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Vaginismus is defined by internal pain and spasm from the muscles forming the entrance or floor of the vagina during vaginal penetration. This is usually felt during either sexual intercourse, digital penetration, insertion of tampons, smear tests or on orgasm.
The issue can either be 'global' – this means it happens without being able to pin point one specific time or action that is troublesome, or 'situational' – it always happens during the same activity, e.g a person is able to have a pain free sex life but always has pain on inserting a tampon.
It will be of little surprise that there are both physical and emotional factors that play a part and one can stimulate the other. For example feeling pain each time you have a medical exam can lead to feelings of fear and anxiety, just as having had a bad sexual experience that makes you feel upset or angry can cause muscular spasm and pain around the vulva or vagina.
Emotional causes:
Ø Fear of pain
Ø Resurfacing of previous negative experiences during medical examinations or sexual intercourse
Ø Guilt regarding ability to have penetrative sex
Ø History of sexual abuse or early exposure to sexual activities
Ø Anxiety or lifestyle stress
Physical causes:
Ø Infections including sexually transmitted, bacterial vaginitis or UTIs
Ø Tissue trauma or altered anatomy following childbirth
Ø Dryness, due to washing techniques, menopause, infection, stage in menstrual cycle, medication side effects
Ø Sinister pathology lichens sclerosis or cancer
Ø Lack of foreplay
Ø Previous injury such as coccyx fracture, hip or groin injuries, abdominal surgery, spinal injuries
How can it be treated?
Ø Emotional support – specialist talking therapies exist for sexual or relationship problems these can both be accessed as an individual or a couple.
- References / sign posting CORST
Ø Specialist Women’s Health (sometimes called Pelvic Health) Physiotherapy
What does this envolve?
- Initially a discussion to understand your full medical history, emotional factors, current symptoms, concerns.
- A physical assessment, initially external to look at muscle balance around the pelvis, and areas of muscle guarding, areas of weakness or pain.
- An internal examination of the pelvic floor muscles is valuable in finding the cause of pain, and understanding how your pelvic floor is working. However this is only performed when the patient is ready.
- Treatment can involve soft tissue massage, stretches, breathing techniques for pelvic floor relaxation, trigger point pressure massage to internal and external muscles, movement pattern re-education, use of vibrators and dilators, acupuncture to the ear or hand. The aim with all treatment is often to reduce the high overactive tone of the pelvic floor muscles, regain normal muscle balance around the pelvis and re-educate your body on how to relax.
Ø Change of tack: sometimes the fear of pain and ‘failing’ to achieve penetrative sex has a large impact on a couples’ sex life. Taking the focus away from penetration to manual or oral foreplay initially can help. Physiotherapy can help advise on techniques, lubricants and ideas which may work for you and your partner. Equally Women who are unable to have a smear test or use a tampon, treatment can start away from the internal element and focus on relaxing other muscle groups which relate to the pelvic floor such as the inner thigh and buttock muscles, acupuncture to specific sites on the ear are also commonly helpful.
Often acknowledging the issue and seeking support is sometime daunting, but often the women I treat say "I wish I'd sought help sooner". Make sure you seek specialist emotional and/or physical therapy so that you get the best information and management strategies to solve the problem.