Somewhere between 5-17% of women are impacted with vaginismus in the United States. Women who complain of vaginismus related symptoms have pain and/or anxiety with penetration at the vaginal region. There are some women who experience vaginismus in response to an event that may or may not be traumatic. Other women experience vaginismus without any known reason. The good news is that regardless of the cause, most women are able to recover from this condition to achieve pain-free penetration.
Before I jump into some helpful tips in overcoming vaginismus, I want to make sure that those suffering from vaginismus recognize that this is a medical condition and does not mean that you are the problem! So, if that thought is present go ahead and ignore it so that you can move towards the goal of overcoming this condition.
Why is pain-free penetration important for so many women?
The answer to this question depends on the individual. The most common answers are related to tolerating use of a tampon and enjoyment of coitus.
Here are some things that you should know to help you conquer vaginismus and/or to help you support a loved one who is working to overcome this condition.
Stress management is essential
Stress is a factor that we cannot always eliminate, but we can be proactive in helping our body’s better respond. If you have a stressful job, or have noticed increases in your stress level, you may notice that overall your body feels tighter. You may recognize more tension in your jaw, neck, or even your butt. Take the time to work on relaxing these muscles. To relax your jaw make sure your back teeth are not touching. To keep your neck and shoulders from tightening up, take a few moments in the midst of stress to stretch your neck and do some shoulder rolls. Even take a moment to un-clench your butt and pelvic floor. How do you do this? Stand up and shake your legs out and let your buttock jiggle a bit. You can also imagine that you are trying to use your vaginal region to lift the seam of your pants towards you, and then channel the song from Frozen to “LET IT GO” to imagine that the pant seam is falling down! The let it go portion is how you relax your pelvic floor muscles. If you feel like you can’t do the lifting portion, that could be an indicator that you are clenching.
Consistency is needed for progress
This is not a process that you can stop when you start to see progress. This is a process that you must see to the finish line and be diligent. Yes, it is okay to take a break, but consistency is key to seeing success. Once you achieve that success then you can likely decrease the routine or regimen, but until then, set a goal to schedule at home activities. Create a relaxing environment to allow for these activities to feel less like a chore, and start with just a few minutes. So what types of activities are we talking about? Dilator use, deep breathing, and stretches. Aim to do these activities at least 4-5 days per week.
Learn to ways to cope with the fear and/or anxiety
Learning to cope with the fear associated with vaginismus is not always an easy task. For that reason, I recommend that you work with a qualified mental health specialist. This step may not be necessary for all women, but for some it is a must in order to notice progress. Your nervous system and your body changes in response to fear and undoing this response can be a delicate matter. Locating a mental health specialist who is able to help you overcome any psychological barriers that exist, has proven key for some of the patients that I see. Yes, there are things that can be done during physical therapy to help address these concerns through visualization, desensitization, and down-regulation techniques. However, we also recognize that various forms of treatment may be outside of our area of expertise and that consulting with another provider would be best for your overall care.
What should you expect with pelvic floor physical therapy when treating vaginismus?
First, your physical therapy should gather a thorough medical history and also determine if primary or secondary vaginismus is present. Primary vaginismus is when a woman has never been able to tolerate any vaginal penetration. This is often identified with failed attempts of using a tampon or of a pap smear. Secondary vaginismus is when vaginal penetration was once achieved, but no longer is possible. Understanding these two classifications can be important in helping develop a treatment approach, and it may identify if there was any event that contributed to the development of vaginismus.
After a thorough history, your physical therapy should assess your overall stress levels, sleep, and nutrition. This is key because these factors can all lead to a cascade of events that result in increased an overactive fight or flight response within your nervous system. And guess what is common with vaginismus? That’s right, a hypervigilant fight or flight response!
Now that the above information has been considered, we can move into the physical assessment. It is likely that this assessment will not involve disrobing of any clothing at the first few visits. So, if that is a fear just speak to your therapist so that clear expectations can be set. I like to get an idea as to how well the patient is moving and check on flexibility in general. I can also get an idea of how well your pelvic floor muscles relax by assessing your breathing in various positions, and by gently palpating the muscles externally near the buttock region.
I believe it is important that these steps precede dilator use and training. For many of my patients, they do well with visualization when introducing the dilator. Yet, I do have some who do best with jumping right into use. The approach depends on the individual and it is important to cater to those needs. Even though I want to make sure that I am addressing these needs, it is important to set the expectation that some discomfort may be present so that we can work towards decreasing the body’s response of aversion. Nonetheless, it is essential to have open communication to ensure that needs are addressed to effectively progress towards goals.
What is the take home message?
You can overcome vaginismus. It may take working with a mental health specialist in addition to a physical therapist. It will take diligence from you as well, but congratulate yourself with each step of progress no matter how big or small it may seem!
Have questions about vaginismus, or looking to overcome it? Feel free to reach out to me!