand. We can voluntarily contract and relax the muscles of the pelvic floor, as well.
Remember, though, vaginismus is an involuntary contraction of the pelvic floor muscles. Releasing the muscles of your pelvic floor is not as easy as just opening your hand. When you have vaginismus, you can be taught to release the muscles of your pelvic floor, but it takes a little work and usually requires some feedback from a pelvic floor physical therapist.
What do you do in pelvic floor physical therapy for vaginismus?
Every woman with vaginismus is different. So, when I treat a woman for vaginismus, I do a thorough evaluation of her pain and other symptoms. But there are five techniques I incorporate into most of my patients’ treatment plans for vaginismus.
You might not realize there is a proper way to breathe, but there is. And you may not be breathing properly. The stress of life does that to a lot of us.
By learning how to breathe properly, you will learn to relieve a lot of stress, which often times leads to a lot of pelvic floor relaxation. Breathing alone is not going to fix your vaginismus, but it can make a world of difference in reducing your pain for other techniques to be more successful.
Before working on the internal muscles of the vagina, I find that most women with vaginismus benefit from stretching. In this case, I mean stretching of associated muscles rather than those of the vagina (although keep reading for more on stretching those muscles).
In particular, stretching those muscles of the low back, hips, and thighs goes a long way in improving pain for many women being treated for vaginismus. In conjunction with coordinated breathing, stretching will allow you to relax; you will better learn how to engage and release the muscles the support your pelvic floor.
Many women, even really strong physically active women, suffer from pelvic floor weakness. Just because your pelvic floor muscles are tight, as is the case with vaginismus, it doesn’t mean they strong. However just starting to do kegels with vaginismus is the wrong approach, first one must learn to relax the pelvic floor muscles.
The reality is, because the pelvic floor muscles are the foundation of your core and key to so many activities, when other muscle groups are weak, we often brace by tightening (or contracting) our pelvic floor muscles and that can be the initial cause for many women’s pelvic pain.
However, with vaginismus it is very important to learn to separate your abdominal muscles, inner thighs, and gluteals muscles from a pelvic floor contraction or kegel(they are the same thing). If you are not sure how to do that then avoid strengthening exercises for now until you can consult a pelvic health therapist. Once we know which exercises you can separate from a kegel, then you can start strengthening the surrounding muscles to help support the pelvic muscles. Until then stick with stretching and breathing.
Manual Muscle Manipulations
Sometimes described as pelvic floor massage, or manual therapy by pelvic floor physical therapists, manual muscle manipulations are one of the most important aspects of reducing pain in the treatment of your vaginismus.
Some women are comfortable using their finger (“digits”) like I often use to release trigger points in the vaginal muscles. Some prefer to use pelvic dilators (like our friends over at VUVA Tech make). And some want to use a Therawand. But regardless of the tool, the goal of manual muscle manipulations is to reduce the tension, pressure, and pain caused by muscle trigger points. And this is one of the best ways to improve your vaginismus.
Some women are uncomfortable with internal work either on themselves or with me, even as a trained pelvic floor physical therapist. While I want women to be comfortable with their bodies and be able to participate actively in their treatment, I know that some times we have to work up to it. Biofeedback is more personal than stretching or breathing, but less invasive than manual muscle manipulation, which is a big reason I use biofeedback to treat my patients with vaginismus.
Biofeedback uses real time electrical signals from your muscles to show you a visual representation of how well you contract and relax the muscles of your pelvic floor. Using a handheld unit, or a computer model we can better teach you how to coordinate your breathing with a Kegel, how to downregulate your nervous system, and how to relax your pelvic floor for maximum benefit.
Bonus Tip: Include your partner, if you have one. I encourage my patients to bring their partner to physical therapy. It helps both people understand the pelvic floor, and I have seen how much better patients respond when they have the support of an encouraging and understanding partner.
By incorporating properly coordinated breathing, stretching, targeted exercises, manual muscle manipulations, and biofeedback, you can enjoy a healthy pelvic floor and you can live your life without the pain of vaginismus.
If you have questions, please call. We are always happy to help other women, we are here to help you “Love Your Life!”
-Lauren C. Peterson, PT, DPT
Clinical Director, FYZICAL Therapy & Balance Centers of Oklahoma City
FYZICAL Therapy & Balance Centers of Oklahoma City provides pelvic floor physical therapy in Lakeside, The Village, Nichols Hills and surrounding NW Oklahoma City. Our pelvic floor physical therapists are specially trained to treat all types of pelvic floor dysfunction including pelvic pain and vaginismus. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.
For those needing pelvic floor massage, we recommend Therawand to our Patients. Checkout the link below.
Originally Posted 2/8/2019