‘Breaking down the Walls’ of Vaginismus – Part II: Management

By: Angelique Montano-Bresolin, PT

Persistent pain associated with vaginismus is often not associated with actual tissue damage. We are often dealing with high tension in the muscles, but the tissues are not damaged, rather, they are just not functioning and responding as we would like them to.

What’s important to note is that:

  • All pain is real and your pain will be influenced by your past experiences and many factors including: biological, psychological and social.
  • Pain is meant to protect us from harm or get us out of harm’s way. But sometimes when exposed to persistent pain experiences, our body can do ‘too good a job’ of protecting us, and so it ends up overprotecting us. It does this by outputting more pain, even when it is not needed or even when there is no damage to our tissues.

There are strategies that can be used to overcome the body's over-protection, so let’s chat now about some of these options.

Strategies to help overcome vaginismus:

It is important to take into account all the possible factors that could be playing a role in the presentation of vaginismus, and sometimes this involves more than just the physical factor of muscle tension or spasm. But first let’s start with this component as it is often a big piece to progressing towards pain-free intercourse or sexual play.

Treating the Biological & Physical Factors of Vaginismus

Vaginismus is characterized by sensitivity and tension in the vaginal muscles so part of treating this is to slowly minimize the resistance in these muscles. This can be targeted by the use of breathing and relaxation techniques to help optimize pelvic floor muscle relaxation, stretches and lengthening exercises for the muscles surrounding and attaching to the bones of the pelvis, as well as the use of vaginal dilators. There are various types of dilators on the market and we offer some of these options. You can go to our products section to learn more about Inspire dilators and Dr. Berman dilator sets

It is best to get some individualized guidance to using the dilators and this is best done with a pelvic floor physiotherapist or a gynaecologist that is well versed in treating vaginismus. But should you decide to try this on your own, consider the information provided in our ‘Dilator DIY Guide’ to assist you through the use of dilators. Our Dilator DIY Guide is FREE with a purchase of any dilator set on our website.

Treating the Psychological and Social Factors involved in vaginismus

Not every person out there will have significant psychological and social factors influencing their pain but it is prevalent enough for us to discuss here. When I speak of psychological factors some examples of this may include:

-what are our thoughts and beliefs around sex/intercourse?

-do you have positive/negative feelings about sex?

-what is your understanding of pain and vaginismus?

-what are your predictions of what will happen with you and vaginismus?

Studies have found that having a good understanding of pain and the physiology of it can help to decrease one’s overall experience of pain1. Hand in hand with this is what I mentioned in Part I - about positive/negative feelings & thoughts and how this can influence pain intensity as well as pain duration. As you can see it is very important to take into consideration these factors and not just the physical ones.

Lastly, when I speak of social factors I am talking about your individual environment. This includes aspects such as:

-your relationship with your partner, family, friends and colleagues

-your ability to access care if you need it

-your community, culture, traditions and their expectations

-society at large 

You can probably understand how having good or ‘not-so-good’ relationships in your life can act as a positive or negative influence on your recovery from vaginismus. For example, having a boss (or intimate partner) that is constantly yelling or putting you down is likely not going to contribute to decreasing stress and tension in your body! Also, being immersed in a culture that sees sex as ‘bad’ or ‘not permitted until after marriage’ can really create a cognitive dissonance (if this is not your belief) that will affect how your body responds when exposed to these situations.

As you can see, vaginismus can be a bit of a puzzle to solve but once you take a look at all the moving parts; breaking down the walls of vaginismus can take time but it is certainly possible and do-able. With the help of dilators, being honest and introspective with your experiences, seeing a pelvic floor physiotherapist and improving your understanding and relationship with pain, you can eventually overcome the barriers and factors at play with vaginismus.



  1. https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475

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