Whilst most women enjoy sex, there are some women who find sex painful and still others who are unable to even have sex at all. This is especially common amongst Muslim women and women of certain cultural backgrounds (typically conservative) due to the shame and detachment often associated with the vulvovaginal area. One of the main conditions that this occurs in is vaginismus.
Vaginismus is not something women have control over…
Vaginismus is an involuntary tightening of the pelvic floor muscles during attempted insertion of an object into the vagina. This could include penetration during intercourse or insertion of a tampon or speculum. When the muscles tighten, women can feel pain, which can range from a mild discomfort to severe pain that can be stinging, burning, tearing, or aching.
Vaginismus is not something women have control over, and some women may be completely unaware that it is happening. In some women, the muscles can become so tight, that it feels like the vagina is totally closed and penetration cannot occur. In others, the muscles allow for penetration, but the tightness of the muscles causes enough pain that intercourse must be stopped.
A woman can have primary vaginismus – which is associated with attempting to have sex for the first time, and being unable to. Women may feel like their partner bumps into a wall where the opening should be. This is the most common cause of unconsummated marriages, and can cause significant distress and consequent relationship issues for newlywed couples.
Secondary vaginismus is when the tightness and inability to have intercourse occurs after a period of being able to enjoy sex. This can happen for a number of reasons including:
- Yeast infections or recurrent urinary tract infections
- After a difficult childbirth
- Prolapse of your pelvic organs into the vaginal area
- Menopause, due to hormonal changes, leading to vaginal dryness or atrophy
- Abuse or trauma
- Pelvic conditions such as endometriosis, cysts, tumours, lichen sclerosus
- Anxiety or stress
- Partner issues
Vaginismus can be treated by your women’s health physical therapist/physiotherapist, who will use a few different treatment techniques to help you have sex comfortably. For primary vaginismus, these include:
- Vaginal desensitization
- Pelvic floor muscle relaxation exercises
- Internal muscle releases around the vagina and pelvic floor muscles
- Vaginal trainers/dilators
In secondary vaginismus, more techniques may need to be employed in addition to the above treatments. Sometimes, a referral to your GP or to a sex therapist or psychologist may be indicated, who will work alongside your women’s health physical therapist. Treatment choices here include:
- Scar tissue massage
- Pessary for prolapse support
- Discussion about vaginal oestrogen with your doctor
- Electrical stimulation
- Hip and pelvic stretches
- Complex management of pathology such as endometriosis including nutrition advice and visceral and fascial release of scar tissue and adhesions
Remember, with vaginismus, it is NOT all in your head. With an appropriate women’s health physiotherapy management plan, women can overcome vaginismus within a few months, and can go on to enjoy a normal, healthy sex life.