By Anita Vandenberg

Do you experience pain with sex or when inserting a tampon? Do you or your partner feel like you hit a wall when trying to enter your vagina, which can make intercourse feel impossible? Have you been told to just "relax" or "use more lube" to make sex happen? Maybe you were told it is normal because you just had a baby, or are peri-menopausal.

You are not alone and what you are experiencing is not in your head. You may have already shared this experience with your physician or other healthcare professionals and are looking for treatment options, or this may be something you have not felt comfortable talking about and wonder if there is help.

What you may be experiencing is called vaginisimus: the involuntary contraction or spasm of pelvic floor muscles that occurs with attempted penetration of the vagina. Provoked vestibulodynia (PVD) refers to pain in the vulva vestibule when touched or with attempted vaginal penetration. There are a number of physical and non-physical causes of vaginisimus/PVD. Physical causes can include frequent urinary tract or yeast infections, tearing or complications with childbirth or history of pelvic surgery. Non-physical causes can include fear or anticipation of pain with intercourse or stress from previous traumatic sexual experience. For some women it can be a combination of physical and non-physical causes or for others there is no physical or non-physical cause that can be found.

Treatment of both vaginisimus and PVD (some women experience both) has a high success rate with pelvic health physiotherapy, along with sex therapy. 

Pelvic health physiotherapists have specialized post-graduate training and certification in internal pelvic health assessment and treatment. A pelvic health physiotherapy assessment involves discussing your concerns, your goals, history of symptoms and medical history. We then look at your posture, how you breathe, the external muscles that attach into your pelvis, including your hip flexors, and assess the sensitivity of the nerves that supply the pelvis. It is important to release any tight external muscles prior to releasing internal muscles as they play a vital role in letting your pelvic floor muscles relax to allow for pain-free penetration. When you are ready for an assessment of your pelvic floor muscles, which involves palpation of the muscles at the opening of your vagina and inside your pelvis, your physiotherapist will talk you through the process and be sure you are comfortable at all times.

Pelvic Health Physiotherapy Treatment for painful sex involves: 

-   Education about your pelvic floor muscles, your condition and why it might be occurring;

-    Learning postures, breathing techniques and various relaxation strategies to help release muscles and relax your nervous system;

-    Internal pelvic floor manual connective tissue release;

-    Eventually using dilators to help with vaginal accommodation.

While physiotherapists work with the physical side of vaginisimus/PVD it is important to also address the fear, anxiety and/or stress that often accompany vaginisimus/PVD, as some women begin to avoid sex and may have difficulties discussing these feelings with their partners. Sex therapists are experts in this area and can work with you through these feelings to help you fully recover and achieve your goals, including a healthy, enjoyable sex life.

At PhysioExcellence, all physiotherapists are certified in pelvic health physiotherapy and we are passionate about helping you regain control over your pelvic pain and accomplish your goals. With your consent, we can work closely with the rest of your health team including physician, specialists, massage therapist, and sex therapist to have your progress be as efficient as possible. If you do not have a team of health professionals we are happy to recommend others who can help in achieving your goals alongside your physiotherapy program.

By: Anita Vandenberg, MSc(PT), BKin(Hon), PMA(R)-CPT

Registered Physiotherapist -Pelvic Health & Orthopaedic

Certified Pilates Instructor

Certified in Acupuncture/Dry Needling

Photo Copyright: / 123RF Stock Photo