What is Vaginismus?
Vaginismus is the involuntary contraction or tightening of the vaginal muscles typically when the vulva is touched. This involuntary contraction can cause pain/discomfort before sex, when inserting a tampon or during a pelvic exam. It can also make it almost impossible to complete a pelvic exam or participate in penetrative sex.
Vaginismus can be primary (never achieved vaginal penetration i.e never been able to use a tampon or have sex) or secondary (previously achieved penetration with no pain but now no longer able).
To date no one specific cause has been identified for vaginismus and it can be multifactorial. A number of factors have been identified as triggers (both physical and psychological) including:
- Recurrent UTI’s or thrush
- Chronic Pelvic Pain (endometriosis, PCOS and more)
- Previous painful experience
- Psychological stress (Anxiety, Depression)
- Fear of becoming pregnant
- Fear of painful penetration
What is Vulvodynia?
Vulvodynia is a complex, chronic condition of the vulva. It may be associated with pain, burning, stinging or discomfort of the external genitals (labia, clitoris and/or vaginal opening). Vulvodynia can affect women of all ages and it is expected that over 8% of women will experience this condition in their lifetime.
Symptoms can differ from person to person but might include:
- Pain/burning with pressure or touch, with sitting for extended periods, from wearing tight pants or underwear, during exercise
- Pain/ burning with urination
- Inflamed or swollen vulva
These symptoms can come and go or they might be constant. In order to diagnose Vulvodynia we have to rule out other causes of similar symptoms such as yeast infections, bladder infections, dermatitis and STI’s.
For both Vaginismus and Vulvodynia it is recommended to have a multidisciplinary treatment approach. This team might include your GP, Gynaecologist, Women’s Health Physiotherapist, Psychologist and/or Sex Therapist. Depending on the causes of each individual case the requirement for each practitioner involvement would be assessed.
Treatment from a Physiotherapy perspective can include various components.
We determine these after a thorough subjective evaluation (we ask detailed questions about your bowel and bladder function, pelvic history and function alongside more general history) and a pelvic exam. Due to the pain that can be associated with pelvic exams, Physiotherapist’s break down the approach to a typical exam and take examination as slowly as needed per patient. After the assessment we can then develop a plan and program for each individual.
Medical therapies such as oral medication (some medications for depression and epilepsy are used to decrease the nerve symptoms), topical creams, localised injections might be recommended depending on the examination. These are managed by your GP or Gynaecologist.
Types of Treatment
- Relaxation Exercises
- Pelvic Floor Down Training
- Manual Therapy
- Self Massage
- Dilator Therapy
- Cognitive Behavioural Therapy
- Relaxation Exercises
- Electrical stimulation
- Pelvic Floor Down Training
- Topical Creams*
- Improved Vulval Hygiene
- Cognitive Behavioural Therapy*
* non-physiotherapy treatment
Education: A lot of the treatment for both conditions is education. It is really important to understand the anatomy and physiology behind your diagnosis as this aids in better treatment. We also spend time educating around bowel management and pelvic floor training specific to each individual.
Relaxation Exercises: These can be very specific to the pelvic floor or a global relaxation program depending on your needs. Relaxation exercises help to desensitise an area to disrupt the pain cycle.
Pelvic Floor Down Training: When we feel pain in our pelvic floor it can cause the muscles to be overactive and we therefore need to focus on ‘turning them off’ rather than making them stronger.
Manual Therapy: This might be internal or external depending on your needs. If your pelvic floor is overactive, typically other areas around your pelvis (i.e back, glutes, hips) will be overactive as well. It is beneficial to work on all areas to reduce symptoms whilst addressing the primary cause. When indicated internal manual therapy helps reduce the tenderness of the muscle by stretching and improving blood flow.
Dilators: Dilators (pictured below) are used to help progressively stretch the tissues of the vagina. There are many different types of dilators and sizes so it is best to discuss these with your Physiotherapist.
If you feel any of the above information relates to you or someone you know please book an appointment with one of our amazing Women’s Health Physiotherapist’s. Pelvic pain of any description should not be regarded as ‘normal’ and individual assessment and management is extremely beneficial.
BExSc, MPhty (Physiotherapist)
Disclaimer: This is general advice only, ensure you always seek individualised advice from your obstetric care provider first.
Betjes, E. (2022). What is vaginismus?. ISSM. Retrieved 22 August 2022, from https://www.issm.info/sexual-health-qa/what-is-vaginismus/
Reed, B., Harlow, S., Plegue, M., & Sen, A. (2016). Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study. Journal Of Women’s Health, 25(3), 276-283. https://doi.org/10.1089/jwh.2015.5397
Henzell, H., Berzins, K., & Langford, J. P. (2017). Provoked vestibulodynia: current perspectives. International journal of women’s health, 9, 631–642. https://doi.org/10.2147/IJWH.S113416
Vaginal Dilators – Medical Grade Silicone Dilator 5 pc. Set. Pelvic Floor Shop. (2022). Retrieved 23 August 2022, from https://pelvicfloorshop.com/en-ca/products/deluxe-silicone-dilator-5-pc-set
Vulvodynia & vestibulodynia. Jean Hailes. (2022). Retrieved 23 August 2022, from https://www.jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/vulva-pain/vulvodynia-vestibulodynia#what-is-vulvodynia