Vaginismus and Physical Therapy: How to Know If You Have It and How to Treat It
Vaginismus is a symptom experienced by people with vulvas where the pelvic floor muscles involuntarily contract or spasm in response or anticipation of any form of penetration, including penetrative sex, tampon insertion or even gynecologic exams.
Due to the personal nature of vaginismus, folks often wait years to discuss their symptoms with their medical providers. Even if you haven’t felt comfortable discussing your symptoms, understanding why they may be occurring and potential treatment options can be a big help. In this post, we’ll look at what vaginismus is, what causes it, and how to treat vaginismus and seek out the care that’s right for you.
What Is Vaginismus?
Vaginismus is an involuntary reaction where a the pelvic floor muscles tighten up or spasm in reaction to attempted vaginal penetratoin. Typically this occurs at the start of sex or the anticipation of sex. However, this can be in reaction to anything penetrative at all, such as a tampon, penis, toys, a finger, medical applicator, or speculum.
These muscle spasms make sex and penetration painful (read more about dyspareunia, or pain with sex here) and can range from mild to severe depending on the individual. With vaginismus, there’s an involuntary response created by the limbic system — the part of the brain that controls behaviors and emotions — to “protect” the body from vaginal penetration. The dysregulation of your limbic system triggers an internal alarm at attempted penetration, leading to the protective mechanism which in this case is the muscle spasm. Because of this protective response, and because of the severe pain associated with penetration with vaginismus, vaginismus is often accompanied by anxiety or fear (leading up to penetrative activities).
Genitopelvic Pain/Penetration Disorder (GPPD)
Vaginismus is often grouped in with a similar condition called dyspareunia, or pain during sex. Both dyspareunia and vaginismus fall under the umbrella term of genitopelvic pain/penetration disorder (GPPPD), and both conditions are considered part of a spectrum of sexual pain disorders.
A GPPPD diagnosis usually means pelvic pain symptoms must be present for six months or longer and be accompanied by or lead to significant distress.
Vaginismus Symptoms
Symptoms of vaginismus include the following:
Vulvar or vaginal pain/discomfort during penetrative sex or attempted penetration.
Tightening or vaginal muscle spasms during sex or penetration when attempted.
Tightening or vaginal muscle spasms during a pelvic exam or when inserting a tampon.
Causes of Vaginismus
The exact causes of vaginismus remain somewhat of a mystery to healthcare experts as these look different for many individuals. Vaginismus is multifactorial and may stem from a variety of causes.
Some of the factors that are thought to cause vaginismus include:
Injuries during childbirth, including vaginal tearing
Prior surgery
Pelvic injury
Idiopathic (no known causes)
Vaginismus and Sexual Trauma
All too often, sexual trauma is blamed for the development of vaginismus. Vaginismus can and does develop in absence of sexual trauma, but understanding the association can help guide treatment for those with a history of trauma. A 2021 study conducted by the Oxford Academic Journal of Sexual Medicine found a significant association between a history of sexual and emotional abuse and the diagnosis of vaginismus. If you think you may have vaginismus and you have a history of sexual abuse or assault, choosing a trauma-informed provider who can help you navigate treatment can help. Addressing both the physical and the psychosocial aspects of your pain can help you return to pleasurable sex.
But remember, too often it’s assumed folks experiencing sexual pain are experiencing it as a result of trauma that they never experienced. Every individuals journey with pelvic pain is their own. It’s our job as pelvic floor physical therapists to support our patients in seeking the kind of care they need.
How Common is Vaginismus?
Vaginismus impacts a relatively small portion of the general population. It’s estimated that between 1% and 6% of women experience vaginismus. However, these numbers may appear lower than they true as many experiencing these symptoms may be hesitant to report them to their healthcare providers.
Vaginismus can occur in anyone with a vulva and at any age. Symptoms may appear as early as the first attempted penetration or early adulthood when someone is attempting sex for the first time.
For others, vaginismus develops later in life.
How to Treat Vaginismus
Treatment for vaginismus is often a two-pronged approach: focusing on muscle reflexes that cause vaginal spasms and addressing the expectation of pain associated with painful sex.
Some of the physical treatments your healthcare provider might recommend include:
Pelvic floor physical therapy: A good physical therapist (ahem!) can teach you relatively simple techniques and exercises to relax your pelvic floor muscles. They can use manual therapy during physical therapy visits to address muscle tension in your pelvic floor and surrounding muscles and focus on nervous system regulation while giving you tools and techniques to use at home between visits.
Topical creams or suppositories: With appropriate medical advice, compound creams and topical medications like lidocaine or muscle relaxants can help ease pain associated with vaginismus.
Progressive desensitization: This is a common treatment approach employed by pelvic floor PTs where vaginal dilators, fingers, sex toys or other tools can be used, sometimes in combination with additional treatments to progressively reduce sensitivity in the vaginal opening. The goal is to make the vulva, vagina and pelvic floor muscles less sensitive to penetration by slowly, progressively increasing what you can comfortably tolerate.
Biofeedback: Your physical therapist can used a device called biofeedback to help you learn to relax the pelvic floor muscles that you may not realize are holding tension. Internal or external sensors can be used for biofeedback to teach your body to release tension it’s holding onto.
Additional treatments your healthcare provider may recommend in addition to physical treatments:
Cognitive behavioral therapy (CBT): CBT can be especially helpful for individuals suffering from past sexual trauma, anxiety, or depression. It’s also a great tool to learn to become more aware of how the fear, tension, pain cycle is contributing to the pain you’re experiencing.
Sex therapy: Seeing a trained sex therapist can be a helpful way to learn how to find pleasure with sex again. Sex therapy can be done individually or with a partner to help navigate intimacy and sexual activity in the face of pain.
Vaginismus is a disorder that can really weigh on you. If you think you may be experiencing it, don’t suffer in silence. Your OBGYN is a great place to start as they can help diagnose the cause of the pain and can help refer you to various treatments or a pelvic health physical therapist for further treatment.
If you’re experiencing pain with sex or think you have vaginismus, schedule an appointment with our pelvic floor PTs, today.
Contact us here for an appointment or call us at 512-766-2649.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.