Vaginismus and Women’s Health Physiotherapy

  • Vaginismus is a condition characterized by involuntary contraction of the pelvic floor muscles.

  • Women struggling with vaginismus cannot perform any sexual activity that includes vaginal penetration. (They may experience the same intense symptoms when placing a tampon or performing a pelvic exam.)

  • It can cause major distress, relationship problems, and prevent women from starting a family.

  • It is possible for vaginismus to heal.

The pelvic floor physiotherapist for the treatment of vaginismus treats existing symptoms, consisting of pelvic floor muscle retraining techniques, and self-management strategies to normalize the muscle tone of the pelvic floor muscles and allow vaginal penetration without pain, anxiety, fear.

How common is it?

Studies conducted around the world report that the prevalence of vaginismus varies between 5% and 17%. However, women are more likely to be under-reported than the actual numbers due to their embarrassment to seek help.

What is vaginismus?

Vaginismus is the involuntary contraction of the pelvic floor muscles. In case a woman cannot have sexual intercourse at all due to involuntary contraction of the vaginal muscles primary vaginismusis called. secondary vaginismus occurs when a woman was able to have intercourse or insert a tampon before but can no longer do so due to involuntary muscle spasms, fear, and pain. Causes in vaginismus can sometimes be related to a painful or traumatic event such as infection, childbirth, gynecological surgery or abuse.

Also known as vaginismus, genito-pelvic pain disorder or genito-pelvic penetration disorder (GPPD), pelvic floor overactivity/hypertonicity, pelvic floor myalgia and is sometimes confused with vulvodynia.

Why is this happening?

It is important to understand that vaginismus is a real condition and that recovery is possible. Although there is a strong emotional component that is the root cause of vaginismus in most cases, there is also a strong physical component in the development of this condition. Mind and body are interconnected.

To understand why the pelvic floor muscles contract involuntarily, first fight or flight We need to understand his reaction. Whenever the body and brain are exposed to a dangerous or traumatic situation, a series of automatic physical responses begin to occur to help cope. For example, consider what a very stressful event can do to the body, such as being threatened, being physically or verbally attacked, or even constantly worrying about something. In these situations, it can easily be felt that some changes are taking place in the body – the heart begins to beat faster, our breathing becomes shallow, or we may hold our breath for a short time, and we usually tighten the muscles around the jaw and tense the muscles in the neck, shoulders, abdomen, and hips. These responses ultimately help us to survive. It is part of a mechanism called the fight-or-flight response that triggers responses in the body to In this way, we are ready to defend ourselves in the event of danger or to escape from the danger as quickly as possible.

From a survival standpoint, it’s a very well designed mechanism. If a lion starts chasing you, this autopilot response could save your life.

Unfortunately, this reaction can be exaggerated and less threatening conditions such as stress, fear, anxiety and it can be very difficult to control this reaction.

In vaginismus, this overreaction of the brain and pelvic floor muscles causes constant muscle tension around the vaginal opening. Muscles become tense and tired. It develops painful areas that can lead to more pain when penetration is attempted. This is a vicious cycle, but with the right treatment method, these symptoms can be stopped and sexual life can continue in its normal course.

What treatments are available and how can a pelvic floor physical therapist help?

Vaginismus treatment should include a multidisciplinary team consisting of a gynecologist, psychosexual therapist and a women’s health physical therapist (pelvic therapist).

The goals are to ensure that there are no untreated gynecological diseases, to understand the root cause of the problem and create strategies to address it, and finally to treat and retrain the pelvic floor muscles. A holistic approach should be adopted that aims to treat the mind and body.

Pelvic floor rehabilitation for the treatment of vaginismus is an intervention consisting of pelvic floor relaxation and retraining techniques aimed at normalizing the muscle tone of the pelvic floor muscles and treating pain to allow vaginal penetration without pain, anxiety and fear. Vaginismus is highly treatable as the muscle is sensitive in nature. Accompanied by a specially trained physiotherapist (pelvic floor physiotherapy), they will guide you through the appropriate steps to overcome vaginismus. Your physical therapist will ask questions, educate you about your anatomy, and evaluate your pelvic floor muscles.

A fundamental part of recovering from vaginismus is being able to voluntarily identify where your pelvic floor muscles are and how to manage them. It is very effective in overcoming vaginismus in combination with manual therapy (trigger point release, dilator therapy, biofeedback) and a home exercise program.

The next step after gaining pelvic floor muscle awareness is to train the muscles to respond differently than usual during intercourse or tampon use. It is a learning process where you develop the skills necessary to take conscious control of this muscle group and change the conditioned reflex so that there is no involuntary tightening. The ultimate goal is to regain control of your mind and body’s response to vaginal penetration and allow you to enjoy relaxed sex.

Anticipation of pain, emotional concerns, or unhealthy sexual messages can also increase vaginismus symptoms. Often, there are underlying negative feelings of anxiety associated with vaginal penetration. Please let your physical therapist know if you need help overcoming such emotional triggers.

If you are experiencing pain or difficulty with intercourse or tampon use, do not suffer in silence! Please consult your pelvic physical therapist for evaluation so they can help you overcome your vaginismus.

Treatment includes a combination of strategies such as training, vaginal manual techniques, supervised exercises for the pelvic floor muscles, and a home exercise plan.

  • Education and Advice – Understanding how the brain activates the fight-or-flight response and how this affects the pelvic floor muscles is extremely important. Your physiotherapist will support you in teaching you techniques to relax the muscles and control this reaction.

  • Manual techniques and exercises for the pelvic floor muscles – treatment usually includes examination of the vaginal pelvic floor muscles and a series of exercises with the help of a physical therapist. This is to help reduce muscle spasm and soreness and retrain these muscles to regain flexibility and function to allow vaginal penetration without any pain. It is important to note that this type of examination and treatment is not painful, although there are sometimes mild discomforts – the goal of the physiotherapist is to create a safe environment where the patient will feel comfortable, the pelvic floor muscles can relax and functionally regain their former health.

  • Home workouts and self-management – ​​this usually includes a combination of exercises to relax the pelvic floor muscles using dilators to help release tension in these muscles.

However, it is important to note that every case is different and the treatment is carefully designed for each woman, always after a thorough initial physiotherapy consultation.

Women struggling with vaginismus often feel guilty, embarrassed and isolated, so it’s important to share this information. Vaginismus is a real condition that can be treated. The sooner you begin your healing journey, the sooner you will start to see improvements.

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