Difficulty inserting tampons?
Pain with vaginal examinations?
Difficulty with penetrative sex?
… you may have vaginismus
What is vaginismus?
Vaginismus refers to “muscle tightness at the vaginal entrance, that interferes with sexual intercourse”. The term is still commonly used, however in recent years the term “Vaginismus” has been replaced with “Genito-Pelvic Pain Disorder” (reference: DSM V). This was done to reflect the fact that there are other factors not just muscle tightness that contribute to the problem, and that it does not just relate to sexual intercourse.
How does it present?
We see many women who have difficulty allowing vaginal entry (be it a penis, finger or object), despite their wish to do so. There is normally pain associated with this, and there can also be problems inserting tampons or undergoing vaginal examinations. It may have always been a problem, or it could have developed after previously not having had issues. Many have had the problem for years – they didn’t know what they were experiencing was common, and that other people also have it. They may have been too embarrassed to talk about it, even with health professionals.
Pain with inserting tampons is often the first sign that there may be something wrong. You should be able to put a tampon in if you wish, with minimal discomfort, and there should be no pain or discomfort once it is inside. Sometimes we see teenagers and young women for help with this, and often it is just a case of teaching them how to relax the pelvic floor muscles to allow the tampon to go in easily.
In a similar way, you should be able to undergo a speculum examination without experiencing excruciating pain. Some discomfort is common but it shouldn’t be unbearable. Regular smears are important if you have ever had sex. If you are concerned it will hurt, explain that you experience pain and ask that plenty of lubricant be used. Some smear takers also stock smaller (paediatric) speculums, so ask for one of those and ask them to insert the speculum very slowly. You could also try to tighten your pelvic floor gently, and then let it relax BEFORE they insert it.
What can I do about it?
Getting help from an experienced pelvic floor physiotherapist can make a big difference. You may only need two or three sessions. Education is a big part of what we do, and we provide you with self-help strategies as part of the treatment. We have expert skills and training in treating these problems – our professionalism and empathy will help you to feel at ease talking about such personal, sensitive matters.
Treatment includes:
👉pain education
👉relaxation training
👉desensitising
👉pelvic floor release
👉dilator use
👉advice around returning to sexual activity
If you have tried something that was painful, the next time you go to do it, your body will protect you. For example, if you put your hand on a hot heater, you don’t leave it there and wonder if you might get burnt. Reflexes kick in and you withdraw your hand quickly. The same thing can happen when you have had pain at the vaginal entrance. The thought of anything entering the vagina (a tampon, finger, penis etc) can cause the muscles to tighten. This is a normal protective, guarding response that is beyond your conscious control. We can help you to overcome this.
Don’t suffer in silence – there is help available. Find a local experienced pelvic floor physiotherapist who can assess your muscles and guide you with the right treatment.