Is my Sexual Pain from Vaginismus or a Hypertonic Pelvic Floor?

When it comes to sexual pain, there’s more than meets the eye. Many women come to me uncertain of whether they’re facing Pelvic Floor Hypertonicity or Vaginismus. Understanding these distinct yet connected conditions can help us navigate potential challenges and empower us to seek the right care.

Now of course, getting professionally examined for sexual pain is best. Use this information as a guide to help navigate your health care experience. It’s best to see a gynecologist or pelvic floor therapist who is familiar with sexual pain to make sure you’re getting the right kind of care and attention.

Picture the pelvic floor as a special team of muscles, forming a supportive base at the bottom of your pelvis. These muscles are a solid foundation, responsible for essential tasks such as supporting organs and helping you control your bladder and bowel movements. But sometimes, just like a clenched fist or tense shoulders, these muscles can become overly tight – this is Pelvic Floor Hypertonicity.

Having a hypertonic pelvic floor doesn’t necessarily imply that your muscles are exceptionally strong; it simply means they tend to be tight and on the shorter side. It’s comparable to leg strength, where the ability to perform splits isn’t solely determined by how strong your legs are. You can have either a strong or weak pelvic floor with pelvic floor hypertonicity. It’s more about the tension and tightness in the muscles rather than their strength.

Pelvic Floor Hypertonicity can be sneaky, causing a range of discomforts that might surprise you:

1. Pelvic pain or discomfort: You might feel a nagging pain in your lower belly, making everyday tasks a bit tougher.
2. Painful intercourse/sexual pain: For some, intimate moments can become painful, and this might be due to Pelvic Floor Hypertonicity’s unwelcome presence. Often this is felt with mid to deeper penetration.
3. Urgency and frequency: Have you noticed yourself rushing to the bathroom more often than others or needing to stop often on road trips to pee? Pelvic Floor Hypertonicity might be the reason.
4. Constipation and trouble with bowel movements: Pelvic floor tightness can impact your bowels and their ability to function normally. Constipation, excessive wiping, or constipation-diarrhea events can be a sign of pelvic floor hypertonicity.
5. Pressure in the pelvic region: You might feel an uncomfortable pressure in the lower part of your belly, possibly a heavy feeling.

Now, let’s turn our attention to Vaginismus, which now falls under the broader category of Genito-pelvic pain/penetration disorder (GPPPD). With vaginismus, we see a malfunctioning or misfiring of our pelvic floor muscles. Imagine your vaginal muscles as protective gatekeepers. When faced with the prospect of something being inserted into the vagina (tampon, finger, speculum, penis), some people’s muscles might respond with involuntary contractions – that’s Vaginismus. (For a comprehensive overview of Vaginismus, check out this post.)

Vaginismus moves beyond just pelvic floor dysfunction to a broader mind-body disconnect. Because of an overreaction of the nervous system and miscommunication within the mind-body connection, women with vaginismus have a difficult time controlling their pelvic floor muscles when faced with penetration. At a subconscious level, the brain communicates to the pelvic floor to clench and protect, making penetration painful or impossible.

Signs and Symptoms to Watch For:

1. Painful attempts at penetration: Vaginismus can cause severe discomfort or even pain during any attempt at vaginal penetration, including during sexual intercourse or the insertion of tampons.
2. Inability to insert objects: Individuals with Vaginismus may find it challenging or impossible to insert objects into the vagina, no matter how small they are (fingernails, tiny dilators, pediatric speculums, etc)
3. Fear and anxiety surrounding sex: Vaginismus can create significant fear and anxiety related to sexual activity, leading to avoidance of intimacy and emotional distress.
4. Muscle tightness and involuntary contractions: During attempts at penetration, the vaginal muscles involuntarily contract, making penetration difficult or impossible. Often women describe this as “hitting a wall” and some experience stabbing or burning sensations.

Pelvic Floor Hypertonicity and Vaginismus may exhibit some overlap, but they are distinct conditions that do not always share a direct correlation. Visualize them as two separate travelers journeying alongside each other, occasionally encountering similar aspects along their respective paths.

When Pelvic Floor Hypertonicity is present, the continuous tightness of the pelvic floor muscles can lead to sexual pain, anxiety, and discomfort. This, in turn, might cause future fear of penetration during sexual activity, since the original experience was painful. This fear triggers involuntary muscle contractions around the vaginal opening- and thus, Vaginismus is born.

Even though these conditions can coexist, they each have their unique focus and symptoms:

• Pelvic Floor Hypertonicity addresses general pelvic pain and potential issues with your bladder, bowels, and sexual pain. While it might affect intimacy, it isn’t solely centered around it.
• Vaginismus, on the other hand, concentrates specifically on the fear and anxiety surrounding vaginal penetration during sexual activity. The main challenge lies in the involuntary muscle contractions that make penetration difficult or impossible.

Certainly, vaginismus isn’t always directly connected to pelvic floor hypertonicity. Having a hypertonic pelvic floor doesn’t necessarily mean you’ll develop vaginismus, but if you experience vaginismus, it’s more likely that you have a tight pelvic floor. It’s important to note that curing vaginismus doesn’t automatically resolve pelvic floor hypertonicity, as one condition doesn’t guarantee the presence or absence of the other. Each can exist independently of the other.

Regardless of whether you think you’re experiencing pelvic floor hypertonicity or vaginismus, the first step is to go see a gynecologist or medical professional who can look further into your symptoms and provide an accurate diagnosis.

If your provider diagnoses you with a hypertonic pelvic floor, seeing a pelvic floor therapist is the next step. A skilled pelvic floor therapist will continue to assess your pelvic floor muscle functioning and be able to provide individualized treatment that may include pelvic floor stretching, strengthening, and control exercises, manual therapy (internal and/or external), and functional positioning to improve activity-specific functioning.

If your provider diagnoses you with vaginismus (GPPPD), you may also be referred to a pelvic health therapist. With pelvic floor therapy for vaginismus, you’ll likely encounter manual exams (internal and external), vaginal training (dilators), and pelvic floor relaxation exercises. It’s important to note that a mind-body approach to pelvic therapy provides the best results for vaginismus recovery, as vaginismus requires a comprehensive and holistic approach to really retrain the nervous system to perceive penetration as pleasurable and not threatening.

If you’re looking for a unique and comprehensive mind-body approach to vaginismus, join our Mind-Body-Sex Reset Vaginismus Program where we use a neuroscience-informed approach to regulate the nervous system and retrain the mind-body connection to ensure the transition from dilator to tampon/penis is possible and pleasurable.

Should you encounter sexual pain, whether that be from Pelvic Floor Hypertonicity, Vaginismus, or a combination of both, know that there is help available. You don’t have to live with and push through sexual pain to enjoy intimacy. There are comprehensive treatments available for both so that sex no longer has to be frustrating or painful, but can be freely enjoyed with pleasure and not pain.