Genito-pelvic pain/penetration (vaginismus) challenges and the pain feedback loop
Anna Schneider, C-IAYT, Ph.D.
Certified Yoga Therapist
Experiencing pain or involuntary resistance during penetrative sex, when using products like tampons, or when participating in medical exams or diagnostic tests can feel terribly isolating and hopeless. However, these types of challenges are shared by so many women/vagina owners and are some of the most common concerns clients wish to address with me at the Proactive Pelvic Health Centre (PPHC).
The PPHC team is especially effective in supporting individuals through genito-pelvic pain/ penetration diagnoses, like vaginismus, because our multi-disciplinary team recognizes that the most effective care is integrative and should address all the complex layers which feed into how one experiences pain, panic and resistance. In this post, I will introduce the role of the nervous system and the pain feedback loop in the anticipatory fear and contraction which make penetration feel impossible, or which prompt pain when vaginal insertion is attempted.
A mind-body connection that predicts and protects
Our system is designed to predict what might cause us harm and to use any available internal or external resources to protect us from that harm. In the case of vaginismus, the system has identified the possibility of penetration as a threat and will ring the alarm bell to begin the cascade of physical spasm, painful sensation, feelings of fear, and avoidant action all to keep you safe - even when that reactive cascade is the very last thing you want.
You want to feel normal and not broken, you want to feel sexually free and at ease with your partner, you want to be able to have routine medical appointments without distress.
And yet, the greater your distress and the more often you go through the cycle of fear and pain in contexts involving vaginal insertion, the more sensitized your system becomes, ringing that alarm bell more quickly, louder and for longer.
When you are experiencing seemingly intractable vaginismus, it is so natural to become frustrated or angry at your system, to feel like it has turned against you. Especially when the consequences can extend so far past penetration in and of itself, often jeopardizing relationships, sabotaging self-worth, and restricting access to medical care.
However, while it may seem counter-intuitive, recognizing that your mind and body have the best intentions and learning how to collaborate with your nervous system and reclaim a feeling of safety in the context of penetration is often the most effective and efficient path to healing. Even when it is hard to believe, our bodies and internal ecosystems are most often on our side, they just need a little guidance.
Reclaiming safety
Pain and involuntary protective contraction is expressed in every aspect of our bio- psychosocial-spiritual experience and so we can’t simply think or rationalize our way out of a pain pattern, “just relax”, or “just calm down”. We need to reclaim a fully embodied, integrated genuine feeling of safety.
To do this we need to know what that even feels like to begin with. You might ask yourself, when I feel safe:
- How does my body feel?
- What is my breathing like?
- What emotions are present?
- How does my heart feel?
- What are the qualities of my mindspace? - How connected do I feel to others?
Some of us may have never experienced a true sense of safety so, if that applies to you, please know I get it! In that case we can still grow our self-awareness and self-regulation, learning to build a sense of safety from the ground up.
In either case, through practice we can gain direct lived-experience of calming our own nervous systems, releasing pelvic floor contraction, remaining present and mindful in challenging contexts, feeling like we are in communication with sensation rather than overwhelmed by it, and feeling empowered in our relationships whether that be advocating for ourselves with medical professionals or with our sexual partners.
Tools we might practice in yoga therapy include:
Somatic mindful movement that: a) hones your ability to intentionally release and engage your pelvic floor, b) encourages the body to release persistent reactive muscle tone and contraction, c) strengthens mind-body connection
Breathwork that engages the parasympathetic nervous system and promotes ease and natural dynamic rhythms in the pelvic floor
Mindfulness of emotions and thoughts
Imagery
Lots of practical tips and tricks for interrupting and updating our system’s prediction narrative about penetration, including working with novel contexts, cues and sensory stimulus anchors
Yoga practices that can be paired with PT tools like dilators and manual stretching
Evidence-based education on topics like: the nervous system, including polyvagal theory, the science of pain care, and the natural role of the pelvic floor in relationship with the rest of our biophysiology.
Feeling like you have professional support on your team, for example:
- Opportunities to practice and learn with your supportive partner so you know they understand your experience, the diagnosis and the ways they can help
- A list of practical requests you might make in preparation for a medical exam or test to set yourself up for success and to help you feel in charge of your own wellness
An opportunity for deep listening and compassion
Folks experience vaginismus for so many varied reasons including: past experience of discomfort (for any reason), cultural or religious messaging, heightened anxiety, a previous medical treatment or procedure, stress within a relationship, feeling unable to verbally say no to unwanted intercourse, and so many more!
As you strengthen self-awareness and self-regulation you might find that pelvic pain is an invitation to discover the personal root of your system’s fear. While it is a challenge that requires heaps of courage and compassion, it is not a challenge you have to face alone, and the richness it can bring to your relationship with yourself and to your sense of empowerment is immeasurable.
You are not alone
If you are interested in trauma-informed yoga therapy practices to support you in healing from limiting genito-pelvic pain - vaginismus - please call the clinic, go to our online booking page to book a private yoga therapy session with me, or add your contact information to our list for upcoming specialized small group workshops.