Undoubtedly, one of the conditions I am most passionate about treating  is vaginismus. I wish I could scream it out loud: THERE'S HELP AND HOPE with the right treatment! I promise.  I have seen so many women  who suffer in silence for many years and finally get the help they need. They often share their frustrations of feeling isolated and alone in dealing with this. Often times, they don't attempt to have sexual relationships or end up losing relationships.  These women often share that they  also don't always participate in activities because they can't use tampons or  menstrual cups. 

What is Vaginismus?  
Vaginismus is characterized by fear, pain and vaginal spasm in anticipation of gyn exam, tampon or menstrual cup insertion, or vaginal penetration with sexual activity (finger, toys, penis). They typical definition describes vaginal muscles (pelvic floor muscles) that involuntarily or persistently contract when women attempt vaginal penetration. The condition can be caused by physical or psychological factors or a combination.  Some describe vaginismus and the reaction of the pelvic  floor muscles as a similar response to when  an object is brought close to someone's eye and there's a reflexive blink and  protection/closure.  

Primary vaginismus usually refers to the experience of vaginismus with first-time intercourse or other vaginal penetrative attempts.  Secondary vaginismus usually refers to the experience of developing vaginismus a little later in life, after a period of pain-free intercourse, gyn exams or tampon insertion.  This can relate to changes after  giving birth, medical conditions that may have even resolved, trauma or abuse, surgery, or having painful  penetration (dyspareunia)  for years that has now  transitioned to  a full vaginismus response. 

How  prevalent is it?  
Reports vary widely because many women don't share they have this treatable condition and suffer in silence. It  ranges from 1 in 1,000 to 16 in 100 women. 

What  types of treatments are available? 
The most important first step is to find  a healthcare provider (GYN specialist, UroGynecologist, or a Pelvic PT) who regularly sees patients with  pelvic pain conditions and vaginismus. Believe it or not, many  OB/GYNs do  not get specialized training in this area.  

In some cases, women still have  hymenal tissue that is completely or partially blocking the entrance to the vagina. I have had many patient cases over the years where the issue was not about the vaginal pelvic floor muscles or pyschological, but a true  block from hymenal tissue (sometimes hidden and farther back than  the entrance).  The treatment may include a very minor procedure (hymenectomy) to  cut some of that tissue away.  There are also  other medical conditions or hormonal deficiencies that should be considered as well. 

Once other medical conditions are ruled out, the ideal treatment  for vaginismus is  specialized pelvic physical therapy. That's what we do!  This is done in a private room and only one on one with someone who completely understands how to address this condition.  In some cases, it  may benefit you to  also see a counselor  who understands  how to address pain and anxiety, as this combination of treatment works very well. 

During pelvic physical  therapy sessions, we assess you as a whole person, not simply  as having vaginismus.  We  want to know about your experience and journey with this first.  There's no rush with examinations.  We  make a plan based on your current status and what your individual goals are.  Your primary goal may only be to have a  GYN exam for the first time, while other women who have been married for years may want to  have penetrative sexual activity for the first time.  We  provide treatments in the clinic (sometimes only 2-6 visits are needed) and also create a home program  for you to do that may include vaginal dilators.  Some women try vaginal dilators at home on their own, which may be enough. We often find that combining the full  range of therapies and home management recommendations  is usually much more effective.  In some cases,  you may also benefit from medications or topical creams  provided by a physician as well. 

We will be happy to share any other information  you'd like about what to expect during treatments. 

Is it ever too late to seek treatment?  
No.  Though  this may start early in life, we  see women  in their 40s-60s who finally decided to get help for this. It's never too late.  We encourage you to  reach out early if you can  (even in your teens). If any health provider tells you "it's just in your head" or " just relax more" or "drink wine," look for a new one.  We hear this all too often and it is not helpful advice. 

