Overcoming Vaginismus With a Women's Health Physiotherapist

Are you a woman who experiences pain whenever you use a tampon? Is a gynaecological exam or a pap smear with your gynae painful for you? Does it hurt when you have sexual intercourse? 

If your answer is yes, then you may be one of the many women in the world who experience a condition known as vaginismus. Results from a local study led by KK Women’s and Children’s Hospital (KKH) have shown that nearly 60% of women in Singapore have a low sexual function, of which vaginismus is the most common contributing factor to female sexual dysfunction. Despite its prevalence in Singapore, it is surprising how little is spoken about this condition. 

Like many women’s health conditions, women often choose to suffer in silence as they are either too embarrassed to seek help or they assume that these issues are normal and they should just put up with it. But, if you have these symptoms, including painful sex, it is worth knowing that there is caring and expert help available to you at PSC Women & Children Centre with our team of women’s health physiotherapists. 

Let’s start by understanding what vaginismus is and what you can do to help your condition. 

What Is Vaginismus?

Vaginismus is the term used to describe vaginal pain (deep or about the entrance) when something is inserted into the vagina. This can be during sexual intercourse or when a speculum is inserted during a pap smear. Vaginismus happens when there is involuntary contraction and tightening of the pelvic floor muscles, which contribute to the onset of pain. 

Depending on your body, some women describe it as a sharp, stabbing pain, while others experience dull throbbing pains around the vagina. The pain, sometimes cannot be eased or relieved by over-the-counter pain medications. 

What Causes Vaginismus?

There is no single cause for this condition, instead, there are many factors that can contribute to vaginismus. Some of these include the lack of sexual knowledge, culture and beliefs, childbirth, thrush infection, urinary tract infections (UTI), endometriosis, hip or back injury, and even menopause. 

In most cases, the cause of vaginismus is unknown, however the condition can be classified into two categories: 

Primary Vaginismus:

Women suffering from this condition never had comfortable penetration or have never achieved penetrative intercourse. Primary vaginismus can also be attributed to negative sexual views and strict sexual upbringing. Most of the time, primary vaginismus stems from fear and anxiety due to the lack of sexual education or information that the patient has. This, in turn, can result in fertility implications. 

Secondary Vaginismus:

This occurs after a period of normal sexual relations. For example, women may experience vaginal pain after a gynaecological surgery, menopause, childbirth, as well as traumatic event such as sexual abuse.  

Each woman’s journey and the trigger factors for vaginismus are different, however, many complain of persistent pain that affects their quality of life over time. As such, it is important to have an individual assessment with a professional women’s health physiotherapist to provide a treatment plan that is unique to your condition. 

What Can You Do To Help Your Symptoms Of Vaginismus?

Here are some simple things that you can do to help relieve the pains of living with vaginismus: 

1. See A Specialised Women’s Health Physiotherapist

When you visit a women’s health physiotherapist, they will conduct a detailed history of your condition and may do a physical examination. From there, the pelvic floor therapist will develop an exercise programme tailored to your needs and teach you exercises as well as techniques that can help you relax your pelvic floor muscles. 

2. Exercise To Relax The Pelvic Area

Sometimes the pain worsens with exercise, especially since the muscles are already tight and painful. Hence, to help relax and improve the flexibility of your hip and pelvic muscles, you can try yoga and rhythmic pelvic tilt exercises instead. You can still engage in high-intensity interval training (HIIT) exercises, however we recommend that you stretch your muscles properly at the end of your exercise routine to relax them. 

3. Communicate With Your Partner

Vaginismus causes pain during sexual intercourse, hence it is no surprise if you find yourself less sexually active than before.Talk to your partner that you want to avoid vaginal penetration until the pain improves. Instead, it is advisable for you and your partner  to explore other forms of intimacy other than vaginal penetration.

4. Seek Treatment For Other Causes Of Pain

We recommend you seek treatment as soon as possible if you are also experiencing pelvis or hip pain that may result in muscle tightening in that area. Going for a women’s health physiotherapy session can teach you how to work those muscle groups and lead a better quality of life. 

Can I Have A Pap Smear If I Have Vaginismus?

Yes. A cervical screening is still important, and vaginismus is not a reason to skip it — but it is a reason to prepare for it rather than simply turning up and hoping.

Tell the person doing the screening first. Say you have vaginismus, or that examinations have been painful before. A doctor or nurse who knows this in advance can work differently: more time, more explanation, and no assumption that you will be able to relax on cue.

Ask about a smaller speculum. Speculums come in more than one size, and a smaller one is often enough to complete the screening comfortably.

Ask whether you can insert it yourself. Many women find that being the one in control of the speculum removes most of the anticipation, which is the part that tightens the pelvic floor in the first place.

Change the position. Lying flat with the legs apart is the default, not a requirement. Lying on your side, or with a pillow under your hips, changes the angle and can make a real difference.

Breathe out as the speculum goes in. Holding your breath contracts the pelvic floor. A slow breath out relaxes it. This is the single technique most worth practising beforehand.

Come in before the appointment, not after. This is where we help most. In the weeks before a screening, our women’s health physiotherapists can teach you to release the pelvic floor on purpose, work through the discomfort gradually and at your own pace, and rehearse the breathing — so the day itself is something you have already practised rather than something you are meeting cold.

If a previous smear was painful enough that you have been putting off the next one, tell us. It is a common reason women come to see us, and it is a treatable one.

Visit A Women’s Health Physiotherapist Today

Our women’s health physiotherapists will guide you to relax your pelvic floor, tummy, buttocks, legs, and back muscles. We teach you stretches and pelvic floor exercises that you can do at home to help, as well as help you overcome the pain and anxiety of vaginal penetration. At the same time, we also provide advice on other approaches that you can take to have a fulfilling intimate relationship whilst undergoing treatment. 

You are not alone in this. Vaginismus is a common issue that is often never spoken about, and there is a solution as well as treatment options available. Our team of women’s health physiotherapists have helped many women just like you, so don’t suffer in silence. Reach out to us and make an appointment today.