Vaginismus and painful sex symptoms have physical and psychosexual components, which is why in this vaginismus blog series, we are focusing on the pelvic floor muscles. The pelvic floor surrounds the vagina and is responsible for the movement of the whole pelvic area.

As you read, hopefully, you will begin to understand that the pelvic floor muscles have many functions and are very emotionally responsive. They also play an important role in the four stages of the female sexual response cycle. Deepening awareness of your mind-body connection and reducing tension and stress in the body will have an impact on this muscle group.

You could consider working with a pelvic physiotherapist as part of a holistic treatment approach if you experience any symptoms of vaginismus. If this feels out of your comfort zone right now, that is 100% okay! Consider putting that on a long-term goal list and focus on what feels right for you – right now. Many of my clients who feel mentally blocked in some way start psychosexual therapy and use it to work towards more practical and physical interventions like specialist pelvic physiotherapy.

I have included in this article an image of the female pelvic anatomy and the reproductive system so that you can see for yourself what the pelvic floor region actually looks like. It may help you to identify the areas related to vaginismus better visually.

In this vaginismus blog series article, specialist pelvic physiotherapist Lorraine Boyce, aka The Down Below Physio tells us about what she loves about being a women’s health physiotherapist. She answers some common questions you may interested in about the connection between the pelvic floor, sexual pain and vaginismus.

Lorraine, what conditions do specialist pelvic physiotherapists treat?

Many people associate pelvic physiotherapy with someone who mainly works with incontinence, prolapse, pregnancy and postnatal conditions but it is much more varied than that! We do also assess and treat common conditions such as pelvic pain, sexual pain, sexual dysfunction including vaginismus, and pelvic muscle tightness.

Pelvic pain and painful sex affect so many women, including younger women who have not yet had children and older women; physiotherapy can benefit any of these women.

The pelvic floor muscles are very emotionally responsive muscles, reacting and reactive to stress and anxiety. When there is stress in the body, there will be linked stress in the pelvic muscles, and everything is interconnected.

Thanks to increased awareness of women’s sexual health, the influence of social media, and content like The Vaginismus Blog Series and the LIVE webinars I host online, women are being made more aware of the variety of conditions that can be treated, such as pelvic dysfunction, sexual pain, vaginal dryness, menopausal symptoms, and any condition affecting the vulva, vagina and pelvic floor.

‘The pelvic floor muscles are very emotionally responsive muscles, reacting and reactive to stress and anxiety. When there is stress in the body, there will be linked stress in the pelvic muscles – everything is interconnected.‘

About Lorraine and her passion

I became a pelvic health physio after years of being a general musculoskeletal physio, then went on to do pelvic health and enjoyed this field. I’ve always been interested in alternative therapies, and my postgraduate degree was in traditional Chinese medicine and acupuncture, so I have always been interested in exercise therapy and alternative therapies in general. I found that pelvic health physiotherapy brings together all these elements because it requires a comprehensive approach to many pelvic health complaints.

Very often, with pelvic pain conditions such as those relating to vaginismus symptoms, there’s an element of tension and anxiety, also the nervous system can be quite heightened, so I draw on a lot of these aspects as part of my whole treatment approach, it is a holistic approach.

I bring relaxation training, mindfulness, and breathwork into treatment and management plans for the best outcome for my clients.

Over the years, I have gained much training and experience in the area of pelvic health, including, more recently, Hormonal Health Training. The more practice and learning I do, the more I love this work; it brings me joy to have found my passion in this field and bring everything together for my clients.

Tell us how women with vaginismus symptoms and sexual pain can benefit from understanding more about their pelvic floor muscles:

When you have pain, such as penetration pain or any painful condition, you often don’t know what is going on. This unknown can make the pain seem worse because you feel you have no control over it, where it is coming from and how long it will be there. Understanding the anatomy and physiology of the region helps women to manage these concerns better.  

You might like to read... [Starting Specialist Pelvic Physiotherapy for Vaginismus with Vie Physio]

During sessions, I go through anatomy and physiology in various ways, including using 3D videos online with a pelvic model. This helps my patients to identify and understand the potential source of discomfort, thus giving them a sense of relief and peace of mind. There is so much value for women to gain knowledge and awareness about how their body works and how the pelvic muscles, vulva and vagina are interconnected. When women are informed, they feel more in control.

Clients often leave my clinic after their first appointments, saying that they feel so much better having talked for the hour session with someone who then explains in simple, straightforward terms what may be happening for them. They leave feeling more in control and with practical tasks to do at home and a management plan to start addressing the pain. It feels easier to manage symptoms, knowing their pain will not be an endless unknown pain now that they understand their bodies better.

Looking at the bigger picture

I often explain to my clients that while the pain might be at the vaginal area, we must also look at what is also happening at the tailbone and low back, the glutes, the inner thigh muscles, the abdominal muscles, the neck and also the shoulders. All these areas feed into the pelvic floor area, so we assess the bigger picture.

For example, if you have very tight hamstrings, it would take a while to gradually get them massaged, stretch them and figure out the reasons why the hamstring muscles are compensating and holding so much tightness, addressing possible hip strength also so that the hamstring can let go.

The pelvic floor muscles, including the vaginal muscles, are the same as anywhere else in the body. It can take a while to unravel the pattern of what is happening and tease apart all the factors and then work to reduce tension and hypertension.

Women with vaginismus often describe a brick wall sensation during intimacy or pain, discomfort and intolerable symptoms related to penetration and tampon use. What role do the pelvic floor muscles have in these symptoms and sensations?

