All About Vaginismus: When “ooooh” becomes “ouch! (Part 2): Physical Therapy
In the first half of this blog series, we chatted about vaginismus, or painful insertion into the vagina. This can be a common problem for people experiencing pain with sexual activity, and has many known causes. If you missed part one where we chatted about the causes of vaginismus, what it feels like and the medical examination, be sure to check it out here.
In part 2, we’re going to chat through the physical therapy first session, treatment strategies, & more! First, let’s talk about the first visit. I get it– this is one of those problems that can make people feel very intimidated when they first start searching for help. But remember, while this problem feels very isolating and rare to you, it actually is pretty common. And pelvic health PTs like us, well, we work with people to deal with this problem All. The. Time.
Your First Pelvic Floor Physical Therapy Appointment
When you first come in for your appointment, we’ll start by sitting down and chatting with you about what has been going on. You’ll get a chance to share more about your story– when this started– what it feels like – and anything else that you think is connected to it. We’ll also ask you a lot of questions– specifics about your symptoms and pain, details about your bladder and bowel function, questions about your childbirth history (if it applies) and your medical history, and more. We’ll want to really get to know you so we can understand the different factors involved in the pain you’re experiencing.
After we chat, we’ll let you know some options for your physical examination, and you’ll get to decide what feels best for you. This is what this can look like:
Movement assessment: We usually start by looking at your posture in sitting and standing, your gait, and the way that you move (from head to toe). This lets us know generally what is happening around your body. Sometimes, areas that may seem disconnected (like your neck and jaw…or even your feet!) can actually be very involved in what is happening at the pelvis
Muscle and tissue assessment around the pelvis and abdomen: We often will want to see how your muscles, fascia and connective tissues move around your belly, hips, and legs. We’ll be looking at whether or not your tissues have restrictions or feel tender to touch. We’ll also see if you have any restrictions in your mobility.
Specific tests: Sometimes, our assessment leads us to wanting to assess further at certain areas– this may mean looking more closely at your spine or hips, testing the way you transfer force, etc.
Pelvic floor muscle assessment: These muscles are often the big player when people experience vaginismus, so assessing them can be very helpful in guiding treatment. The way we examine the muscles though, really depends on the person. First, know that our goal for the exam is to be very gentle– we have no “goals” for what has to happen, and this lets us just examine based on what you and your body are ready for. For some patients, we don’t do any internal vaginal examination for a few visits. We may focus on examining and treating other muscles or areas in the body– or we may aim for an external examination of the pelvic floor muscles. Other patients feel ready to have an internal examination right away. And others fall somewhere in between. Our main goal is always to have a strong partnership with our patients and to work with them to find the best examination approach that works for them.
After our examination, we’ll make recommendations for treatment. Typically, we start with working with our patients once per week for around the first 6-8 sessions. Some people need a little more weekly, and others a little less. After then, we often are able to space visits out. Generally, patients work with us for around 2-4 months total– but this can vary. Some people’s bodies require a more gentle and graded approach, and we aim to respect what each individual needs. Others respond very quickly and end up needing less time than we even anticipated!
Physical Therapy Treatment
Our treatment approach will vary based on what the individual needs, and on what our examination found. Some of the components that are often involved include:
Manual physical therapy: This can include soft tissue treatments for the pelvic floor muscles and the muscles around the pelvis. It can also include the use of other tools like dry needling, cupping, and more. You can find more information about internal manual physical therapy here .
Vaginal trainers/dilators: These can be an important treatment option for people with vaginismus (but they aren’t for everyone!). We wrote an entire blog on the topic, and you can learn all about them here.
Specific exercises: We often will recommend exercises to help your body modulate tension overall, and improve other factors we observed during the initial evaluation that we think could be connected. This can include gentle movement sequences like this one, but this is often individualized to the person.
Lots of education: We believe knowledge is power, so we spend a lot of time helping people learn about their bodies. The more people understand the response their muscles are having, the more they’re able to promote change. We chat through everything from anatomy to neurophysiology to sexual habits to bladder and bowel health to so much more!
The Team Approach
Sometimes, people with vaginismus can make very quick progress with physical therapy alone; however, in many cases, a multidisciplinary team approach is often ideal. The reality is that problems like this are complex and working with different practitioners who have different skill sets can be hugely beneficial. A multidisciplinary team could include practitioners like Gynecologists, Physiatrists, Colorectal Providers, GI Specialists, Psychologists, Acupuncturists, Yoga Therapists, Massage Therapists, and more! The right team for you will depend on your specific needs for helping your body make progress. Some of the medical treatments that can be helpful in combination with pelvic health physical therapy can include:
Intravaginal compounded creams/suppositories (muscle relaxants, combination creams that help to improve pain or decrease nerve sensitivity, etc)
Trigger point injections
Botox injections
Oral medications (some aiming for muscle relaxation, others for calming the nervous system)
Oral or vaginal hormones (ie topical estrogen)
Other injections (ie pudendal nerve blocks, stellate ganglion blocks)
Working with a skilled practitioner who is knowledgeable about vaginismus is key in determining the best approach for you! (Learn what to look for in a pelvic floor physical therapist here.)
Closing Thoughts
If you’ve been struggling with vaginismus, please know that you are not alone. Help is available and you can having pain-free sexual intimacy and pelvic exams! Reach out to our office today to take the first step in feeling better!
The Expert Physical Therapists At Southern Pelvic Health Are Here For You