If you’re experiencing pelvic pain, the first thing to know is that you’re not alone. Vaginismus—a type of pelvic pain—can feel isolating and confusing. Many people (including some doctors) have never heard of vaginismus. Fortunately, there are health professionals out there who can help you treat it.
Vaginismus is a condition where the vaginal muscles are so tight that penetration is painful. With vaginismus, the brain and body are caught in a negative cycle. The brain expects penetration to be painful, so the vaginal muscles tighten to “guard” against pain. Because the muscles are tight, penetration is more painful.
For people who have always experienced vaginismus, it’s called primary pelvic pain. For people with primary pelvic pain, it may have always been painful to insert a tampon, complete a pelvic exam, or have penetrative intercourse. I recommend the animated video Tightly Wound for a first-person account of what it’s like to experience primary pelvic pain. Fair warning, it’s not the cheeriest video. However, if you have struggled for years with vaginismus it could help you feel less isolated.
If someone lived for years without vaginismus and developed it later in life, it’s called secondary pelvic pain. Pain may have been brought on by stress, trauma, relationship concerns, or a physical condition. If you’re looking for a first-person account of living with secondary pelvic pain, I recommend the “Sex Hurts” episode from the Bodies podcast.
If you’re experiencing pain with vaginal penetration, see a doctor to get a medical examination and diagnosis. You can call the doctor’s office ahead of time to see if they have experience working with pelvic pain. There are medications that can help, but those might not be the first line of treatment. If you’re diagnosed with vaginismus, the doctor will probably recommend pelvic physical therapy before medication.
Pelvic physical therapy alone might help resolve vaginismus. The PT might recommend stretches, breathing exercises, or dilators. Dilators are a series of phallic devices which are inserted into the vagina. Treatment starts with a small dilator size. Patients insert the dilator and breathe deeply, trying to relax the vaginal muscles. Over time, the vaginal muscles can become accustomed to the sensation of the dilator. Once the patient can insert a dilator without pain, they can work up to a larger dilator size.
Pelvic physical therapy in conjunction with talk therapy can be helpful, which is one of the reasons I decided to rent office space from a Grace Pelvic Health, a pelvic physical therapy practice in Durham. If pelvic physical therapy alone isn’t helping you achieve your goals, trying talk therapy might help.
In our culture, it’s common for people to have anxiety, shame, and guilt about sex. Trauma, sexual stigma, and relationship concerns can all contribute to pelvic pain. Does it feel safe to have sex? Do you like your body? Do you feel like a sexual person? Sex therapy is a place where you can speak about topics that are often taboo.
It’s very common for pelvic pain and low libido to go hand-in-hand. Some people start experiencing low libido and then sex becomes painful. For others, sex becomes painful and that reduces their libido. If you’re experiencing low-libido, all sexual activities (even non-penetrative ones like oral sex) might be unappealing.
Pelvic pain can be a response to sexual trauma. However, there’s a common misconception that pelvic pain is always caused by sexual trauma. For people who experience vaginismus due to something like general life stress, it can be frustrating to have people (such as doctors) assume that this is reason for your pain. Know that whatever the cause of your pain (even you don’t know the cause), you’re not alone.
This post should not be substituted for medical care from qualified health professionals.