In many ways, the body has a built-in protective response happening within us, including in the pelvic floor muscles. There are many reasons why someone may experience sexual pain and discomfort, and this can be because of this muscle group.

Women often tense and hold the pelvic floor muscles and the back passage sphincter muscles tight throughout the day. Tensing these pelvic floor muscles, which include the vaginal muscles, can be an unconscious strategy to deal with stress, anxiety and busyness. In the same way, people tense up their shoulders when they’re stressed and anxious.

Tight pelvic floor muscles can also be the nervous system going into protective mode due to trauma, pain, or to prevent access to the vagina area, making this muscle group go into protective overdrive. In some situations, this response is functional and does serve a purpose – but only sometimes. We can reset them, reset the nervous system response, and encourage these muscles to relax and release again.

Awareness is the first step. If you hold a lot of tension and tightness in the body or pelvic region, learn to develop an awareness of where this is happening and then focus on how to relax that area when you become aware of the response.

You can use breathing techniques and breathwork to relax the tummy muscles, pelvic muscles and general tension in the body throughout the day.

Also, leave aside time for yourself during the day to wind down your nervous system so that you are not always on the go and never get time to calm down and relax the muscles. There is a lot of potential to release restriction and pain in these pelvic floor muscles. It does take time for definite and doesn’t happen overnight that these pelvic muscles relax, which is where pelvic physiotherapy is beneficial.

Signs the pelvic floor muscles are tense;

Several signs suggest tension in the pelvic floor muscles and that they are not relaxing fully. Essentially, you might have pain in the vaginal and vulvar area, in the back passage or the coccyx area; this can present as back aching pain, throbbing pain or sharp and tense pain, especially with contact associated with trying to insert a tampon, penetration or having a smear test.

• Pain and penetration issues such as having penetrative sex, feeling blocked completely or if penetration can occur, feeling restricted, and taking lots of time to feel more comfortable.
• Difficulty and pain with using tampons, dilators and having smear tests.
• Feeling like you have overactive bladder symptoms, experiencing frequency and urgency when you need to urinate, a sensation to urinate comes on suddenly.
• Difficulty emptying the bowel, constipation or just difficulty passing a bowel movement, or a feeling that the bladder or the bowel isn’t entirely empty.

What are other physical signs of tension in the body that could signify tension in the pelvic floor? 

Self-awareness is key to identifying tension in the body! Some common symptoms are headaches, stiff upper neck, shoulder muscle tension, clenching the jaw, grinding teeth, jaw pain, holding the tummy muscles, shallow breathing and any of these physical symptoms.

Usually, the nervous system is involved in each of these muscular responses. Rarely is it just the muscles themselves, usually when there is muscular tension, there’s also nervous system tension which is why we assess the whole picture – the nervous system flexibility, spinal flexibility, glutes where the sciatic nerve passes through, the surrounding muscles like inner thighs tend to be quite tight and stiff, and upper tummy muscles.

‘You can use breathing techniques and breathwork to relax the tummy muscles, pelvic muscles and general tension in the body throughout the day.‘

It is a valuable strategy to tap into regular breathing segments though the day if part of the reason why you’re having pelvic pain is because of holding tension, stress, anxiety, or a traumatic experience.

You might like to read... [3 Ways Relaxation Helps You Manage Stress and How to Practice It]

This can help to calm your nervous system and ease your mind to help take some of that tension and anxiety away, and this leads to an overflow of tension release from the pelvic floor muscles.

Getting partners involved in physiotherapy treatment plans

Generally, clients come to me themselves, but we are happy to have a client come with her partner if that is helpful for her and for them.

Sometimes, their partner might need some advice and guidance as well as how to navigate the pelvic pain scenario and be part of the conversation about introducing penetration together which we can all do together in session.

I always talk with my clients about communicating with their partner because their partner also needs to be on board with the approach and to work with them when they’re at the stage of introducing penetrative touch and intimacy.

You might be interested in...[The Impact of Vaginismus on the Woman, Her Partner, and the Couple]

It can be beneficial for a partner to be fully involved and communicate openly on every aspect of her physio plan. Women often report that their partners are worried about hurting them during intimacy, so open, clear communication is the best way to address that.

The best strategy is to introduce penetrative sex and touch progressively. Some products, such as the Oh Nut, are little silicon rings that a male partner can put on his penis to reduce the penetration depth, can be used. It is all about communication, creating and using lubrication, maybe using a dilator or vibrator and having plenty of foreplay.

Taking a holistic and integrative approach

Linking various disciplines and services for women with pelvic pain is really helpful. As a pelvic health physiotherapist in my approach, I provide physical techniques, including dilators training, muscle work and exercises, tension awareness and attention-holding exercises. We also talk about how breathwork and visualisations can be used.

‘When women are informed, they feel more in control.‘

I recommend that my female clients consider counselling or psychosexual therapy where needed as part of the more holistic approach to their overall progress and, of course, learning and developing self-awareness. All these treatment approaches complement each other in many ways.

Lorraine’s resources for women with pelvic pain

Lorraine has a weekly newsletter which you can sign up for on her website, that is all about female pelvic health. You can book an appointment at her clinic in Donegal, Ireland or an online appointment here.

Lorraine does LIVE segments and webinars on Instagram on pelvic physio topics such as painful sex, post-pregnancy, menopause, pelvic exercises, stretching, and vaginal exercises. Everything relating to pelvic health that she believes is beneficial for her clients!

You can find lots of instructional videos to watch on my Instagram/downbelowphysio video feed. Check out my website downbelowphysio.ie and get in touch.

Read more articles in The Vaginismus blog series for women and feel empowered! Reach out to info@orlaghreid.com if you have any questions you would like featured in the series.