What Is Vaginismus? - Episode 16
In this episode, I discuss what vaginismus is. Including the causes, the way it's diagnosed, and the treatment.
I referenced MedlinePlus in preparation of this episode.
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Dr. Kari: Welcome to the Morone Pelvic Health Podcast. Hi, I'm your host, Dr. Kari Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education, personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence. Welcome back to the podcast. I am in the series of talking about symptoms that pelvic physical therapy can help with regarding muscles and tension. Last week I talked all about how pelvic physical therapy can help with painful periods. And today I'm talking about vaginismus and how pelvic physical therapy can help with it. So I am referencing the Medline Plus article on the internet, and I'm going to link it in the show notes if you want to read through it. And what I wanted to first do is talk about what vaginismus is, some of the causes of it, how it's diagnosed, some of the treatments, how pelvic physical therapy can help with it, and what the outcomes are. Just put simply, so vaginismus is an interesting diagnosis. In my words, in my layman terms, it's when your vaginal muscles contract and prevent entrance into the ******. I've seen it in my clinic. I've seen it at labs, I've seen it with patients. I have spoken with friends and family that it sounds like they deal with it. And it's interesting because this article says it's not common. But I think what I've seen is it might be a little more common than we realize in some variation. And I do talk a lot about things being on a continuum, on a spectrum. So it's not necessarily you have it or you don't. You might have it for a period of time or you might have it a little bit. That's just my approach to it as a pelvic physical therapist that might differ from other people. And if you do have a difference of opinion, shoot, share it with me. I would love to keep the conversation going, but basically it's when your body does not allow anything to come into the ******. Now, what the website says is it says that I'm going to just read it. Vaginismus is a spasm of the muscles surrounding the ****** that occurs against your will. The spasms make the ****** very narrow and can prevent sexual activity and medical exams. And so that's where I think there is a difference, because you think sexual activity and you think medical exams, usually it's a pep. You're getting that pep at the gynecologist on a yearly exam. But there are other times when you might want to enter your ****** during your cycle. Many women use tampons. More people are starting to use cups and menstrual discs. And some people want to be able to just know their body, not from a sexual perspective, but sometimes people want to just put their finger in there just to kind of check things out, to get familiar with your body. And anytime you can't get anything into your ****** that in my opinion is vaginism. I've seen people in my clinic that, yeah, they can't have sex or they can't have a medical exam, they kind of suck it up and deal through the sex. There's blood, there's pain, but on a casual day, they cannot enter a tampon into their ******. I have seen this with patients more than once. So that's why I don't all the way agree with this specific definition. And I prefer to say it's whenever nothing can get inside the ******, because where there is a will, there is a way. And sometimes people will kind of push through that muscle spasm and it causes all sorts of chaos. I don't want someone to feel like they don't well, no, let me not say that. So I just wanted to differentiate the difference between what my definition is and what is being put out there on the internet now. What are the causes of vaginismus? Most of the times we don't know. We can look back. Sometimes hindsight is not 2020. Sometimes you can look back and say, oh, that first sexual encounter was not ideal and that caused some fear and some pain and now we're in the cycle. Or you could be a victim of abuse, sexual abuse. You could have had a bad experience for a gynecological exam, or it could be, you don't know. I've had patients that have had very strong religious thoughts and practices around sexuality and because of that, they have become fearful of sexual encounters. And that fear alone has caused vaginismus. Something that is listed as a cause, which I do agree with, is mental health. So there is a strong component between vaginismus and mental health because when you've experienced pain, generally speaking, your brain wants to avoid the pain. And when you are avoiding pain, your body goes into fight, flight or freeze, which fighting flighting or freezing all activate muscular activity, right? Are you with me? So if you want to avoid something, those muscles are going to tense up. Like if someone punched you in the shoulder and you see them ball up their fist and lunging at you, you're going to freeze like you're going to tense up your shoulders. So you can rebound that force. You're going to fight back, which means you might push them away from you or you're going to flee, which is you might shift, right? All of those motions take effort, take muscle excavation to avoid that pain. The same thing can happen in and around the ******. Fighting, sliding or freezing might mean tensing those vaginal muscles. So if you've had an encounter, or you're fearful of an encounter because of what you've been raised or been taught or told, or been a victim of a bad vaginal exam, gynecological exam, or been a victim of sexual abuse, those muscles will tense because they have to tense when you're fighting, you're fleeing or you're freezing. So that's how the mental component affects vaginismus. And sometimes it can take a while or multiple multidisciplinary team to help you overcome vaginismus because there are so many layers to it. Symptoms talked about it a little bit in the definition. Symptoms can be difficulty with penetrating the ******, so difficulty putting in a tampon, difficulty inserting a menstrual disc or cup unibility difficulty or pain associated with inserting penetrating the ****** with sexual activity or pain during a vaginal exam. Gynecological exam notice all of these things have to do with something going inside of your ******. Your ****** is a two way street. Things come out of it like babies, but things should be able to go into it, such as a ***** during penetration or a tampon during menstruation or a finger during pelvic physical therapy or a tool during a gynecological exam. So there is nothing wrong with anything going into or out of the ******. But if there is the inability because of tightness or extreme pain due to the tightness, those are the symptoms of the