Genito-Pelvic Pain / Penetration Disorder (Vaginismus)

Genito-Pelvic Pain/Penetration Disorder, or vaginismus, is when the pelvic floor muscles spasm when vaginal penetration is attempted. This can make penetrative intercourse or tampon insertion extremely difficult and painful. Pelvic Health Physiotherapy can help by releasing muscles that may be causing the contractions, and by teaching you how to control your vaginal muscles.

What Is Genito-Pelvic Pain/Penetration Disorder (Vaginismus)?

Vaginismus refers to the involuntary contraction of the vaginal muscles when attempting to insert something into the vagina. This may occur with intercourse, tampon insertion or pelvic exams. With intercourse, women/vagina owners and their partners often describe it as if they are “hitting a wall or barrier” when attempting entrance into the vagina.

Vaginismus causes significant pain and, in some cases, makes intercourse impossible. Vaginismus may be:

• Primary or Life-long (a woman has always had this issue) or

• Secondary or Acquired (a woman was previously able to have intercourse without muscle contraction and pain)

What Is The Role Of The Pelvic Floor In Vaginismus?

Vaginismus is a learned reflex. This means that a woman comes to associate intercourse or vaginal insertion with fear or pain. So, her body automatically reacts to protect itself by contracting the vaginal muscles within the pelvic floor. 

Here’s an analogy to help you better understand vaginismus. We’ve all been poked in the eye with a finger at some point, so our eye automatically closes when we see a finger coming. Vaginismus is a similar reflexive response. It cannot simply be “willed away”— telling a woman with vaginismus to relax will not eliminate the problem. However, learning how to release and relax the vaginal muscles through Pelvic Health Physiotherapy, can.

How Can Pelvic Health Physiotherapy Help?

Pelvic Health Physiotherapy can help by releasing the muscles that may be causing the contractions and by teaching women how to better control their vaginal muscles. Pelvic Health Physiotherapists also integrate a holistic, biopsychosocial approach to treating vaginismus. This means that they aim to get a better understanding of the many other factors that drive your particular pain, including physical, biological, psychological, social and environmental issues.

 Pelvic Health Physiotherapists, like those at Proactive Pelvic Health Centre, are experienced at breaking down physical tasks into its component parts. For sexual activity, this would include: 1) range of motion or flexibility, including within the vaginal entrance 2) strength in the pelvic floor and 3) endurance. They will look at each component and work to improve these functions, while also working to minimize what you don’t want – pain. Your physiotherapist’s treatment approach can include:

• Assessing the source or driver of the pain (e.g., muscle tightness or sub-optimal control over the vaginal muscles, relational or trauma contributors to the tension)

• Treating a physical barrier (e.g., using dilators, manual therapy, relaxation exercises or manual stretching)

• Strengthening the pelvic floor (e.g., using exercise or electrical stimulation)

• Improving flexibility (e.g., using manual stretching)

• Improving sensation (e.g., using biofeedback exercises to help clients “feel their body” better)

How Do We Approach Treatment for Vaginismus?

At Proactive Pelvic Health Centre, we’re dedicated to helping individuals gain confidence and control over their bodies, so that they can have the fulfilling intimate relationships they deserve. Based on a thorough health assessment, a personalized treatment plan will be developed by your Pelvic Health Physiotherapist.

If you’re suffering from painful intercourse, know that you’re not alone – and pain-free intimacy is possible. With a structured, evidence-based plan, our Pelvic Health Physiotherapists work with you in a safe environment to help you release any shame or embarrassment, and re(gain) control over your body.

Book an appointment to learn more about how we can help.

What Other Treatments Are Available?

There are a number of other treatments that may benefit you that may be used in addition to Pelvic Health Physiotherapy, as part of a holistic treatment plan. These include: 

Sex therapy

Often when a woman experiences pain during intercourse, as with vaginismus, she comes to associate intercourse with pain and disappointment. She may feel guilty for disappointing her partner, and may also resent her partner if the partner shows their own disappointment. Some women start to avoid sex, and even avoid kissing and touching for fear that it will lead to sex. Often, women and their partners have difficulties talking about the issue and helping each other through the challenges of vaginismus.

Sex therapy helps couples talk about their sex life and the impact vaginismus has had on their relationship.  Often both partners are affected, and sex therapy allows partners to move past this hurt. With homework assignments and specific strategies, sex therapy helps couples rediscover passion and pleasure.

Breathing techniques

Did you know that the way you breathe can influence the health of your pelvic floor and overall health? Proper breathing comes from the diaphragm, which is a domed-shape muscle under the rib cage. Parallel to it is our body’s foundation: the pelvic floor muscles. During normal inhalation, the diaphragm and the pelvic floor descend. Upon exhalation, the diaphragm pulls the pelvic floor up providing a lift support for the organs. When this function is disrupted, compensations can arise which may lead to pain and difficulties, such as vaginismus.

Learning the diaphragmatic breathing technique can help improve the function of your deep core muscles and pelvic floor.

How to practice diaphragmatic breathing:

1. Lying on your back with your knees bent, place one hand above your belly button, just below your rib cage. You may put the other hand on the side of your rib cage.

2. Breathe in slowly and notice the stomach rise slightly, the chest remains calm as the ribs expand laterally.

3. Breathe out, let the stomach fall naturally and the rib cage fall back to resting position.

4. Repeat the entire sequence five to ten times.

5. Practice regular intervals throughout the day.

6. Once you have mastered it lying down, you can progress into sitting and standing. But don’t forget the need for proper posture.