Vaginismus is a condition that affects the muscles of the pelvic floor and involves involuntary spasming or clenching of the pelvic musculature. Typically this reactive tightening of the muscles is in response to insertion or the attempt of insertion of an object into the vagina, making vaginal intercourse painful and sometimes impossible. Thankfully, this condition is becoming more and more recognized by the mainstream media. But coming along with it are some misconceptions about vaginismus that we'd like to clear up.
Kegels, done correctly, are a great strengthening technique for the muscles of the pelvic floor for many women and men. However, someone who is struggling with vaginismus is not a good candidate to begin practicing kegels. While kegels may be introduced later on to help the overall pelvic and core musculature function together during certain body movements, they should be avoided at first. The focus of treatment should instead be on the ability to consciously recognize and relax the pelvic floor muscles. It is best to receive this treatment under the direction of a specialized women's health physical therapist who can guide you through imagery and biofeedback techniques. Also, consider our physical therapy digital download chapter packages to assist you at home.
Dilators are an incredibly helpful tool for those with vaginismus. Their function in the treatment process, however, isn't so much to "stretch" the tight muscles of the pelvic floor. The pelvic floor muscles are already quite capable of stretching far beyond what is needed for sexual intercourse (think, delivering a baby). The problem with vaginismus is that the central nervous system (the brain and all its related systems including the spinal cord and nerves) is sending signals to the pelvic musculature to brace itself for what it considers or 'remembers' to be painful: vaginal penetration. So dilators work by desensitizing the central nervous system (see Myth #3 for more on this) and by providing trigger point release (intentional pressure to points of muscular tension for the relief of pain, much like in your neck or shoulders). To learn more about the science of chronic pelvic pain and the use of dilators in the treatment of vaginismus, purchase the DVD Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain. We recommend dilators from Syracuse Medical Devices as they are made of medical grade material and have a consistent length. It is important to have a long enough dilator to be able to reach the second layer of the pelvic floor musculature even with the smallest dilator in diameter.
If you continue doing as you have been doing - having sex that is painful, then setting yourself up in that same environment with your partner will actually perpetuate or re-enforce the pain - because your mind is already anticipating the pain - it is a known response and you cannot just "force" a relaxation response instead. But if we remove the “red flags” from the brain and place YOU IN CONTROL using the dilators, we can re-train the brain to realize that there doesn’t need to be a “fight or flight response”, we can begin to “unwind” the nervous system. When you start with an extra small dilator and can insert and move it and do self stretches with low to no pain - then the brain starts to realize that - OK - that wasn’t so bad and the secondary responses of muscular tensions ease also allowing for less pain and your overall confidence level with repeated successful sessions with the dilator allows you to become ready for return to intercourse with low to no pain. It is important that you abstain from intercourse (not intimacy) during dilator sessions until you can progress to the proper size. So essentially what happens is you change the perception in your brain about the health of your vagina, decreasing the sensitivity of your nervous system to keep the muscle tension in check to help achieve a good end result.
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.