Vaginismus Physiotherapy Mississauga
Curezone Physiotherapy, Mississauga collaborates with a team of providers providing treatments in various Pelvic health conditions including Vaginismus.
What is Vaginismus?
Vaginismus is a painful feeling of discomfort or inability when inserting a tampon, finger, penis or during a doctor’s internal pelvic exam. It occurs when there are involuntary contractions of the muscles in the outer third of the vagina.
- Primary Vaginismus: when a woman has never been able to have pain free intercourse due to pelvic floor muscle spasm
- Secondary Vaginismus: pain that develops sometimes later in life after a traumatic event such as childbirth, surgery, or a medical condition.
With Vaginismus, there is usually significant Connective Tissue Dysfunction that needs to be addressed first before any internal work. It is suggested that you follow up the self-help treatment for connective tissue dysfunction before embarking on the stretching exercises with the dilators.
What causes Vaginismus?
As is common with women’s reproductive health research, we still are discovering what the causes of PP are. In my clinical experience, every single client may have different factors that may contribute to PP. What I would recommend is to consider the following factors and how they may be helpful for you to understand and treat your PP.
- Hormonal issues (post partum, perimenopausal, menopausal, estrogen based birth control use etc.)2
- Emotions and perceptions regarding sexual enjoyment1 and communication/closeness regarding sexual health with partner1
- Vaginal dryness1
- Pelvic floor muscle tension
- Allodynic/hypersensitive vaginal and pelvic tissues
- Respiratory diaphragm issues (i.e., how you breathe)
- General perceptions of health and wellness1
- Depression, anxiety1
- Central sensitization (I will screen you for this!)
- Potential nutritional, dietary sensitivities (still emerging research)
- Vaginal dryness from menopause, childbirth, breastfeeding, medications
- Skin disorders that cause ulcers, cracks, itching, or burning
- Infections, such as yeast or urinary tract infections
- Uterine fibroids
- Irritable bowel syndrome
- Radiation and chemotherapy
Some factors also affect a person’s ability to become aroused can also cause dyspareunia. These factors include:
- stress, which can result in tightened muscles of the pelvic floor
- fear, guilt, or shame related to sex
- self-image or body issues
- medications such as birth control pills
- relationship problems
- cancer, arthritis, diabetes, and thyroid disease
- history of sexual abuse
What are the symptoms of PP?
- Pain while inserting a tampon or during penis penetration
- Pain with particular partners.
- Deep pain during thrusting
- Burning pain or aching pain.
- Throbbing pain, lasting hours after intercourse.
What are my treatment options?
- It is becoming increasingly clear that a multidisciplinary approach is beneficial for helping people experiencing Vaginismus . However, this can be challenging for a variety of factors including time and funding.
- Education: by helping to describe the role of the pelvic floor musculature in the pain cycle and provide techniques that can be used in the home environment
- Manual Therapy to mobilize muscle and soft tissue, normalize overactive muscles, improve circulation and desensitize areas
- Desensitization therapy: learning vaginal relaxation techniques, such as Kegel exercises, that can decrease pain.A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily. Occasionally, a technique called biofeedback may be recommended. A small probe is inserted into your vagina, which monitors how well you are doing the exercises by giving you feedback as you do them.
- Sex therapy: learning how to re-establish intimacy and improve communication with your partner.
- Water-based lubricants rather than petroleum jelly or other oil-based lubricants are preferable. Oil-based lubricants tend to dry the vagina.
- Psychologic therapies, such as cognitive-behavioral therapy and mindfulness-based cognitive therapy
- Pelvic muscle relaxation exercises, sometimes with biofeedback can help women with tight pelvic muscles learn to consciously relax them.
- Meditation/relaxation techniques
- Somatosensory remapping and desensitization techniques
- Yin yoga with a focus on pelvic floor relaxation
- Discussions regarding the influence of hydration, caffeine consumption, and other potential irritants and pelvic floor function
- Discussions on how pain works in the body and what we now know regarding pain science
- Internal and external muscle release/manual therapy
- Retraining your respiratory and pelvic diaphragm through breath technique.
- Use manual therapy to release the muscles either externally and/or internally that are causing the contractions.
- The vaginismus treatment kit has been reviewed in the American Physical Therapy Association’s Journal Of Women’s Health Physical Therapy and is recommended for use by therapists with all vaginismus patients.¹
Some general points about pelvic floor muscle exercises:
- Choose a convenient time and place where you can exercise regularly.
- Put a reminder about pelvic muscle exercises somewhere obvious to you (or set an alarm on your watch or mobile phone).
- Avoid quick pelvic floor muscle exercises where you don’t hold the contraction, as these tend to cause an increase in pelvic floor muscle resting tone.
- Be aware that it will take 6 to 8 weeks of regular exercise before you can expect to see a possible improvement, and approximately 3 months for the pelvic muscles to strengthen (or indeed for you to feel more confident that you are releasing them effectively) to a remarkable degree.
- You could try inserting one finger into the vagina to check the strength of your squeeze as you pull in the pelvic muscles. Alternatively, if this is daunting, you may be able to feel a pelvic floor contraction if you place the tip of your index finger on the perineal body (on the outside, between the vagina and back passage).
- If you are overweight, try reducing your weight.
- Try not to become constipated, as a full bowel will put pressure on the bladder, and straining to empty your bowel will weaken the pelvic muscles.
- If your job involves lifting, think of your pelvic muscles as well as your back – pull up your pelvic muscles when lifting a heavy weight.
- If you smoke, consider giving up, since constant coughing puts a strain on the pelvic muscles.
Teach the posture strategies that may help to relax the muscles that are contracting involuntarily.
Teach appropriate timing of the contraction and relaxation of the pelvic floor muscles.
Educate the client about the condition and why it might be occurring, and reoccurring.
Teach the client various strategies for getting the muscles to relax
Make sure you book your appointment today and get assessed by our physiotherapist now.