Vaginismus and the Fear-Tension-Pain Cycle

What is vaginismus?

Vaginismus is an anticipatory, involuntary contraction of the pelvic floor muscles which may prevent any sort of penetration into the vagina or cause it to be painful.

Why does someone develop vaginismus?

There are many different reasons that contribute to the development of vaginismus. It could be related to what you were told about sex growing up or it could have been the lack of information you were given. There may have been a history of sexual assault or a traumatic birth. Maybe you deal with generalized anxiety or health anxiety. Or maybe none of the above, but there is usually a conscious or unconscious fear component to the development of vaginismus.

It could be a situation of primary vaginismus in which the person had pain and difficulty the very first time they tried to insert something into the vagina. Secondary vaginismus is when a person had no pain or difficulty with penetration initially, but then developed the condition later on.

The Fear-Tension-Pain Cycle

It all starts with fear. If someone has a fear of pain, tissue damage, trauma or negativity associated with penetration, the body will perceive penetration as a potential threat. The body is very smart at protecting us from harm. It will work hard to prevent or avoid any sort of perceived threat to it. In vaginismus, this results in excessive muscle contraction of the pelvic floor muscles. This tightening of the pelvic floor will create pain with attempted penetration. When a person repeatedly is experiencing pain with every attempt of penetration, the nerves that innervate the vagina also become protective. They may become highly sensitive which can result in burning or stinging pain with gentle touch at the opening of the vagina. This cycle will become reinforced as a person continues to have painful experiences meaning that the person develops increased fear, and therefore increased tension.

How do we break this cycle?

Treating vaginismus is all about starting at a place that is pain-free and non-threatening. For some people, the first step may just be education. It is extremely beneficial for a patient to understand vaginismus, as well as their anatomy. Self exploration using a mirror and their fingers can be a great first step to reducing fear. Eventually, a patient may progress to digit insertion, dilators and penetrative sex if that is their goal. However, it is extremely important that their treatment and exercises do not elicit pain. If a patient has pain every time they have a treatment session or use their dilators, the fear-tension-pain cycle will continue to be reinforced. It is vital for the patient to go at their own pace so that they can slowly over time have less fear, less tension and therefore less pain. Your physiotherapist will help guide you through an appropriate progression of exercises and strategies to help you achieve your goals related to vaginismus.

If you are struggling with vaginismus, we can help! Don’t let vaginismus continue to prevent penetration for you. Our experienced team of pelvic health physiotherapists can guide you through your rehab and recovery from vaginismus.

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