Role of Pelvic floor rehabilitation in Vaginismus

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Vaginismus is a condition characterized by involuntary muscle spasms or contractions of the muscles surrounding the outer third of the vagina. These contractions can make any form of vaginal penetration, like tampons, finger or sexual intercourse, extremely painful or even impossible. Vaginismus is typically a response to the fear or anticipation of pain, and it can be triggered by emotional, psychological, or physical factors. Common causes include previous traumatic sexual experiences, anxiety, fear of penetration, or a history of sexual abuse.

Vaginismus can be classified as either primary or secondary. Primary vaginismus occurs when the woman has never been able to have penetrative intercourse because of the involuntary contraction of her vaginal muscles. Secondary vaginismus occurs when a woman has previously been able to have intercourse but is no longer able to tolerate penetrative sexual activity, because of the involuntary muscle spasms. Secondary vaginismus may be situational and is often associated with dyspareunia (i.e. pain during sex), indicating a need for a specific pain management strategy in its treatment.

The main goal of pelvic floor physiotherapy in vaginismus is to address the muscle tension and dysfunction in the pelvic floor region and improve the patient’s ability to relax these muscles.

Here are some key aspects of the role of pelvic floor physiotherapy in vaginismus:

Assessment and Education:

A trained pelvic floor physiotherapist will first thoroughly assess the patient’s posture and pelvic floor muscles to determine the extent of muscle tension and specific trigger points. They will also educate the patient about vaginismus, pelvic anatomy, and the role of the pelvic floor muscles in the condition.

Muscle Relaxation Techniques:

Pelvic floor physiotherapy involves teaching the patient various relaxation techniques to help them consciously relax their pelvic floor muscles. These techniques may include deep breathing exercises, progressive muscle relaxation, and biofeedback.

Manual Therapy:

Manual techniques such as trigger point release, myofascial release, and soft tissue manipulation may be employed by the physiotherapist to reduce muscle tension. Commonly used techniques are Theiles or sweet spot release or Wise-Anderson’s technique.

Dilator Therapy:

Pelvic floor physiotherapists often use vaginal dilators as part of the treatment plan. Dilators are graduated cylindrical devices that come in various sizes. The patient gradually progresses from using smaller to larger dilators, helping the pelvic floor muscles adapt to the presence of an object and reduce the reflexive spasm response.

Emotional Support:

Vaginismus can be emotionally distressing for patients, and pelvic floor physiotherapists are trained to provide a supportive and compassionate environment to address any psychological factors contributing to the condition.

Home Exercise Program:

A personalized home exercise program may be prescribed by the physiotherapist, which includes relaxation exercises and dilator training that the patient can practice on their own.

Progress Monitoring & counselling: Throughout the treatment process, the physiotherapist will assess the patient’s progress and make adjustments to the treatment plan as needed.

It’s important to note that vaginismus can have complex underlying causes, including physical, emotional, and psychological factors. Therefore, a multidisciplinary approach is often recommended, involving collaboration between pelvic floor physiotherapists, gynaecologists, and mental health professionals to provide comprehensive care for individuals with vaginismus. The success of treatment depends on the severity of the condition, patient compliance, and addressing any contributing factors effectively.