Vaginismus…a term that maybe was once unfamiliar may be on your radar thanks to Meghan Trainor.
On an episode of her podcast “Working on it”, Trainor shared that she has pain with penetration with her husband. Furthermore, she was surprised to learn that penetrative sex is not supposed to be painful. Her doctor eventually diagnosed her with vaginismus.
You can check out the highlight here: https://www.youtube.com/watch?v=OMZ0MibMVJI.
Vaginismus is an involuntary contraction of the pelvic floor muscles that makes penetration painful, difficult, or impossible. ¹
You can suffer from primary vaginismus, meaning that penetration has always been painful, or secondary where you had pain free vaginal penetration in the past. ¹
One of the hardest things about vaginismus is the why. There are associations between sexual abuse/assault and vaginismus ², but very often people still experience vaginismus with no prior history of trauma.
Sex can be very much wanted by the individual, or perhaps it’s just an exam at the gynecologist, or using a tampon. You are not to blame for vaginismus. Your muscles go under involuntary contraction, this is more than just relaxing.
Do you suffer from vaginismus? Keep reading to learn how pelvic floor physical therapy can help you.
Assessment and treatment
Your pelvic floor physical therapist will assess your muscles. Depending on your comfort level, your therapist will do an external and internal (vaginally) muscle assessment. Pelvic floor PTs have done extensive training to do this type of muscle analysis.
Once areas of tension or pain are identified, your PT can help desensitize your muscles, work on stretching, and take you through techniques to lengthen your muscles.
You may do something called biofeedback. With biofeedback a small internal sensor or external sensors determine your resting muscle tension. You are able to see that tension on a screen. Your PT will then guide you through different activities for lengthening or relaxing your pelvic floor.
Dilators are an essential part of a home program for vaginismus. Dilators are tools made for gradual vaginal stretching and desensitization. You start from a size that you can tolerate and work your way up to give you the confidence for sex, an exam at the gynecologist, or tampon use.
You can find one of our favorite brands here: https://www.intimaterose.com/collections/vaginal-dilators?gad=1&gclid=CjwKCAjwx_eiBhBGEiwA15gLN5TsRlEl9i_jXJTxg_5Pg4K72YbGx0iCIhJpq0Xz5NoJvFflrkfl7xoCYTEQAvD_BwE
Your pelvic floor physical therapist will tailor a dilator program to you taking into consideration your goals and starting point. Below is just a sample dilator program, but follow the advice of your physical therapist.
Find a private space where you won’t be interrupted. A relaxed semi-reclined position is helpful so a bed with a headboard you can rest on or the bathtub may work best. Try to create a relaxing environment; put on some music, a podcast you enjoy, or light some candles if that’s your thing.
It may be helpful to spend some time just taking the dilator and touching around the labia without insertion, especially if you have a lot of anxiety about using the dilator. You can stay at this step as long as you need to build confidence.
Pick a dilator that you think you can tolerate and get plenty of lubricant.
Insert the dilator a few inches. You don’t need to insert all the way.
Just breathe for a minute or so with the dilator stationary. A little discomfort or stretching is okay, but this should not be painful.
After this, you can angle the dilator to stretch the vaginal opening. I instruct patients to think of the vaginal opening like a clock with 12 o’clock being up toward the clitoris and 6 o’clock toward the anus. You don’t need to angle toward 12 or 6 because the urethra and rectum are there.
Angle the dilator to stretch at the 1,3,5, 7, 9, and 11 positions. Hold 30 seconds each spot and repeat the whole sequence 3 times. You may notice one side or a specific direction is a little tighter.
Finally, you can move the dilator in and out a few times to finish out the program.
Dilators need to be practiced consistently to see progress. Try for at least 4 times a week.
Referral to specialists
Pelvic floor physical therapists can really help you out with this condition, but sometimes you may need a little extra assistance.
Your pelvic PT can refer you to a sex therapist, recommend talk therapy, or send you to a physician if you have underlying conditions that may benefit from medical management (ie vulvodynia where you may benefit from a topical).
Sex should never hurt. If you suffer from vaginismus, know that you’re not alone, but also that you can get better with the help of pelvic floor physical therapy.
- Melnik T, Hawton K, McGuire H. Interventions for vaginismus. Cochrane Database Syst Rev. 2012;12(12):CD001760. Published 2012 Dec 12. doi:10.1002/14651858.CD001760.pub2
- Tetik S, Yalçınkaya Alkar Ö. Vaginismus, Dyspareunia and Abuse History: A Systematic Review and Meta-analysis. J Sex Med. 2021;18(9):1555-1570. doi:10.1016/j.jsxm.2021.07.004