- Vaginismus is a condition characterised by the involuntary tightening of the pelvic floor muscles, the muscles around the opening of the vagina.
- Women struggling with vaginismus find any sexual activity that involves vaginal penetration painful – also referred to as dyspareunia – or impossible, and in many cases can experience the same intense symptoms when inserting a tampon or undergoing pelvic examinations as well.
- It is a common condition and, in the UK, affects 1 in 500 women.
- It can cause immense distress, relationship problems and it may prevent women from starting a family.
- Vaginismus is a real condition and healing is possible.
- Specialist Physiotherapy for the treatment of vaginismus is an intervention consisting of pelvic floor muscles retraining techniques, education and self-management strategies that aim to normalize muscle tone of the pelvic floor muscles and treat any pain in order to allow vaginal penetration without pain, anxiety and fear.
How common is it?
Studies worldwide have reported that the prevalence of vaginismus varies between 5% to 17%. However, it is most likely to be underreported due to women feeling embarrassed and ashamed to seek help.
What is vaginismus?
Vaginismus is a condition where pelvic floor muscles, tighten involuntarily. When a woman has never been able to have penetrative intercourse because of the involuntary tightening of her vaginal muscles it is called primary vaginismus. Secondary vaginismus occurs when a woman has previously been able to have intercourse or insert tampons but is no longer able to do this because of the involuntary muscle spasms, fear and pain. In vaginismus the causes can sometimes be related to a painful or traumatic event such as an infection, childbirth, gynaecological surgery or abuse.
Why does it happen?
It is important to understand that vaginismus is a real condition and that healing is possible. Although there is a strong emotional component, which is in most cases the root cause of vaginismus, there is also a strong physical component to the development of this condition. The mind and the body or more specifically, the brain and body are linked.
To understand why the pelvic floor muscles tighten involuntarily we need to first understand the fight-or-flight response. Whenever the body and brain are exposed to a dangerous or traumatic situation, there are a set of automatic and physical responses that start happening in order to help overcome it. Let’s think about, for example, what a very stressful event such as being threatened, attacked physically or verbally, or even constantly worrying about something can do to the body. In these cases one can easily feel some changes happening in the body – the heart starts beating faster, the breath becomes shallow or we can even hold our breath for brief periods of time, and generally clench the muscles around the jaw and tense the muscles around the neck, shoulders, abdomen and hips. These reactions are part of a mechanism called the fight-or-flight response which triggers reactions in the body to help us to ultimately survive – to be quick and ready, to either defend ourselves or run away from danger as quickly as possible.
Looking at it from a survival point of view, it is a very well-designed mechanism. If a lion started chasing you, this auto-pilot response could very well save your life.
Unfortunately, this response can also be exaggerated and be triggered by less threatening circumstances such as stress, fear, anxiety or even memories of being unsafe and in pain in the past in a similar situation – and it can be very difficult to control this response.
In vaginismus this overreaction of the brain and the pelvic floor muscles leads to constant muscle tension around the vaginal opening. The muscles become tense, in spasm, tired and develop painful areas which can end up leading to more pain when there is an attempt to stretch or penetration. It is a vicious cycle (figure 1) but the good news is that it can be stopped and it can improve.
Figure 1 – Pain cycle. Source: Adapted from Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. J Sex Med 2012;9(08): 2077-2092.
What treatments are available and how can specialist physiotherapy help?
The treatment for vaginismus should ideally involve a multidisciplinary team consisting of a Gynaecologist, Psychosexual Therapist and Women’s Health Physiotherapist.
The goals are to make sure that there is no gynaecological disease left untreated, understand and find strategies to deal with the root cause of the problem and lastly to treat and retrain the pelvic floor muscles. A holistic approach should be taken that aims to treat the mind and the body.
Specialist Physiotherapy for the treatment of vaginismus is an intervention consisting of pelvic floor release and retraining techniques that aim to normalise muscle tone of the pelvic floor muscles and treat any pain in order to allow vaginal penetration without pain, anxiety and fear.
The treatment involves a combination of strategies such as education, internal vaginal manual techniques, supervised exercises for the pelvic floor muscles, as well as a home exercise plan.
- Education and advice – It is extremely important to understand how the brain activates the fight-or-flight response and how this affects the pelvic floor muscles. The physiotherapist will spend a long time teaching techniques to relax the muscles and control this reaction.
- Internal manual techniques and exercises for the pelvic floor muscles –treatment usually involves a vaginal pelvic floor muscles examination and a series of exercises done with the help of the physiotherapist. This is to help reduce the muscle spasm and pain and retrain these muscles to regain flexibility and function to allow vaginal penetration without any pain. Although sometimes mild discomfort can be present it is important to mention that this type of examination and treatment is not painful – the goal of the physiotherapist is to create a safe environment in which the patient feels comfortable and in which it is possible to relax and regain function of the pelvic floor muscles.
- Home exercise program and self-management– this usually involves a combination of exercises to relax and to stretch the pelvic floor muscles using dilators to help release the tension on these muscles.
However, it is important to mention that every case is different, and that treatment is always carefully tailored for each woman after a thorough initial physiotherapy consultation.
Women struggling with vaginismus often feel guilty, embarrassed and isolated and that is why it is important to share this information. Vaginismus is a real condition that can be treated. The sooner you start your journey to recovery, the sooner you will start seeing improvements.
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