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  • Christine MacMillan, PT

The Truth About Vaginismus


Vaginismus is a treatable condition where vaginal penetration is not possible due to extreme spasm and contraction of the muscles that surround the vagina (aka the pelvic floor muscles). Usually, attempts at penetration – whether during sexual activity, or with a tampon or a finger – are painful and there is a feeling of a complete blockage.


Vaginismus can develop after having been previously able to have vaginal penetration, and in this scenario often develops following a painful vaginal experience like a difficult vaginal delivery, a surgery, or a negative or painful sexual experience.

For other people, there is no inciting incident at all, and they encounter this painful spasm at their very first attempt to penetrate the vagina (during their first attempt at sexual intercourse or when trying to insert a tampon for the first time).


It is not well understood why some people develop vaginismus and others do not. One explanation is that the spasm is a protective reflex to what is consciously or subconsciously perceived as threatening. The body reacts - without thinking - to block the perceived threat of penetration. This reflexive spasm can be compared to the reflex of blinking when something approaches the face quickly – without any time to consciously decide to close your eyes, your body does it automatically. In a similar way, the pelvic floor muscles contract without your conscious control, to “protect” the pelvis. But importantly, just as you can consciously stop yourself from blinking, you can also learn to consciously control your pelvic floor muscles and stop the spasms from happening.


So how does pelvic physiotherapy help?


We know that the source of the “block” is muscular in nature, and the wonderful thing about muscles is that they are trainable. Physiotherapy is first and foremost aimed at developing more awareness and control of this muscle activity. The goal of physiotherapy is NOT to simply stretch the vagina, because vaginismus is not simply a problem of tight muscles. The goal is to develop the control needed to override your body’s protective response and decrease the amount of spasm in the pelvic floor.


The mind also has a big role in vaginismus, as there is a direct “line of communication” between the thoughts we have and the activity in the pelvic floor. Consider how a dog responds to fear by tucking its tail between its legs. This is similar to what happens in humans – our bodies respond to “threat”. (i.e. fear, anxiety, stress, worry) with an automatic tightening of the pelvic floor, pulling our tailbone between our legs. This is part of our “fight or flight” response and is meant to help ready us for action.


If you suspect you might be suffering from vaginismus, consider booking an assessment with a pelvic health physiotherapist who can assess your pelvic floor and get you started on a path to recovery. Vaginismus can be very distressing and often leaves people feeling hopeless. But rest assured, there is so much you can do to retrain your body and take back your sexual health. As always, if you would like to reach out to me for more information, email me at cmacmillanpt@gmail.com or come work with me at Cooper Physiotherapy Clinic in Ottawa.

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