PFMT is a conservative intervention that can lead women to have less sexual dysfunction.
Considerations When You Have Vaginismus or Dyspareunia
If you are suffering from a sexual dysfunction such as vaginismus or dyspareunia, maintaining an optimal resting-length on your pelvic floor muscles is really important as pelvic floor dysfunction is a contributing factor. Conservative treatments for these conditions are generally multi-modal, meaning that you will undertake additional practices as well as pelvic floor muscle training. On this page, we will explore these treatments. You gynaecologist or pelvic floor physical therapist can help to decide which treatments are best for you.
Pelvic Floor Muscle Training (PFMT)
Traditional pelvic floor muscle training is one of the the primary non-surgical treatments for vaginismus and dyspareunia. PFMT involves exercising pelvic floor muscles to restore muscle strength and function. In the case of sexual dysfunction, the PFMT exercises are often focused on teaching the pelvic floor muscles to relax and on retraining pain receptors2.
The type of training you are offered will depend on the overall symptoms of your pelvic floor dysfunction and your symptoms. For example, if you have hypertonicity (typical with vaginismus), you will generally be offered only reverse Kegels and relaxation exercises. Otherwise, if suffering from hypotonicity (common with incontinence or pelvic organ prolapse), you will also be offered strengthening exercises.
Consistency and variation with is key. By performing the exercisers in varying positions and consistently practicing daily. You can sign up for our 30 day pelvic floor challenge to get an insight into what varied training looks like. Each video in the 30 day challenge includes strength exercises and relaxation exercises. You will find the timestamp for the relaxation exercises in the second half of each video. This is not intended to replace a proper assessment by your healthcare professional.
A Multimodal Program That Treated the Physical and Psychologic Aspects of Vaginismus Enabled Women to Achieve Pain-Free Intercourse
Dilation Therapy For Vaginismus
A key treatment for vaginismus (and occasionally for dyspareunia) is vaginal dilation therapy. A 2021 study found that there was a significant relationship between vaginismus grade and dilator requirement4. Dilation is usually offered in a stepwise approach based on the grade of vaginismus with fingers being used for the grades 1 to 3, progressing from baby finger only to using the middle and index fingers together. For more severe grades (4 & 5), medical grade dilators like those in the image are typically used to gradually encourage the relaxation of pelvic floor muscles.
As vaginismus is a protective response, the use of dilation can be seen as a method to communicate safety to the nervous system. When undergoing dilation therapy, you may be asked to perform self dilation first with your own fingers. If you are in a sexual relationship, you may be asked to bring your partner to your physiotherapy session and to have them assist with the dilation. Dilating with your partner also contribute to the communication of safety to your nervous system which can be a critical step in overcoming vaginismus.
When using dilators for therapy, you will typically begin with the size that feels comfortable for you, using the smallest if none are comfortable. There are two different methods that are suggested for dilation; 1. Leave in method – which you insert the dilator and allow yourself to relax. 2. Moving method – where you mimic penetration by moving the dilator in and out.
You can read our article on 5 steps to overcome vaginismus for some additional information on dilation.
Additional Conservative Treatments For Vaginismus and Dyspareunia
1. Manual Therapy
Physical therapists will often perform manual therapy to help reduce pain and tension within the pelvis. These therapies include myofascial release, trigger point therapy, massage, and scar tissue manipulation and they are performed in combination with pelvic floor muscle training and other physical therapies.
2. Cognitive Behavioural Therapy (CBT)
Sexual function involves both body and mind, therefore, when dysfunction is present, one of the primary treatments addresses your thoughts on in relation to your genitals and sex (amongst other things). Thoughts such as “this is going to hurt” or “my vagina is too small” can trigger a protective response from the nervous system which can exacerbate the symptoms of vaginismus and dyspareunia. Thoughts can stand in the way of relaxation, and relaxation is required in order to let go so orgasm can occur. CBT provides an opportunity to assess your thought patterns with a view to changing those thoughts that compound sexual dysfunction. This type of therapy addresses the mental aspects of sexual dysfunction and is generally combined with physiotherapy.
3. Psychological Therapy
Like CBT, psychological therapy is intended to treat the mental aspects associated with sexual dysfunction. This generally involves speaking with a psychologist to deal with issues that contribute to your mental health. By addressing mental health issues and past traumas, your mental state should improve and this can have a positive impact on sexual function. Again, this therapy would be combined with physiotherapy, which addresses the physical aspect of the condition.
4. Sex Therapy
Sex therapy is a psychological therapy specifically focused on sexual function. Whereas psychological therapy will address your general mental health, sex therapy focuses specifically on your mental health with regards to sex and sexuality. Like the other behavioural and psychological therapies, this therapy would generally be combined with physiotherapy in the treatment of sexual dysfunction.
Hormones (tablet or vaginal estrogen), anti-depression meds, anti-anxiety meds, pain meds and topical anaesthetics (such as lidocaine) are sometimes offered in the treatment of vaginismus and dyspareunia. Medications are not typically offered as a first line treatment but may be offered if your doctor feels they could be of benefit.
Explore the Types of Sexual Dysfunction
You may be interested in exploring the types sexual dysfunction. You can do that from here:
Treatment Options for Sexual Dysfunction
Having reviewed the conservative treatments for vaginismus and dyspareunia, you may be interested in reviewing the invasive treatments. You can do that by clicking the button below. If you did not find what you were looking for, you can search this site using the search bar at the bottom of the page.
- Franco MM, Pena CC, de Freitas LM, Antônio FI, Lara LAS, Ferreira CHJ. Pelvic Floor Muscle Training Effect in Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Med. 2021 Jul;18(7):1236-1244. doi: 10.1016/j.jsxm.2021.05.005. Epub 2021 Jun 27. PMID: 34187758.
- Sorensen J, Bautista KE, Lamvu G, Feranec J. Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus. 2018 Mar 27;10(3):e2379. doi: 10.7759/cureus.2379. PMID: 29805948; PMCID: PMC5969816.
- Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 2017 Jun;5(2):e114-e123. doi: 10.1016/j.esxm.2017.02.002. Epub 2017 Mar 28. PMID: 28363809; PMCID: PMC5440634.
- Kiremitli S, Kiremitli T. Examination of Treatment Duration, Treatment Success and Obstetric Results According to the Vaginismus Grades. Sex Med. 2021 Oct;9(5):100407. doi: 10.1016/j.esxm.2021.100407. Epub 2021 Aug 5. PMID: 34364175; PMCID: PMC8498957.