Vaginismus is a form of pelvic floor dysfunction that involves the involuntary contraction or tightening of the pelvic floor muscles in response to penetration or an attempt at penetration.

“Penetration” can include many things—intercourse, pelvic exams, or the use of menstrual products or sexual aids.

This involuntary contraction can be painful, and is often associated with trigger points, sensitivity, and in some cases may involve other symptoms of pelvic floor dysfunction.

Vaginismus causes not only physical responses, but also emotional responses, as it can be confusing when your body does not respond the way you expect.

Individuals with vaginismus may have symptoms of stress and anxiety as a result of their condition, which can also affect body image and confidence.

The pelvic floor therapists at Hive Therapy and Wellness understand that vaginismus involves more than just physical struggles. We are here to listen to you and be your biggest motivators!

All health matters, and nobody should feel ashamed for seeking treatment that could improve their sexual health.

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Vaginismus can be caused by both physical and emotional factors, or a combination of the two. Below, we’ll look at how each of these factors can contribute to vaginismus:

Physical Causes of Vaginismus

Pelvic floor dysfunction: Tightened pelvic floor muscles are a major characteristic of vaginismus, as they are what causes the persistent contractions that are activated by attempts at penetration.

These tight muscles can contain painful trigger points, which are areas of hypersensitivity in the muscle tissue that can also cause referred pain.

Pre-existing conditions: Other conditions such as endometriosis, interstitial cystitis, pelvic inflammatory disease, or vaginal infections can exacerbate pelvic pain and pain guarding, contributing to tight pelvic floor muscles and vaginismus. 

Previous injuries, surgeries, or pelvic trauma: Individuals who have had previous pelvic injuries or surgeries, or who have experienced trauma such as childbirth may have more sensitivity or pelvic floor dysfunction that can contribute to vaginismus.

Surgeries and injuries can also create scar tissue or adhesions, which can limit tissue mobility and worsen pain.

Central sensitization: Chronic pelvic pain and pain caused by other conditions can create a hypersensitive nervous system, which makes an individual more susceptible to pain and muscle spasms.

Therefore, these individuals would be more likely to experience vaginismus in response to previous painful experiences.

Harmful habits: Some behaviors such as poor posture or certain restroom habits can contribute to tight pelvic floor muscles. This refers to poor posture when standing or sitting, as well as spinal or pelvic misalignment, which can put pressure on the pelvis.

Harmful restroom habits can include how you sit on the toilet, if you strain during bowel movements, if you hold urine for a long time, and other restroom habits that can create tension in the pelvic floor.

Hormonal changes: Hormonal changes such as from pregnancy, menopause, or birth control can cause vaginal dryness and decreased arousal, which worsens discomfort during penetration.

Psychological Causes of Vaginismus

Fear or Anxiety: Being afraid of penetration, whether due to fear of pain or from negative past experiences, can contribute to tension in response to penetration.

Religious or cultural beliefs: Some beliefs in different religions or cultures can negatively impact views on sex and sexuality, leading to stress and anxiety associated with shame or guilt. These emotional responses can lead to increased muscle tension and tightening.

Negative experiences: Traumatic experiences with penetration such as abuse or repeated painful attempts at penetration can lead to both emotional and physical responses to future attempts, which can unfortunately create a cycle of vaginismus symptoms that may worsen as a result.

Pelvic floor physical therapy plays a very important role in treatment of vaginismus by not only addressing any physical dysfunctions of the pelvic floor, but also increasing your emotional comfort through desensitization, and building your confidence through treatment and education.

At Hive, we want you to not only feel heard in your concerns, but also welcome and comfortable in our clinic. Our physical therapists are here to create a holistic treatment plan that is not only catered to your unique needs, but also to your comfort level.

If any form of treatment or examination makes you uncomfortable, we can still find other ways to work with you!

While internal and external examinations or treatments can be extremely beneficial for vaginismus, we understand that each person has a different tolerance for those experiences.

Therefore, we always will request your consent before performing any task. You are always in complete control—meaning you can rescind your consent at any time, even if you granted it previously.

With that being said, what does pelvic floor therapy treatment look like for vaginismus?

Hive’s physical therapists work to identify your potential causes of vaginismus, reduce your pain, and improve your pelvic floor function and comfort through comprehensive treatment.

The treatments used to address vaginismus may include the following:

Manual Therapy

Manual therapy treatment involves hands-on techniques or tools that manipulate muscle tissues in order to reduce tension, address trigger points, and improve muscle flexibility.

Manual therapy can be performed internally or externally to reduce pain, improve muscle function, and desensitize a patient to touch.

This treatment can be used to address painful scars as well, by encouraging better tissue mobility and improving comfort of any areas with scar tissue.

Especially in the case of vaginismus, dilator therapy is a common form of manual therapy and desensitization. Dilator therapy is a form of treatment utilizing tools called dilators, which allow a person to practice penetration at their own pace.

They come in a wide range of sizes, and allow you to gradually increase the tool size over time with consistent practice.

Pelvic Floor Training

For those with vaginismus, it is essential to reduce pelvic floor tension and improve pelvic floor coordination.

Treatments like neuromuscular re-education and biofeedback can help improve your understanding and control of your pelvic floor, and how it contracts and relaxes.

Your pelvic floor therapist will also teach you exercises and relaxation strategies that will help improve the coordination of your pelvic floor muscles, as well as allow you to build both confidence and control.

Education

The pelvic floor physical therapists at Hive Therapy and Wellness can provide a wealth of information and education for their patients.

They can help you better understand your body, symptoms, condition, and pain thanks to their years of education, training, and experience.

Not only can physical therapists help you lessen your anxiety through education and understanding, but they can also provide education on at-home care and practice—such as relaxation techniques, pelvic floor exercises, and safe dilation strategies.

Behavioral modifications

Pelvic floor physical therapists can reduce pressure and pain in the pelvis by correcting harmful postures and other habits.

In order to reduce straining and prevent the build-up of tension in the pelvic floor, they will provide treatments that improve posture and alignment for your hips, back, and pelvis.

As mentioned previously, some behaviors and bathroom habits can contribute to pelvic floor tension and pain.

Therefore, your physical therapist can educate you on the correct toilet posture, how to avoid straining, and how you can improve aspects such as diet and hydration.

Collaboration

Lastly, the physical therapists at Hive Therapy and Wellness are prepared to collaborate with other professionals as necessary to best provide treatment for their patients.

This can include any sex therapists, gynecologists, or mental health professionals that you currently receive treatment from.

This collaboration can be an important part of your holistic treatment experience. The physical therapists at Hive are determined to help you not only restore your pelvic floor function, but gain confidence and comfort, too!

As part of your holistic treatment experience, your care plan at Hive Therapy and Wellness can involve any of the following treatment methods:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback