Many IC patients are familiar with common things that can cause IC flares from diet to car rides. But, there are also some lesser known flare triggers that we need to be aware of like vaginismus. It’s something many women haven’t heard of, but it needs to at least be on the radar of IC patients. Understanding what vaginismus is, how its treated and how to manage the flare that it can cause is important.
What is vaginismus?
Vaginismus is a type of pelvic floor dysfunction. While general pelvic floor dysfunction results in too tight (or too loose) pelvic floor muscles all the time, vaginismus is different. Vaginismus occurs when the vaginal muscles involuntarily tighten in anticipation of penetration. This can occur with attempted penetration from a finger, tampon, penis or medical instrument.(1) Caused by involuntary muscle spasms, the muscle tightening can be a bit uncomfortable or very painful, depending on the patient and situation. Vaginismus often results in painful intercourse and pelvic exams.
An estimated 1 to 6% of women have been diagnosed with vaginismus, but many doctors think the condition is much more common and often unreported. Many women aren’t willing to talk about vaginal pain in relation to penetration with their medical care providers.(2)
Risk Factors
Vaginismus can occur at any age and any time. The symptoms may appear with the women’s first sexual encounter, the first time she tries to insert a tampon or her first pelvic exam. But, it can also start later in life. Nobody knows for sure what causes vaginismus, but we do know some common risk factors. Anxiety disorders, childbirth injuries (like vaginal tearing), prior surgery and fear of or negative feelings about sex are all risk factors.(1)
Having other pelvic pain conditions, such as pelvic floor dysfunction or IC, could also be a risk factor for vaginismus. If you are anxious about penetration causing a flare or hurting, then your vaginal muscles might be more likely to contract and tighten. Or if you are already dealing with pelvic pain, like from generalized pelvic floor dysfunction, IC, endometriosis or vulvodynia, then the nerves in your pelvis may be on overdrive and result in a reflexive muscle spasm.(3)
Diagnosis
Diagnosing begins with taking a medical history. Your medical care provider will want to know about your pain — when it started and what it feels like — along with other pertinent questions. Be as honest as possible about your experiences and pain, even if some of the questions and answers are embarrassing. A physical exam can then confirm the diagnosis. Your medical care provider will look for other causes of your symptoms to rule them out.
Your healthcare provider can do things to help make the physical exam more tolerable. Ask for him or her to apply a topical numbing cream outside of your vagina before the exam.(2) Examining for vaginismus does not require use of a speculum either, which is a relief to many women.(3) Be sure to ask about that ahead of time so you can be as relaxed as possible.
Treatment
A variety of treatment options are available to help with vaginismus. In fact, treatment success rates for vaginismus are a whopping 90%.(2) The treatment regime is not always the same for each woman and may take some trial and error. A combination of treatments is usually needed.
Desensitization
Using either vaginal dilators (or a finger) can help desensitize the nerves and muscles in the vaginal area. You use them at home and on your own, so you can relax as much as possible. Starting with the smallest dilator (they come in sets of four or five), insert it as far as it you can go until you start to feel pain. Then hold it in place for five minutes while taking slow, deep breaths to help relax your pelvic floor. Some women find vibrating dilators helpful. The goal is to perform these exercises daily in order to build muscle memory(3)
Physical Therapy
Pelvic floor physical therapy can also be helpful in treating vaginismus. If you are unable to tolerate insertion completely, the therapy should start externally and progress from there. Be sure to look for a physical therapist who specializes in the pelvic floor and is certified by the American Physical Therapy Association.(3) Check out the ICN’s Find A Provider page for help.
Psychotherapy
Seeing a counselor or therapist is an important part of treatment for vaginismus. It does not mean that the symptoms are all in your head but rather you may have some emotions you need to work through. Addressing any trauma, anxiety or relationship issues can help in treating vaginismus. Even if you don’t have any things to work through, you are still managing pain, which is a stressor. Having a trained professional to talk with and help you manage those feelings is important.(3)
Botox
Using Botox to treat vaginismus isn’t quite as common, but it can help relax vaginal muscles when injected under anesthesia. The effects wear off after 10 to 12 weeks, so it’s a therapy best used in conjunction with the other therapies in hopes that by the time the effects of Botox wear off, the vaginal muscles will be able to relax on their own.(3)
References:
- Cleveland Clinic. Vaginismus. Oct. 28, 2020.
- McRae M. Fast Facts: What You Need to Know About Vaginismus. Healthy Women. Nov. 15, 2021.
- Gunter J. The Vagina Bible. Piatkus. 2019.
