Vaginismus physical therapy: pelvic physical therapy vaginal dilators

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We need to talk about physical therapy for vaginismus! A sassy person with black skin and yellow hair looks upwards with a slightly pursed friendly grin.

“When the doctor told me I would have to do vaginismus physical therapy, I nearly passed out because I had no idea what that would entail. It's not something I've heard anyone else talk about before.”  |  Photo: ©Carlos David / Adobe Stock

Physical therapy for vaginismus: pelvic physical therapy and vaginal dilators

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Vaginismus physical therapy may help if you have sexual pain. Erin’s true story of how vaginismus physiotherapy helped her enjoy sex again.

The following conversation has happened countless times in the last four months of my life:

“I can’t; I have physical therapy.”

“Oh, for what?”

“My vagina.”

I’m sure you can imagine the look on people’s faces when I decide to tell them what my appointments are really for.

I struggle with something called vaginismus, which essentially means I can’t control the muscles in my vagina. Like, no matter how mentally or physically relaxed I am, my vagina doesn’t follow suit. 

My vagina spasms involuntarily, and if I attempt to insert something during a spasm, it feels like I’m being stabbed in the vagina. Even tampons can cause pain on a bad day.

Let’s talk about vaginismus physical therapy

It wasn’t until after attempting to have sex and then experiencing excruciating vaginal pain after sex for four years that I finally got an answer to my question: why does my vaginal area hurt so much? And that answer came after two weeks filled with four different gynecologists and just as many vaginal inspections. I had vaginismus.

When the doctor told me that one way to reduce or eliminate pain in the vagina would be vaginismus physical therapy (vaginismus physiotherapy), which usually involves a combination of pelvic physical therapy and vaginal dilators, I nearly passed out! I had no idea what that would entail. It’s not something I’ve heard anyone else talk about before until then. It sounded embarrassing and painful.

So, I’m here to tell you what vaginismus physical therapy – pelvic floor physical therapy and vaginal dilators – looks like, for anyone who is curious.

Before my first vaginismus physical therapy appointment, I was practically shaking in the waiting room. I had no idea what to expect – was it just going to be stretches or yoga for vaginismus? Or was she going to physically, forcibly, you know…stretch my vagina? I was nervous, to say the least. 

Before my first vaginismus physical therapy appointment, I was practically shaking in the waiting room. I had no idea what to expect – was it just going to be stretches and yoga?

What is vaginismus?

Vaginismus, classified under the umbrella term of genito-pelvic pain/penetration disorders, is a penetration disorder where women experience persistent difficulty achieving vaginal penetration. It is frequently characterized by the involuntary contraction of the pelvic floor muscles in response to physical contact or pressure. This contraction prevents non-painful sexual intercourse.

Vaginismus is usually classified being either primary or secondary.

  • Primary vaginismus refers to cases when a female has never been able to have comfortable penetration. And, in some cases, has never achieved penetrative intercourse. This has implications for the consummation of marriage and fertility.
  • Secondary vaginismus occurs after a period of normal sexual relations before the onset of symptoms. For example, this may occur after a traumatic event such as abuse or having a baby.

Some women’s symptoms are caused by physical or psychological abuse. For other women, the underlying cause of vaginismus might be due to medical conditions such as endometriosis, fibroids, or UTIs. And in some women, there may be no identifiable cause whatsoever.

Source: Health Direct Australia

What does vaginismus physical therapy entail?

When I first met my physical therapist to start my vaginismus physical therapy, all my worries washed away. She came out with a bright smile on her face and welcoming me back to the treatment room, where we spent forty minutes talking about my vaginal pain, the causes of vaginal pain, and various treatment options. We spoke of yoga for vaginismus, treatment timelines, and different topical treatments for vaginismus. 

She answered all of my questions about vaginismus treatment. She told me everything I would ever need to know about pelvic floor physical therapy and vaginal dilators as a form of physical therapy for vaginismus.

Pelvic floor physical therapy entails both external and internal work once a week, plus there’s a ton of homework. We do stretches, and then, when it comes to internal work, she plays relaxing music and gives me heating pads while she literally, yes, stretches out my vagina. It sounds really strange, and it is, but at the same time, I’ve never felt so empowered and in control of my body.

She makes me feel more autonomous than any medical professional ever has before. I obviously can’t speak to all pelvic floor physical therapists in the world – but if they’ve received training similar to mine, then I bet they’re awesome.


7 Steps to Pain-Free Sex 
by Claudia Amherd


A complete self-help guide to overcoming vaginismus, dyspareunia, vulvodynia & Other Penetration Disorders

Physical therapy for vaginismus at home

For home therapy for vaginismus, I have to use vaginal dilators (vaginismus dialators), which is a whole process on its own. I have to get myself relaxed (i.e., grab my heating pad and watch Netflix), use TONS of lube, and use the dilators. They’re basically plastic dildos that come in six different sizes, and my goal is to make it up to the biggest size.

For reference, the smallest one is about the size of a tampon. 

For anyone who is trying out dilators to treat painful sex – I highly recommend doing something fun while dilating. Otherwise, your brain will just continue to associate insertion with pain and discomfort.

It'll be uncomfortable and probably painful if you binge a Netflix show while doing it, but your brain will also associate dilating time with whatever you’re currently binging. Positive reinforcement for the win!

Despite spending time in college on the Health and Wellness Crew, studying women’s health, and educating myself as best as possible, I hadn’t heard of vaginismus until I watched a YouTube video about the condition. According to my pelvic floor physical therapist, it’s not uncommon at all. It’s just not talked about because women are told that pain during sex is normal and healthy (spoiler alert: it’s not).

There are treatment options if you or anyone you know is struggling with painful vaginal sex. Physical therapy for vaginismus (pelvic floor physical therapy) is just one of them – there are also topical numbing treatments, vaginal dilators on their own, and even surgery.

You’re not a lost cause, and you’re not alone. And by talking about physical therapy for vaginismus, I hope that I can educate people about painful sex because sex is NOT supposed to be painful, and if it is, there are ways to treat it.

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Article by
Erin Moynihan

Erin Moynihan, the author of 'Vaginismus physical therapy: pelvic physical therapy vaginal dilators,' is a content writer from Seattle, WA who loves making people uncomfortable.