vaginismus. Now, I thought this was interesting, the exam and the test. A pelvic exam can confirm the diagnosis. Yes. Either you can get something in there and it's painful, or you can't basically, that's pretty much how you diagnose this egg. Diagnose it now, in real life, what I've seen in the clinic is when someone has vaginisms, yes, there could be pain with the muscle spasm, and you can't enter the ****** or you can with extreme pain, but you also see other physical changes. Increased respiration rate, increased tension around the jaw, the face, the neck, the shoulders, nervousness fidgeting. All of those things people do when they're physically not comfortable. That to me is also a part of the exam. If someone is I can do a pelvic exam, an internal exam, and they say, yeah, it's a little discomfort, but she's able to still carry in a conversation, she's still in a relaxed state, that's fine. But if she's saying, yeah, it kind of hurts a little bit, and you can see her kind of doing those shallow breaths and her jaw is tight and her foot starts twitching, yet she might be saying it's a little bit uncomfortable, but the body is saying it's not comfortable and it's really not happy. With this exam to continue. So that's, to me, what I look at in the diagnosis process, in the exam process of diagnosing someone with Vegenism now treatment, I thought this was great. They recommend a multidisciplinary healthcare team. Gynecologists think that's pretty much a given. Pelvic physical therapist? Yes, I'm partial. I think that's a given. And a counselor and I think that is amazing because the gynecologist is going to check you from a medical perspective. Check and treat you from a medical perspective. The physical therapist is going to check and treat you from a physical perspective. And then the counselor or the therapist, mental therapist, is going to treat and manage sorry, assess and treat you from a mental health perspective because, remember, there are different causes of vaginismus. And if you've got multiple layers causing the vaginismus, you should have multiple people on your team to overcome it. I will say the clients that every single client that I've seen in the clinic that made progress and did well with Pelvic physical therapy to overcome her vaginismus also had a gynecologist that she trusted and a mental health therapist that she worked with in conjunction with working with me in the same time frame in order to overcome that. So what types of things can be done to treat vaginisms? I can't speak too much directly for what gynecologists and sexual counselors or therapists do, but I'll give it a go. So gynecologists, they're looking at you from a medical perspective. Is your blood work within normal limits? Are your hormones okay? You might need some sorts of medications or creams to help you to endure other treatments. And so that's where your gynecologist is going to come through. A lot of times, people are diagnosed in the gynecological exam. Other times I've seen people will come straight to Pelvic physical therapy. They've heard a friend talk about it. They've read something on the Internet. A Pelvic physical therapist can also confirm if you have vaginismus or not. Now, the counselor or the mental health therapist, she's going to dig deep from an emotional perspective. She's going to help you uncover and manage those emotional stresses. If you've had a bad gynecological exam, if you've been a victim of some sort of trauma, if you've been a victim of some sort of sexual abuse, notice I said those separately because you could have been a victim of trauma that wasn't necessarily sexually related, but could be impacting that Pelvic floor. She's going to or he is going to help you manage things and give you tools uncover those things and give you tools to manage them from a mental health perspective. And then the Pelvic physical therapist, we I am going to work with those muscles. We're going to work with that central nervous system and the muscular system to help calm things down. If those muscles are really tight, we're going to do things to increase the flexibility of those muscles. If those muscles are weak, we're going to do things to make them stronger. If they are not coordinated, we're going to do things to help those muscles coordinate. So when it's time to relax, they know how to relax. So that is all of the things that can be done for Pelvic, for vaginisms. Notice something that I didn't say that's recommended everywhere is kegels. Most times people are doing kegels, which is what they don't need to do. Or when they're doing kegels, they're not doing them the correct way. Just like any other exercise, the relaxation is just as important as the contraction. So you want to contract and relax. Just like thinking about a bicep curl. You don't contract the bicep curl. Bend your elbow as far as you can and hold it there for 30 minutes, saying, I'm working out my biceps. No, you contract your bicep, bend your elbow, and then you extend your elbow fully. Relax the bicep, and you might do ten or 15 reps of those, right? Those bicep curls up and down. Contract, relax. Same thing is true with the kegels. If you do do the kegels, which generally I don't recommend, but if you do do the kegels, make sure you are relaxing just as long, if not longer, than you are contracting, because both are equally important. That relaxation piece is often what's missed, which is why people can do more harm than good doing kegels. So I just assume, say, don't do them, because if you're not doing them right, it's not worth doing them. But that is my overview of vaginismus. I have had patients in the clinic that have had vaginismus in the past, have had some sort of life event happen, or some sort of medical event happen, and the next thing you know, 1015 years later, the vaginismus comes back. It can happen. So if you have had symptoms of vaginismus in the past or currently, it would be good to check out a local Pelvic physical therapist so you can get the treatment that you need. If you're in or around the Atlanta area, hit me up. I would love to be your Pelvic health physical therapist. If you're not in and around the Atlanta area, hit me up, because I do virtual sessions and I still want to help you either way. I just wanted to really create a safe space to discuss what vaginismus is, what are some options to treat vaginismus and give you some ideas of what those treatments look like. So thank you so much for coming to this episode. Next week, we're going to dive into Levator ANI syndrome. Thank you for listening to this episode of The Moron Pelvic health podcast. Please do me a favor and leave a review so that more people can find this content and end. Make sure you like and subscribe yourself so you never miss another episode.