What happens if a glass of wine is not able to FIX your lady parts!!

“Everything looks might be too much in your head about it.. Just take a few deep breaths ..have a glass of wine and RELAX.” Sarah started sobbing with frustration as she narrated the “medical advice” she received from her provider. Sarah felt dismissed, felt that her problem was not real and all she needed to do was relax down there but…. HOW?

We ought to ask ourselves - When in the history of time has anyone relaxed by telling them to relax? If a few deep breaths is all it took...wouldn't it be intuitive for folks to try that on their own?

Sarah kind of thought the same and went on to a search mission on social media. She stumbled upon Instagram posts about vaginismus and it felt like they were talking about her vagina! She could relate to the pain with vaginal insertion, she had experienced the fear of gyno appointments, the sight speculums made her feel tense, she knew exactly what it meant when “it just won’t go in!”.. she always awkwardly ended her dates before anything got “physical”... Sarah felt validated..felt that she was not the only one dealing with this and most importantly Sarah felt hope !

This story unfortunately is not a rare occurrence. Women dealing with vaginismus often struggle with finding medical help. Vaginismus is an involuntary spasm of the vaginal canal that makes it painful, difficult and sometimes impossible to insert any object inside the vagina. In the USA as many as 21% women reported genital pain with sex. In other parts of the world the number was found to be as high as 54% and yet most women suffer in silence. This is perhaps due to shame, gender superiority and cultural taboos around vaginal health. Vagina is hardly a dinner table conversation and sexual health can often be neglected as a part of overall health. Talking to someone about a private parts issue can be challenging. It is hard to find doctors that specifically treat genital pain issues and sadly many women get dismissed by healthcare providers. Some find a set of vaginal dilators and figure out what to do with them and a handful get referred to pelvic floor physiotherapy.

Pelvic floor physios can help with “down-there” problems!!

Physical therapists are movement experts, the neuromusculoskeletal system is our thing! Our pelvic bowl … the thing that allows us to twerk has muscles at the bottom. Pelvic muscles are like muscular underwear holding precious cargo inside the body. The muscles in and around the vagina relax, lengthen and allow the vagina to expand to allow penetration, accommodate speculums and tampons and so on! If there is something going wrong in that process one may experience difficulty, pain or total inability to allow anything inside the vagina.

If the vagina is dealing with an infection, irritation or other challenges it is likely to cause pain. When we experience fear or pain these muscles automatically clench and close the vagina. Powering through the pain, increases the perceived threat which then might lead to a stronger clench. This gets us stuck in a loop of pain and spasm and more pain and more spasm. Our brain has one main job of avoiding pain… physical pain from an injured tissue, emotional pain from the past experiences and in all events it has only one reaction..clench!! Over time this excessive squeezing can lead to pelvic muscles that are tight, tender and have trouble relaxing. Physical Therapists working in pelvic health can help you navigate these challenges.

But WHY????

That is the most important question ! Solution to any problem starts with finding the root cause. Vaginismus is not any different. There are several causes of vaginal pain and spasm.

Sometimes the root cause can be easily identifiable like a medical problem with a well established treatment and other times we can’t find the root cause. Understably the latter is frustrating and tends to take a longer route in the process of diagnostics. . Medical management by a physician is essential to sift through all the different things contributing to your symptoms. Getting a clean bill of health for the tissues can be reassuring in this process. Your doctors will help you manage infections, hormones and other issues in the vaginal tissue.

But what if the issue is NOT in the tissue..

Our brain lives inside our body and our body lives inside our world. They interact and influence each other and shape our overall health including sexual health. Holistic management of genital pain demands a biopsychosocial approach just like everywhere else in healthcare. The bio piece of the puzzle is dealt with by the physicians like a gynecologist, urogynecologist and such. Psychotherapist specifically sex therapist can help with navigating psychological health part of these struggles. And ofcourse the muscular piece .. find a skilled pelvic floor physical therapist and now you have your dream team ! At a muscular level Pelvic floor rehabilitation provider might empower you with musculoskeletal tools to break away from the pain-spasm cycle. Research in support of Pelvic floor physical therapy is an effective non-invasive option for neuromuscular issues of the pelvic floor.

Navigating vaginismus is hard … and here are 3 things I tell all my patients dealing with vaginismus.

it can get to your head but it is NOT in your head!!

It can get better takes work but it can work !!

Team work makes the dream work.So find your 3Ps - Physician , Pelvic PT and Psycho/ sex therapist

Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014 Oct 1;90(7):465-70. PMID: 25369624.

Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019 Dec;31(6):485-493. doi: 10.1097/GCO.0000000000000584. PMID: 31609735.

Liu M, Juravic M, Mazza G, Krychman ML. Vaginal Dilators: Issues and Answers. Sex Med Rev. 2021 Apr;9(2):212-220. doi: 10.1016/j.sxmr.2019.11.005. Epub 2020 Jan 31. PMID: 32014450.

Ghaderi F, Bastani P, Hajebrahimi S, Jafarabadi MA, Berghmans B. Pelvic floor rehabilitation in the treatment of women with dyspareunia

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