​What if I've tried treatment and it hasn't worked in the past? 
There's  not an exact standard of care for the treatment of vaginismus.  Over the years, I've heard  patients share all sorts of stories about  treatments and "potions" they  received. Many of our patients have seen 10-15 healthcare providers before finding us. The most important piece of advice is  DON'T GIVE UP.  There's hope and there are people who can help you.  (Refer to the directory below for healthcare providers in your area).

Here's an article I wrote that explains ways  that physical therapy and dilators can help.  Physical Therapy and Dilators. What's the  Connection?    ~ Tracy Sher

Some  more information and resources for you:

Vaginal Dilator Guide for Patients.  Pain, Fear,  and Anxiety

Vaginismus  Website  - How Many Women Have Vaginismus?

​Listing of Pelvic Health Professionals All Over the World. Ultimate Directory.

According to the 2016 study (and previous studies) on postnatal pelvic girdle pain, Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study  , women with pain activate muscles differently.  There's help for this! 

The important findings are: 
During the subsequent ipsilateral leg lift (lifting  the  leg  on the same side as the painful  pelvic region):
* pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women
*Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles and the muscles of the lower lateral abdominal wall

 We know from previous studies (one of many) that  there are many prognostic factors that  can relate to  persistent pelvic girdle pain  such as  age, muscle function, disability, and previous  fitness level/pain  levels . What  does this all mean for patients ? How  can we help  those of you who are dealing with lumbar and pelvic pain , even years after having a  baby? 

The key is to address  each patient individually. There are numerous layers to  the pain experience  - beyond just the location of pain.  It  is likely also simplistic and  erroneous to assume that the pelvis is  "too unstable" or that the  sacroiliac joint  is just hypermobile  (there are certainly cases of  people who have hypermobility as a component such as with Ehler's Danlos Syndrome, but even then, there are other factors). If you find that you have been seeing other healthcare professionals for years telling you that your leg, sacroiliac joint, or pelvis keeps going "out," that's likely not the issue.   From a whole-person perspective, there are  factors to consider such as hormonal, physical, sleep/lifestyle, social, and psychological (not "it's-in-your-head type, but rather effects of anxiety, stress, previous pain, or previous trauma, etc) .  Therefore,  addressing  these factors AND  taking a closer look at  the  pre-activation/motor control of the muscles and general movement patterns  is  an ideal approach.  

If you are a patient dealing with  pelvic  girdle pain,  sacroiliac joint pain, lower back pain  after having a baby (even years later), there's a  lot of hope for getting better!  A pelvic physical therapist  can assess you individually to  facilitate the best plan for your daily life and also provide an optimal exercise plan to  guide you to relatively pain-free  movements! This goes beyond simply giving a list of exercises and  saying good luck!  That's why so many women continue to have pain for years later.  We can also work closely with your pregnancy /postpartum specialists  - there are some incredible ones out there too. 

For professionals - The key is how do we improve/facilitate the proposed disturbed motor activation patterns that influence women's ability to stabilize the pelvis during leg? How much do we train "pre-activation?"
There seem to be distinct professional views: 1. Some say just get patients moving in pain-free ways and this will help with improving neural/motor activation and don't focus on pre-activation and minutia; or 2. Others focus heavily on individual "pre-activation," movement patterns, segmental/"core" strengthening. Couldn't it be the case that we include both of these strategies (and individualize as needed) - not so much thinking we are increasing strength, but rather improving motor patterns and activation on a neural level? 

Another consideration:  EMG testing can be subpar for understanding the underlying issue regarding muscle activation. In other words, patients may not be pre-activating pelvic floor as a result of shortening of the muscles rather than simply not activating due to weakness or other. Therefore, just working on activating the pelvic floor prior to an activity, may not be the best treatment. We still have to look at each individual and assess  all of the  variables.
**  Did you know that Tracy Sher, MPT, CSCS and Alma Bautista, SPT,  at Sher Pelvic Health are both Certified MuTu  Pros™ in  postnatal fitness?  Minal Saraf, MSPT also specializes in  Pelvic PT for pregnancy/postnatal.