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Understanding Vaginismus

Do you have…

Pain with tampon insertion?

Pain with vaginal penetrative intercourse?

Pain with your annual gynecological speculum examination?

 

Did you know that although these symptoms may not be uncommon, they are NOT NORMAL and more importantly a PELVIC PHYSICAL THERAPIST may be able to help you!

 

What is Vaginismus?

 

Vaginismus is defined as the persistent or recurrent difficulty in allowing entry of a penis, finger or any object (i.e. tampon, gynecological speculum, etc) into the vaginal canal despite the woman’s expressed wish to do so. Often those with this diagnosis additionally experience avoidance, anticipation, fear or experience of pain and variable involuntary contractions of the pelvic musculature.1

 

How Prevalent is Vaginismus and Why Does It Occur?

 

The reality is, is that vaginismus is probably more prevalent than that documented within the available scientific literature primarily secondary to one factor… NO ONE TALKS ABOUT IT.

 

These symptoms can occur across the lifespan with some women experiencing symptoms as early as their adolescent years, with first discovery while attempting to insert a tampon for the first time, others noting association of onset with an episode(s) of physical, psychological, or sexual trauma, some noting association with pregnancy and postpartum and others noting association with aging and the occurrence of perimenopause/menopause.

 

Understanding the Anatomy

 

When visually inspecting the external genitalia you will first identify the Labia majora (outer “lips” with hair) with the Labia minora (hairless inner “lips”) visualized in-between the Labia majora. The Labia majora and Labia minora are known collectively as the vulva.  The area located between the Labia minora is known as the vulvar vestibule and contains the opening to the urethra (i.e. urethral meatus) and the vaginal opening (i.e. vaginal introitus).

 

The vaginal canal extends from the vaginal opening/introitus (location of the hymen/hymenal remnants) to the cervix, the bottom aspect of the uterus, with the vaginal canal approximately 2-5 inches in length. The vagina is a stretchy, muscular canal that plays a significant role in childbirth, pregnancy, menstruation and the sexual response. It is supported within the pelvic cavity by a combination of ligamentous, connective tissue and muscular attachments.

 

So, you may ask, how may all of this contribute to pain? The research has shown that involuntary pelvic floor muscle activity is part of the general defense mechanism that occurs during exposure to threatening situations, not restricted to situations with a sexual content.2 Reflexive contractions of these muscles can create relative narrowing of the vaginal canal and can secondarily cause pain with attempted vaginal penetration or inability to tolerate penetration.

 

Why It Is Important to Address Vaginismus 


Although the narrative is slowly changing, historically pain associated with vaginal penetration has been deemed to be “normal” by many, but the matter of the fact is that PAIN IS NOT NORMAL.

 

No matter how long these symptoms have been occurring, the reason for onset of symptoms, nor the severity of symptoms, these are symptoms which can be treated and can RESOLVE!. The treatment approach utilized and the members of your medical “team” may vary dependent on your specific situation but may include your primary care physician, medical specialists (i.e. gynecologist/obstetrician, urologist), a pelvic physical therapist, mental health practitioner and holistic providers.

 

Treatment Approaches for Vaginismus

 

If you believe that you have vaginismus or have been previously diagnosed with vaginismus it is important that you seek treatment. Not only does this diagnosis influence your quality of life, to include your relationship health, menstrual health, and self-image, but can also impact your ability to tolerate regular gynecological screening for reproductive cancer.

 

If you believe that you are experiencing vaginismus, first and foremost it is important that you are evaluated by a medical provider for the completion of a thorough medical evaluation to rule out structural or other physical abnormalities that may be contributing to this pain state. Upon completion of a medical evaluation, if deemed medically necessary and appropriate, you may benefit from the receival of pelvic physical therapy services. In accordance with your comfort level and tolerance, a pelvic physical therapy evaluation will assess in-depth the function and coordination of your pelvic floor muscles thus allowing your pelvic physical therapist to create a comprehensive treatment plan that may combine the utilization of manual techniques, exercises, stretches and behavioral therapy to address your symptoms.

 

Change the narrative. Seek help. Regain back control of your pelvic health.

 

  1. Basson R. Women's sexual dysfunction: revised and expanded definitions. CMAJ. 2005 May 10;172(10):1327-33. doi: 10.1503/cmaj.1020174. PMID: 15883409; PMCID: PMC557105.

  2. Van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001 Apr;39(4):395-408. doi: 10.1016/s0005-7967(00)00007-3. PMID: 11280339.

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