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Vaginismus: Understanding Symptoms, Treatment Options, and the Transformative Role of Pelvic PT with Manual Techniques

Updated: Feb 22


COPE PT pelvic PT vaginismus

Vaginismus is a complex and often distressing condition that affects women, causing involuntary muscle spasms in the pelvic floor, particularly around the vaginal area (the perineal & levator ani muscles, specifically). In this detailed blog, we will explore the causes, symptoms, and various treatment options for vaginismus, with a specific focus on the transformative impact of Pelvic Physical Therapy (PT) employing manual therapy techniques.


Women experience vaginismus for different reasons and realize it with different activities. Some women say that when they use a tampon, it feels like the tampon is hitting a wall. Some women experience vaginismus when going for their gynecological exam, and the use of a speculum is extremely painful. For others, penetrative intercourse nearly impossible due to pain.


These issue can impacts your ability to engage in preferred activities, impacts your access to necessary healthcare, and may put a strain on your quality of life.


But you are not alone and it is not all in you head... ask for help!


Fortunately, physical therapy is a common treatment for vaginismus at COPE PT.


COPE PT pelvic PT vaginismus

The clinching of vaginal muscles is not unlike tightening the muscles of your hand. When you clinch the muscles of your hand, you make a fist; when you clinch the perineal and levator ani muscles, you close the opening of the vagina. Just like you can’t hold anything once your fist is closed, insertion into your vagina is painful, if not impossible, while your pelvic floor muscles are clinched.


Vaginismus is an involuntary contraction of the pelvic floor muscles. Releasing the muscles of your pelvic floor is not as easy as just opening your hand. When you have vaginismus, you can be taught to release the muscles of your pelvic floor, but it takes a little work and usually requires some feedback from a pelvic floor physical therapist.


I. Causes of Vaginismus:

Understanding the root causes of vaginismus is crucial for tailoring effective treatment plans. Some common causes include:

Psychological Factors:

  • Anxiety related to past traumatic experiences, such as sexual abuse or difficult childbirth.

  • Fear of pain associated with penetration, often exacerbated by societal or cultural influences

Physical Factors:

  • Infections or medical conditions affecting the pelvic area.

  • Hormonal imbalances and certain medications contributing to muscle tension.


II. Symptoms of Vaginismus:

Recognizing the symptoms of vaginismus is essential for early intervention. Symptoms may manifest in various ways:

Painful Penetration:

  • Pain or discomfort during attempts at vaginal penetration, including sexual intercourse or the insertion of tampons.

Muscle Tightness:

  • Involuntary contraction or spasm of pelvic floor muscles.

  • Difficulty relaxing the pelvic muscles voluntarily.

Psychological Impact:

  • Anxiety and emotional distress related to the fear of pain during intimacy.

  • Strain on personal relationships due to sexual difficulties.


III. Treatment Options for Vaginismus:

Effective treatment for vaginismus involves a comprehensive approach. Various treatment options include:

Psychotherapy:

  • Cognitive-behavioral therapy (CBT) to address psychological factors.

  • Counseling to explore and manage emotional aspects.

Medical Interventions:

  • Topical anesthetics for pain reduction during penetration.

  • Botox injections to temporarily relax pelvic muscles.

Pelvic Physical Therapy (PPT):

  • Manual therapy techniques, including soft tissue mobilization and myofascial release.

  • Biofeedback to enhance awareness and control of pelvic floor muscles.

  • Therapeutic exercises for improved muscle flexibility.

Gradual Desensitization:

  • Step-by-step exposure to vaginal penetration using dilators or graduated exercises.


IV. Pelvic Physical Therapy and Manual Techniques:

The beautiful thing about our muscles is that they all work in the same way. Just as they tighten, they can be lengthened to release. And when you need treatment for vaginismus, you need that pelvic floor relaxation. The pelvic floor physical therapists at COPE PT are trained to teach you to relax and release the muscles of your pelvic floor.

Pelvic Physical Therapy, particularly when incorporating manual therapy techniques, has shown remarkable success in managing vaginismus, manual muscle manipulations are one of the most important aspects of reducing pain in the treatment of your vaginismus.:

Soft Tissue Mobilization:

  • Skilled therapists use hands-on techniques to release tension in the muscles surrounding the vagina.

  • Gentle massage and stretching help alleviate muscle tightness and improve flexibility.

Myofascial Release:

  • Targeted release of tension in the fascia, the connective tissue that surrounds muscles.

  • Promotes relaxation and improved function of the pelvic floor muscles.

Trigger Point Release:

  • Identifying and releasing specific trigger points in the pelvic floor muscles.

  • Relieves localized tension and discomfort.

Patient Education:

  • Empowering patients with knowledge about their pelvic anatomy and the role of muscles in vaginismus.

  • Providing tools for self-care and ongoing management such as dilators, ohnut and pelvic wands.





Vaginismus is a challenging condition, but with a tailored treatment plan that includes Pelvic Physical Therapy and manual techniques, there is hope for relief and improved quality of life. Manual therapy, in conjunction with other therapeutic approaches, addresses the physical and psychological aspects of vaginismus, promoting relaxation, flexibility, and enhanced control over pelvic floor muscles. If you or someone you know is grappling with vaginismus, consider consulting with a qualified healthcare professional, such as a pelvic physical therapist, for personalized guidance and support on the journey to overcoming this condition.


Schedule your appointment today, you are not alone.



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