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Contrary to popular belief, kegels are not the answer to vaginismus! Vaginismus is caused by a pelvic floor that is hypertonic, meaning a pelvic floor that is likely both tight and weak. This can include your entire pelvic floor or just one side or section. Hypertonic pelvic floor muscles must first be relaxed before proper strengthening can begin. The process of relieving tension from the pelvic floor could take a few days, weeks, months, or years, depending upon a number of variables including the root cause of your vaginismus, the need for other types of treatment (i.e.therapy), how you move your body throughout your day, how often you do your exercises, and more. 

Be aware that your body is unique and not all of the options listed below may feel right for you. It’s helpful to work with a physical therapist (PT) who specializes in the pelvic floor to support you as you get to know this part of your body more intimately. A pelvic floor PT can help you discover the nuances within your pelvic floor. For example, you may have tight pelvic floor muscles on one side of your body, contributing to vaginismus, but healthy muscle tissue on the other side. A pelvic floor PT will provide a diagnosis and support you with physical treatment that is customized to your body. 

Stretching and Yoga for Vaginismus

The pelvic floor is an amazing part of our bodies where a ton of muscle groups and bone structures come together to support our entire torso. Pelvic floor muscles themselves are interwoven to create a solid structure to hold our organs in and up. They also connect to and rely upon the muscles in our legs and torso for support and stabilization. This interconnection is one of the things that can make stretching and strengthening the pelvic floor complicated, even without adding the layers of psychological distress that can correlate with vaginismus. 

Common areas of the torso and lower body that may contribute to vaginismus are tight hips/thighs, IT bands, gluteus, and psoas. Luckily, there are many yoga postures and stretches that can relieve tension in these areas.

Strength Building Exercises for the Core and Pelvic Area

The muscles of our pelvic floor are interwoven and depend upon surrounding muscle groups for stabilization and support. A PT can assess if your surrounding muscle groups are contributing to vaginismus and where you may need to build strength in order to take the work out of your pelvic floor. For example, you may need to shift how you are engaging your core and if/how you are using your outer glutes to stabilize your body vs. your pelvic floor. You will also want to eventually strengthen your pelvic floor muscles, but must first relieve the tension and tightness.

Trigger Point Therapy and Myofascial Release (MFR)

The tension that has been built in your pelvic floor and the surrounding area may result in what essentially are knots, similar to those you might get around your shoulders and upper back. Depending upon the location of the knot/tension, you can use trigger point therapy, MFR, or massage techniques. This may be done externally on your core, psoas, hip flexors, inner thighs, glutes, your feet, etc. Externally, you can use your hands, foam rollers, and MFR balls like Rad Roller or Yoga Tune Up. Internally, the walls of the vagina can be lightly massaged with your fingers or trigger point devices like this one. A pelvic floor PT can also conduct internal massage. This can be helpful in assessing your starting point, progress being made, and where you might be consistently holding tension.

Insertion Devices

To both stretch the pelvic floor and acclimate the nervous system to penetration, tools like dilators can be used. Dilators such as these from Intimate Rose come in sets with varying widths. Start with the most comfortable width and work your way up. If you are working your way up to have penetrative sex with a partner with a penis, aim to use a dilator one size larger than their penis. A typical dilation session can be 15-30 minutes. Dilating can be frustrating at first but rewarding in many ways. In addition to preparing your body for penetration, it can also be a great way to get to know your body. Work your way up slowly and gently, and don’t be surprised if you need to bounce between sizes throughout this work. For example, if you hold emotional tension in your pelvic floor and are dilating on a particularly stressful day, you may need to use a smaller size than what you have worked up to. To make dilating more comfortable, relaxing, and enjoyable, you can stretch beforehand, give yourself or receive a massage, set the mood with low light and candles, and play music.

Breath Work and Meditation

You may be surprised to learn that something as simple as your breath could have a big impact on your pelvic floor tension and pain. When you inhale, your  breath should reach all the way down to your belly, low back, and your pelvic bowl. If you notice your breath stays up in your chest, you may be what pelvic floor yoga teacher Leslie Howard refers to as a “reverse breather.” When your breath doesn’t reach that low, it is likely due to tension in your core or pelvic floor. Conscious breathing and yoga postures can bring the breath downward and release tension in the pelvic floor. You can also add a layer of visualization or meditation to your breath work. These techniques can help you identify and release physical, emotional, or energetic blocks in your pelvic floor.

Botox for Vaginismus

Botox isn’t just for your face! It can be used to ease tension and tightness in the vaginal walls, too. The involuntary muscle spasms or contractions that cause vaginismus can be alleviated through Botox. Keep in mind that Botox is not necessarily a silver bullet toward pain-free sex. Medical practitioners typically only recommend Botox if a patient is not making progress through PT or other therapies, and will likely also pair Botox with a strict dilator regimen after the procedure. Gaining a sense of pleasure from penetration after Botox can take additional work.

With all of the physical treatment options for vaginismus available to you, it’s easy to get overwhelmed. The important thing is to just get started. A pelvic floor PT can be incredibly helpful in assessing your pelvic floor and helping you to become more familiar with this incredibly important part of your body. They will also help you come up with a treatment plan. Keep in mind that progress might not be linear, and you may need to address mental or emotional needs in order to fully heal. But getting started with a physical practice can be an excellent way for you to make and dedicate time for your self-care and to get to know yourself and your body in a new way. You can do this!

f you're curious to learn more about how yoga can supplement your vaginismus journey and the work you do with a physical therapist or psychologist, download the FREE Mind + Body + Spirit Guide to Lasting Change.