One of the biggest misconceptions out there about Vaginismus is that you cannot fix it, or that you will be managing it forever.
Luckily this isn't true. Vaginismus is not a lifelong disease like ALS or other autoimmune disorders. Vaginismus is primarily a musculoskeletal presentation of painful sex. So let's dive into what it is, and how you can go about fixing it!
What is Vaginismus?
Vaginismus is where the muscles in your pelvic floor, particularly the ones around your vulva and vagina, spasm or involuntarily close making penetration either completely impossible or severely difficult. Read more about what the pelvic floor is on our blog here, and why tight muscles can create so much pain here.
There are other reasons and diagnoses that cause painful penetration or painful sex, and Vaginismus is only one of those. The other diagnoses include:
Vulvodynia: Nerve pain at the entrance of the vagina within the vulva
Dyspareunia: Generally just the main term for painful sex. It can be caused by endometriosis or chronic pelvic pain.
The common symptoms of Vaginismus are listed below. You can also read more in-depth about them in this blog.
Inability or difficulty to penetrate the vaginal cavity due to muscular spasms.
Pain with attempted penetration.
Involuntary leg shaking with attempted penetration.
Anxiety or a history of trauma around penetration, which can often then make the presentation worse.
Can be accompanied by difficulty with bowel movements (constipation), or urinary urgency (over active bladder).
Traditional Treatments for Vaginismus
Treating Vaginismus should be a multimodal approach with the team consisting of you, your OBGYN, your Pelvic Floor Physical or Occupational Therapist, and your mental health therapist or sex therapist. You can read more about what pelvic floor PT is here.
If you are able to build this team, however, you are one of the lucky few. The hard part is that access to providers who can and will listen, who insurance will cover, and who exist in your area is limited. This is why we need more accessible care, and this is why we need more options for home remedies.
The traditional treatments include:
Dilator therapy: This should only be used in conjunction with some type of physical therapy where they can confirm this treatment will be helpful for you. See the below graphic for an example of what they look like.
Mental health or sex therapy: Pelvic pain and trauma often are linked, and trying to treat one without the other can prove to be difficult.
Medications: Sometimes getting prescriptions to medications to help relieve the discomfort can be a huge game changer in making therapy more comfortable. Consult with your gynecologist or primary care about if any of these may be right for you:
Topical Estrogen
Vaginal moisturizer with hyaluronic acid
Suppositories consisting of muscle relaxants and pain medication
Medication for anxiety or depression if this is linked to your pelvic pain and to be used in conjunction with mental health therapy.
At Home Treatments for Vaginismus
As discussed previously, this isn't a life long condition but it can be complex. Creating the right game plan and strategy and make or break your home treatment, especially if you don't have access to these medical providers listed above.
Step One: Establish goals
This is probably the most important step. A plan without a goal is just like boarding a plane without a destination. Sure you're going somewhere, but where? Having a goal or goals help to keep you consistent.
Example goals would be:
I want to be able to have pain free sex with my partner.
I want to be able to have a pain free pelvic exam and pap smear by my medical doctor.
I want to be able to use a tampon or medical cup while I have my period.
Step Two: Establish a regular treatment timeline
This is a lot like working out to gain muscle mass or run a race. You have the goal to get 26.2 miles under your belt, but running sporadically every other week isn't going to get you there. You have to create a weekly regime that you stick to.
Luckily the regime doesn't have to be hard or time consuming. This may look like doing 20 minutes of stretches three times per week, deep breathing for 5 minutes daily, and performing dilator therapy once a week. Whatever your plan is, keep it regular and consistent to see progress.
Step Three: Gather resources and support
The individuals who usually meet their goals are those that have accountability and support. If you have a partner with whom you want to have sex, include them in your program. I recommend they not only regularly cheer you on and support you, but be willing to have clear and honest discussions about what YOU want and need for your safety and pleasure.
If you have at least one provider you can regularly check in with too, that is beneficial.
You also may need tools to perform your at home treatment, so gathering those can make it easy to get the ball rolling:
Dilators if appropriate and a quality lubricant to accompany them.
Yoga mat for stretching.
A safe space to perform your treatment in, such as your bedroom for dilators or living room for the yoga.
An online program, if desired, such as this one.
Step Four: Stay Consistent
This is a culmination of all of the steps above, and the step where you will actually start to see results. One week of home treatments likely won't show much progress, but many weeks to months overtime will if you stay consistent with your plan.
It is helpful, again, to think of this like running a marathon. It will take time, a plan, consistency, and support but it is completely possible to achieve with all of these elements.
More Resources
Treating your Vaginismus at home can feel daunting without some sort of guidance, which is why I built an online program for this purpose.
I want everyone out there suffering to have a supportive OBGYN, a skilled pelvic floor PT, and an awesome, trauma informed sex therapist to accomplish their goals. I recognize, though, that this is really not possible for a large majority of Americans.
So I put together videos that include absolutely EVERYTHING I ever give any of my patients to do at home, plus more education and resources to dig through and enjoy. If you're wanting to treat your vaginismus at home, and don't have access to helpful providers to guide you, then this is the program for you.
Use coupon code 'blog' for 20% off.
TLDR:
Vaginismus is completely treatable, and yes you can treat it at home with the right knowledge and resources. To be successful you need to have your goals clearly defined, a regular treatment schedule planned out weekly, people to support you, the right tools at your disposal (like dilators), and the ability to stay consistent.
An excellent resource to guide you through doing this at home, especially if you don't have access to in person therapy, is this online program built for exactly this purpose: to treat vaginismus at home. This program was built by a pelvic floor physical therapist with years of experiencing helping people conquer their painful sex and achieve their intimacy goals.
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things pelvic health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.