Biopsychsocial Treatment Approach to Vaginismus
Claudia N. Benavides, PT, BSc PT, DPT
What is Vaginismus?
Vaginismus is a condition characterized by spasms of the pelvic floor muscles that interferes with vaginal penetration. Also known as Genito-Pelvic Pain/ Penetration Disorder, includes signs and symptoms of fear, anxiety, pain, pelvic tightness, tension, and narrowing of the introitus or external opening of the vaginal canal.
Addressing vaginismus requires a biopsychosocial approach. In pelvic health physiotherapy this holistic model considers the complex interplay between biological, psychological, and social factors in understanding and treating a person presenting with this condition. This approach contrasts with the traditional biomedical model, which primarily focuses on physical symptoms and pathology. By integrating the biopsychosocial model, pelvic health physiotherapists aim to provide more comprehensive and effective care, addressing the full spectrum of influences affecting someone's health and well-being.
What can contribute to or cause Vaginismus?
1. Physical Conditions (Biological):
Infections: Recurrent urinary tract infections or yeast infections.
Gynecological Issues: Endometriosis, polycystic ovary syndrome (PCOS), or vulvodynia.
Childbirth Injuries: Birth trauma or soft tissue injury (tears, episiotomy).
Hormonal changes leading to vaginal dryness and atrophy: Menopause, treatment-induced
menopause (cancer treatment)
Gynecological Surgery: gender-affirming surgery, pelvic prolapse repair
2. Psychological Factors:
Past trauma
Fear of Pain: Anticipation of pain during intercourse.
Anxiety Disorders
Stress: High levels of stress can exacerbate muscle tension.
3. Social Factors:
Lack of social supports
Relationship Issues: trust or communication with a partner.
Stigma: Harmful beliefs or misinformation about intimacy.
Medical Procedures: experiences with pelvic exams (Ultrasound, PAP smear).
Socioeconomic status
Through education, support, and personalized treatment plans, pelvic health physiotherapists empower those persons diagnosed with vaginismus to take an active role in their recovery, fostering long-term health and well-being.
Physical Conditions (Biological)
Assessment and Diagnosis: Pelvic health physiotherapists start with a detailed assessment to understand the biological basis of the condition. This includes taking a thorough medical history, conducting physical examinations, and using diagnostic tools to identify musculoskeletal, neurological, or other physiological issues. Understanding the biological aspects allows physiotherapists to develop targeted treatment plans that address specific dysfunctions.
Treatment Techniques
Manual Therapy: Techniques such as joint mobilizations, manipulations, and soft tissue massage are used to relieve pain, improve mobility, and enhance tissue healing.
Exercise Prescription: Personalized exercise programs are designed to improve function. Exercises are tailored to the individual’s treatment goals.
Modalities: Use of modalities acupuncture, biofeedback, sitz baths.
Psychological Aspect:
Mental Health Considerations Recognizing the significant impact of mental health on physical recovery, pelvic health physiotherapists incorporate strategies to address psychological factors:
Screening for Psychological Distress: Physiotherapists may use questionnaires and interviews to screen for anxiety, depression, stress, and other psychological issues that could hinder recovery.
Cognitive Behavioral Therapy (CBT): While pelvic health physiotherapists are not psychologists, they can incorporate basic CBT principles to help patients reframe negative thoughts, manage pain, and reduce fear-avoidance behaviours. They may also assist patients with finding appropriate mental health and sexual health experts that are skilled in helping people manage mental health concerns presenting with vaginismus.
Patient Education and Empowerment Education is a key component of the biopsychosocial approach. Pelvic health physiotherapists provide detailed information about the condition, the rationale behind the treatment plan, and the expected outcomes. This knowledge empowers, reduces anxiety, and increases treatment adherence.
Relaxation Techniques Incorporating relaxation techniques such as deep breathing exercises, progressive muscle relaxation, and mindfulness can help reduce stress and muscle tension, contributing to overall well-being and pain management.
Qigong: A form of mind-body exercise that combines movement, meditation, and controlled breathing to reduce stress and enhance mental well-being, contributing to relaxation and decreased muscle tension. Meeting Yourself Where You Are
We all have good days and bad days - with our capacities to look within and hold space for ourselves and others changing according to how well our daily needs are met.Some days you’ll be able to engage in self-compassion practice and tolerate painful experiences for long durations of time while other days you may only be able to turn towards bodily discomfort for 30 seconds. The practice of mindful self-compassion asks you to meet yourself wherever you are with understanding, acceptance, warmth and kindness. Whenever you feel overwhelmed, give yourself the grace of taking a break from your practice and redirect your attention to a neutral or even enjoyable activity. When done with awareness, taking a break from tending to our pains is not distraction - it is an act of self-compassion.
Social Aspect
Support Systems: Pelvic health physiotherapists understand the importance of social support in the recovery process. They encourage the support of friends/partners to enhance motivation and adherence to treatment plans. This can be done with daily walks with friends and relatives, indoor/outdoor recreational activities, and support groups.
Communication and Therapeutic Alliance
Building a strong therapeutic alliance through effective communication is crucial. Pelvic health physiotherapists use active listening, empathy, and patient-centered communication to build trust and rapport. This relationship fosters a supportive environment where patients feel understood and motivated to engage in their treatment.
Social and Environmental Factors
Pelvic health physiotherapists consider the person’s social and environmental context, including work, home life, and community resources. They may provide advice on ergonomic modifications, recommend assistive devices, and refer patients to social services or community support programs.
Biopsychosocial is Holistic and Collaborative
An integrated biopsychosocial approach to treating vaginismus involves collaboration among healthcare providers, including gynaecologists, physiotherapists, psychologists, sexologists, and sex therapists. This multidisciplinary team works together to create a personalized treatment plan that addresses the unique needs of each patient.
If you've been experiencing pelvic pain or have been diagnosed with vaginismus, it's time to take action. A pelvic health physiotherapist can offer specialized care tailored to your unique needs, helping you regain control, reduce pain, and improve your overall quality of life. Don't let these issues hold you back any longer. Reach out to a pelvic health physiotherapist today to start your journey toward better health and well-being. Expert help is available to guide you through effective treatment options. Take the first step towards a healthier, more comfortable life by scheduling a consultation with a pelvic floor physiotherapist now. You deserve to feel your best!
Sources:
Frawley H, Shelly B, Morin M, Bernard S, Bo K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i M, Schizas A, Slieker-ten Hove M, Takajasji S, Voelkl Guevara J. An International Continence Society (ICS) Report on the Terminology for Pelvic Floor Muscle Assessment. Neurourol Urodyn. 2021 DOI: 10.1002/nau.24658
Bo, Kari, et al. "Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice." Third Edition, 2024, pp. 492–504.