Vaginismus or pain penetration disorder is a condition in which the vaginal muscles involuntarily contract or spasm, making penetration uncomfortable and/or almost impossible. Individuals diagnosed with vaginismus often seek pelvic floor therapy, where they learn to relax their pelvic floor muscles using a variety of therapeutic techniques and interventions, such as muscle stretching, assisted internal and external manual stimulation of the pelvic region, and meditative practices.
Aside from using dilators to treat vaginismus, there are other great tools patients can add to their therapeutic tool kits. Having multiple methods or techniques can be extremely beneficial and assist in self-exploration as well as self-acceptance. It is important to remember that all bodies are different and so what works for one individual seeking treatment may not work for another person.
The key is to listen to what the body needs and to try different methods from a place of non-judgment. When the techniques that are helpful or effective are identified, one may consider adding them to a personalized treatment list and incorporating these techniques as needed. Below are some effective practices that may help.
Breathwork may perhaps be a cornerstone of vaginismus treatment. Most pelvic floor specialists will attest to the importance of breathwork in helping the muscles relax and lengthen. Directional breathwork is a particular kind of practice that asks participants to imagine their breath being directed to a specific area or region of the body.
During pelvic floor work at home or with your provider, breathe normally and then proceed to deepen your breath and imagine your breath entering the pelvic area, allowing for increased space. If you are dilating with a finger or tool, imagine that the breath in your lungs is adding space around that tool.
Next, if the tool is aimed towards a side of the vagina, you can envision your breath expanding out to the sides of your ribs and stomach, again, allowing for more space. Envisioning the breath traveling to key parts of the body can be very soothing and enable patients to more deeply connect with their bodies in a safe, grounding way.
The next tip is perhaps the oddest of them all, but nonetheless, it is just as important and valid as the rest. During dilation or penetration, simple movements like moving your feet and your toes can actually lessen the pain and discomfort. Why is that? The explanation lies within what is known as the sensory homunculus, which is a representation of the amount of area each body region takes up within our brains for sensory processing.
The amount of space our limbs and body regions take up for this processing is disproportionate to our actual bodies. For instance, in an image of the sensory homunculus, a person’s mouth and hands are depicted to be noticeably bigger and more exaggerated than they normally would be on any given human body. This is because the brain has many parts devoted to the sensory processing of information from the mouth and hands.
So while the body parts themselves may be small or large, these sizes are not represented on the sensory homunculus image, which instead illustrates which body regions take up more sensory areas in the brain. The feet and toes are processed next to the sensory areas of the brain which process sensations from the genital region, which explains why moving one’s toes or feet can actually bring about a release during uncomfortable penetration.
To practice this, one might decide to dilate with their preferred tool in a safe environment alone, perhaps laying on their back with their knees bent. Then proceed to gently flex and move the toes. This movement alone can bring about a release. If the feet are elevated, placing pressure onto the back of the heel, release the foot down into the surface you are laying on, and note how this change in position affects the pelvic floor.
Visualization goes hand in hand with directional breathing, but aside from visualizing your breath, you can also choose to visualize what you want your vulva to look like or symbolize. Many patients with vaginismus report imagining their vulvas as dark, bottomless pits or black holes, but these ideas can harm the healing process and halt progress. Reframing these images into more positive and uplifting ones that are in line with your therapeutic goals may bring about significant change.
Flowers are commonly used to positively symbolize vulvas. It is up to each individual what symbol they are comfortable using, but for those who may be unsure, a flower is an excellent starting point. Roses in particular are a popular choice due to the many layers of petals that make up a rose; evocative of the layers found in the vulva, such as the minor and major labia, the vestibule, clitoral complex, vaginal canal, and cervix. During dilation, a person may choose to envision their vulva as a flower that progresses in stages from a bud to full bloom. This meditation can decrease discomfort and tension in a similar way to directional breathing.
Use of “I am” Statements
For many, treating vaginismus can be a very emotional experience and has the potential to bring up a lot of conscious as well as unconscious emotions. These can be especially difficult to deal with, but talking about any emotions that come up during treatment sessions (at home and at the physical therapy office) can be extremely powerful and cathartic.
One way to explore these emotions and identify limiting beliefs a person may possess which inhibits treatment is by using short “I am” statements out loud. For example, if a patient mentions that having vaginismus makes them feel inadequate, the patient could repeat the phrase “I am inadequate” out loud until that feeling disappears completely. Once this is accomplished, the individual can begin repeating out loud the opposite of the previous statement, such as. “I am capable,” until they agree with that statement.
Lastly, journaling is a wonderful and creative way to process one’s personal therapeutic journey. In this journal, you may choose to discuss your goals in more depth, what you like about physical therapy, what scares you and why, any new resources you have found which have been helpful, and any techniques you would like to try.
The journal can also detail the events of each therapy session, including what went well and what did not go well. Personal mantras are a great addition because they can continually encourage you as you progress through treatment and allow you to stay grounded.
Everyone’s treatment will look different because not every method will work for everyone and that is completely normal and valid. As you continue on your healing journey, navigating pain penetration disorder, and life in general, I hope you find the tools that best serve you and give yourself the grace, love, and acceptance you need for the journey.
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