struggling with vaginismus?
Have you ever heard of vaginismus before?
Or maybe you’ve been told that you have vaginismus by your physician or gynecologist? Vaginismus, which is commonly referred to as “levator ani syndrome” and falls under the umbrella term “genito-pelvic pain and penetration disorder,” is when a person experiences pain during sex or sexual activity that involves successful or attempted pelvic penetration where the muscles around the vaginal opening (or pelvic opening) involuntarily contract.
The first thing to know about vaginismus is that it is NOT your fault. If you have been told to “just have a glass of wine” or to “just use more lubricant” or that things are “all in your head” these are all things that are not true. Vaginismus occurs from involuntary (meaning you literally have no control over it happening) contractions or spasms of the muscles wrapping around the vaginal opening when there is any form of attempted pelvic penetration including:
Pelvic exams and speculum insertion (like what happens with your gynecologist)
Tampon or menstrual cup use
Sexual activity (this can occur with “PIV” or penis in vagina penetration, finger use, and even the use of a tongue or toys)
Picture of the underside of a pelvis where it shows the pelvic floor muscles (structures in red) wrapping around the pelvic openings including the front (vaginal) opening and back (anal) opening. These are the muscles that involuntarily contract with pelvic penetration causing vaginismus.
Vaginismus or levator ani syndrome can happen at any point in a persons lifetime, but can frequently show up when a person first tries to use menstrual products, like tampons or menstrual cups, or during their first sexual encounter (called primary vaginismus). It can also occur later in life when a person has been able to do all forms of pelvic penetration pain-free including sex, menstrual product use, and gynecologic examinations, and then begins to occur causing pelvic penetration to no longer be possible or be difficult to achieve (called secondary vaginismus).
While it is still not totally clear from the research if there is any one particular cause of vaginismus or levator ani syndrome, there are different things that we know can contribute to this including:
Frequent vaginal (yeast or bacterial vaginosis) and/or urinary tract infections (UTIs)
General anxiety
Negative feelings or fear surrounding sex and intimacy
Trauma to the body and pelvis including surgery, injuries from pregnancy and childbirth, and rape or abuse
Hormonal changes (think pregnancy, postpartum, menopause, perimenopause, and birth control use)
Cancer treatment (frequently gynecologic cancers and treatment including radiation and surgery)
As a Duke Women’s Health Residency Trained and Board-Certified Women’s Health (WCS) and Pelvic Floor (PRPC) Physical Therapist, I love treating pelvic pain including vaginismus and levator ani syndrome and work with folks struggling with vaginismus. I can promise you that no one else will be quite as excited that you are able to use a tampon or menstrual products, be able to tolerate a pelvic exam pain-free, or tolerate any and all forms of pelvic penetration during sexual activity quite like me if we’re working together. Think of me like your own personal cheerleader.
If you’re struggling with vaginismus or levator ani syndrome, here are a few practical tips to help improve things:
Set realistic expectations.
This is something I go over a lot with my clients. Usually by the time folks make it to me they have likely seen multiple specialists and have tried alllll of the things and have been struggling with their symptoms for at least a year (but frequently way longer than that). I usually tell people that pelvic floor physical therapy treatment for vaginismus is not a sprint but a marathon. And if your symptoms didn’t start overnight, the treatment for things won’t be quick either. Hopefully this will help to take some pressure off that things will improve (I promise they will), but to give your body the grace and space that it needs to heal. Slow is good and totally to be expected.
Dilator therapy.
Dilators (I sometimes call them vaginal or pelvic accommodators) start pretty small in size (think like the size of your pinky finger) and gradually increase in size. These are helpful to use with vaginismus to gradually improve the pain response and involuntary contraction of your pelvic floor muscles that occur with attempted pelvic penetration. This can sometimes feel a little nerve wracking to clients that I’m working with to start trying to do the thing that is causing pain. But I promise you it is 1000% worth it and every client I have worked with it has helped them to get back to doing what they’re wanting to do (like penetrative sexual intercourse, tampon or menstrual cup use, and being able to have pelvic exams comfortably).
See a pelvic floor therapist if you’re struggling.
You don’t have to deal with your symptoms any longer. No, it’s not all in your head. No, you did not cause this to happen. And no, typically having a glass of wine will not fix things. Pelvic floor physical therapy is considered a first line of treatment for vaginismus or levator ani syndrome and can start addressing any symptoms you may be struggling with as soon as you feel ready. All recommendations provided above are general recommendations and not a one-size fit all solution for everyone.
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re looking for vaginismus or levator ani syndrome treatment and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor treatment for vaginismus.
Thinking that you may benefit from pelvic floor physical therapy treatment? Or know someone else struggling with vaginismus that you think may need care? Reach out here to schedule a pelvic floor physical therapy appointment with me today. At Flora Physical Therapy I am passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
