Why Things Feel ‘Too Tight’ Down There: Understanding Vaginismus and How Pelvic Floor Therapy Helps
What is Vaginismus?
Many women who come into my office to seek help for pelvic pain have been given misinformation that being tight is a good thing. While the pelvic floor muscles need to be strong and supportive, being “tight” is another story. This leads to what we call “non-relaxing pelvic floor” and is associated with symptoms such as pain, urinary urgency, frequency, and constipation. Vaginismus is the involuntary tightening of the muscles in the vagina. Those with Vaginismus experience muscle spasms that can make it nearly impossible for anything to penetrate the canal. Patients will describe pain and/or the inability to use tampons, have a gynecological exam, or participate in penetrative intercourse. This condition also affects one’s mental and emotional well being, by often resulting in embarrassment, low self-esteem, and fear.
Why does Vaginismus occur?
We still don’t know why one person develops vaginismus over another. The prevalence in the United States is said to be between 5-17% and is thought to be underestimated. While we don’t know an exact cause, there are some very common factors that may trigger symptoms to flare, including:
Anxiety disorders
Trauma - read more here about trauma and pelvic floor dysfunction
Prior surgeries
Urinary or vaginal infections
Any of the above will create tension in the pelvic floor muscles, by triggering an activation response whereby the muscles move into a guarded position involuntarily.
Pelvic floor therapy for Vaginismus
Pelvic floor therapy is extremely effective in treating Vaginismus! Treatment includes learning how to get your pelvic floor muscles to relax, dilator training to improve muscle stretch, and desensitization techniques.
Other treatments that can be helpful in conjunction with Pelvic floor therapy include:
Topical lidocaine or other compounding creams prescribed by a physician
Sex Counseling and/or Sex Therapy
Cognitive Behavioral Therapy (CBT)
Starting With Desensitization
One thing you can get started with is desensitizing your tissues and nervous system! The goals here is to teach your body and nervous system that touch/penetration vaginally is not a threat. A great starting point is to practice touching your body in non-threatening ways - in areas away from the vagina. Maybe this includes touching yourself over your abdomen, inner thighs, or back. Tuning into what you’re doing and acknowledging your boy’s response, instead of dissociating, is essential. Progressively working closer to the vagina, enables your nervous system to adapt, instead of sounding the alarm in the absence of a threat. This can be accomplished with your hand, a soft blanket, or anything that feels safe.
Dilator Training
Dilators are therapeutic tools used to promote gradual and gentle relaxation of muscles with a low-intensity, longer-duration stretch. Oftentimes, people will start by applying gentle pressure externally and then work their way to internal use. Dilators come in sets with various sizes that allow for gentle progression towards your own goals. They come in a variety of materials but most people choose to use a silicone set, because they are softer and often less intimidating than the plastic or glass alternatives. A pelvic floor therapist can guide you in how to use these at home in the most effective and safe way for your body. One brand that I recommend most is New Flora (for those who are interesting in purchasing, feel free to use my discount codes RPHDELRAY at checkout).
Other Treatment Strategies
Aside from dilator work and desensitization, Pelvic Floor Therapy helps to treat vaginismus by working on:
Pelvic floor muscle coordination - with the goal of relaxing the muscles
Hip, spine, and pelvic mobility
Hip strengthening, to better support the pelvic floor (therefore letting it relax)
Nervous system regulation
Posture and movement pattern optimization
Soft tissue manual work
Important Points 👇
Treating Vaginismus is not a quick process and should never be forceful. The goal is to create gradual improvements in the tissue as well as target contributing factors such as the nervous system, trauma responses, and your beliefs/fears surrounding your symptoms and vaginal penetration. Resolving Vaginismus is possible! Pelvic Floor Therapy doesn’t have to be scary - read here to learn more about what a trauma-informed therapy session can look like. If you’re interested in getting started, reach out to our clinic and learn how we can help!
