Spotlight on Pelvic Floor Problems: Vaginismus
What is vaginismus?
Vaginismus is a medical condition in which vaginal penetration of any kind is painful and sometimes impossible to tolerate. This can include penetration during partnered sex, with a speculum during a gynecological exam, or even with attempts to insert a tampon. Vaginismus has been shown to affect more than 15% of people with vaginas at some point in their lives, and it can have profound effects on self-esteem, wellness, and interpersonal relationships. Fortunately, this condition is very treatable with the right interventions, particularly when performed under the direction of a specialist like a pelvic health physical therapist!
How is vaginismus diagnosed? What are the symptoms?
Historically, vaginismus was defined by the presence of persistent and involuntary spasm of the muscles of the outer third of the vagina that prevents or interferes with sexual intercourse. However, advances in research and treatment in recent years have led to a more nuanced understanding of the condition, and experts have actually combined vaginismus with another condition, called dyspareunia, into a broader categorization known as genito-pelvic pain/penetration disorder (GPPPD). This new definition allows for diagnosis of the condition if a patient presents with one or more of the following complaints or symptoms for 6 months or longer:
· Vaginal muscle tightening with attempts at penetration
· An experience of pain, tightening, or burning with attempts at penetration
· Intense fear of penetration
· Voluntary avoidance of sexual activity
· Decreased or absent desire for sexual activity
This new definition of vaginismus, or GPPPD, allows providers to identify patients who might be struggling with pain even if they don’t present with the classical muscle spasm during attempted penetration. It is also more inclusive of folks who don’t engage in heterosexual intercourse but still suffer in some way from the impact of painful vaginal penetration.
What are some treatments for vaginismus? How can pelvic floor physical therapy (PFPT) help?
Like many pelvic pain conditions (and pain conditions in general!), vaginismus often requires a multidisciplinary approach to treatment, involving a variety of healthcare providers and interventions. While vaginismus/GPPPD is characterized by psychological fear of vaginal penetration, the condition is definitely NOT “all in your head”. In many cases, there are clear physical problems that are contributing to a patient’s symptoms and pain. This is where a pelvic floor physical therapist can help: a pelvic PT can help patients learn how to gently stretch and release tight pelvic floor muscles that may be preventing penetration or causing pain. A PT can also instruct patients in the use of tools like vaginal dilators that help further improve the flexibility of pelvic floor tissues and decrease sensitivity with penetration. Pelvic physical therapists are also skilled in identifying and treating imbalances in other regions of the body, such as the hips, lower back, and abdomen, which may be contributing to pelvic floor dysfunction.
In addition to addressing these physical impairments, a multidisciplinary approach to care will also consider other elements that may be contributing to a patient’s pain. A physician can help rule out other conditions that could be causing pain with penetration, such as vaginal dryness related to hormonal imbalance, and possibly prescribe medications that may assist in the management of pain. A mental health practitioner can help patients address any psychological barriers to penetration, such as fear, anxiety, or issues with low libido. This team approach to care can help patients with vaginismus reach their goals, whether they are to engage in penetrative sex with a partner or to simply be able to use a tampon without pain.
How do I get help for my vaginismus?
Come see us at Roaring Fork PT! Our pelvic floor specialist, Caitlyn, has the training and skills necessary to evaluate you and help you develop a plan for treating your symptoms. If you have Medicare, you’ll need a referral from a physician first - your primary care physician or a specialist physician you see for bladder or pelvic problems can refer you to PT. For most folks with commercial (non-Medicare) insurance, however, a physician referral is not required to see a physical therapist - call us today at 970-927-9319 to learn how we can help!
Sometimes seeking care for a medical condition, particularly one that affects such a private part of the body, can be challenging and intimidating – we get it! That’s why we have an FAQ page on this website to help address your questions about pelvic health physical therapy: check it out above. If you still have questions—and it’s totally okay if you do—give us a call at the clinic and ask for a call back from Caitlyn: she’s happy to talk with you more about what to expect before you even step foot in the clinic. We look forward to helping you soon!
Acknowledgements: information for this blog post was derived from professional clinical experience as well as the following sources:
Basson, R. (2005). Women’s sexual dysfunction: revised and expanded definitions. Canadian Medical Association Journal, 172(10), 1327–1333. https://doi.org/10.1503/cmaj.1020174
Pacik, P. T., & Geletta, S. (2017). Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sexual Medicine, 5(2), e114–e123. https://doi.org/10.1016/j.esxm.2017.02.002
Perez, Samara, and Yitzchak M Binik. “Vaginismus: ‘Gone’ But Not Forgotten.” Psychiatric Times, 2016, www.psychiatrictimes.com/view/vaginismus-gone-not-forgotten.