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Vaginismus is when the vagina suddenly tightens up when you try to insert something into it. It is the body’s automatic reaction to the fear of some or all types of vaginal penetration. It can be painful and upsetting, but it can be treated.

Vaginismus Types

There are two main types of vaginismus.

Primary

This is when a woman has had pain every time something entered their vagina, including a penis (called penetrative sex), or when they’re never been able to insert anything into their vagina (such as tampon, menstrual cup or a suppository)

Secondary

This is when a woman has had sex without pain before, but then it becomes difficult or impossible. 

It can also be situational, occurring only with certain partners or in particular circumstances, or it can occur independent of partner or circumstances.

Vaginismus is a condition that consists of overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration.

Vaginismus Symptoms

Painful intercourse (dyspareunia) is often the first sign of vaginismus. The pain happens only with penetration. It usually goes away after withdrawal, but not always. Sometimes the pain can linger on for a while. Some women describe it as a burning or a feeling like the penis is “hitting a wall.”

Other common signs of vaginismus include:

  • Not being able to insert a tampon
  • Fear of pain or sex
  • Loss of sexual desire
  • Burning or stinging pain during sex
  • Gynaecological exams can be extremely painful or impossible

These symptoms are involuntary, meaning a woman can’t control them without treatment.

Vaginismus Causes

The reasons for vaginismus are not always clear, but some things thought to cause it include:

  • fearing that your vagina is too small
  • a bad first sexual experience
  • an unpleasant medical examination
  • believing sex is shameful or wrong
  • a painful medical condition, like thrush
Image: Hope & Her (www.vaginismus.com)

Vaginismus Diagnosis

It is important to seek a diagnosis for any type of sexual pain, including pain due to penetration. Some women may have an underlying physical cause to their vaginismus that needs to be determined so that it too may be treated. It can be difficult to diagnose vaginismus. Diagnosis of vaginismus is based on a full medical and psychosexual history. Physical examination is a critical component of diagnosing vaginismus. It may not be possible at the first appointment, but is needed at some point to exclude organic pathology.

Vaginismus treatment

Vaginismus is a highly treatable condition that does not require any invasive procedures. There is no surgery to cure vaginismus. It is very important to seek a second opinion if surgery to ‘widen’ the vaginal opening has been recommended, as this does not normally resolve the penetration problem but instead may further complicate the problem.

Treatment usually focuses on:

  • managing your feelings around penetration
  • exercises to gradually get you used to penetration

How can physiotherapy help?

  • Relaxation techniques ( mindfulness, breathing and gentle touching exercises to help you learn to relax the vaginal muscles). Watch my video on breathing for happy & healthy pelvic floor here https://www.instagram.com/p/CRN46pZA3fz/
  • Education to help understand vaginismus
  • Pelvic floor manual therapy and release exercises are a key part of treatment for pain conditions like vaginismus, prior to any strengthening program. Check out my video on pelvic floor relaxation practice here https://www.instagram.com/p/CW6NYLagHOa/
  • Vaginal trainers ( tampon-shaped objects in different sizes to help you gradually get used to having something put into your vagina)

Majority of women will also benefit from psychosexual therapy (a type of talking therapy that aims to help you understand and change your feelings about your body and sex).

Not sure what to expect on the first visit to a women`s health physiotherapist? Click here: https://mnaphysiotherapy.com/what-happens-at-the-first-womens-health-physiotherapy-appointment/

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References:

Vaginismus – NHS (www.nhs.uk)

Vaginismus Treatment: Clinical Trials Follow Up 241 Patients – PMC (nih.gov)Vaginismus Treatment: Clinical Trials Follow Up 241 Patients – PMC (nih.gov)

Interventions for vaginismus – PMC (nih.gov)

 

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