Pelvic floor muscles would go into spasm because of an injury, an orthopedic or a neurological issue, after surgery, childbirth, and certain medical conditions. Treatment is available through an acceptable medical intervention that is readily available.
And then there is the psychosomatic pelvic floor muscle tightening, a reactionary phenomenon to vaginal penetration, that is what primary and secondary vaginismus is all about. In this category, the muscles are perfectly healthy and injury-free but are working in anticipation of protecting against the ‘scary’ vaginal entry.
In the case of primary vaginismus, the muscles are an anticipatory-anxiety reaction, resisting even before anything is actually penetrating.
In the case of secondary vaginismus, the woman is totally cognizant of how pain-free vaginal penetration used to be but is now apprehensive or even traumatized (PTSD) by adverse events, such as menopause, cancer treatment, complicated surgeries, other medical involvements, etc.
In both primary and secondary vaginismus, the psychosomatic balance must be addressed because the genitals are a component of our Fight or Flight stress response mechanism: just focusing on vaginal insertions (finger, dilator) is not addressing the emotional (psycho) component, while just telling the woman to relax is not addressing the physical (somatic) component.
Emotional stress or anxiety are ALWAYS present with vaginismus, may it be mild or severe and disruptive. The treatment may be more ‘physically-oriented’ for some women, while for others more ‘anxiety-oriented.’ Regardless, both components must be addressed and balanced for a complete resolution.
Vaginismus is not classified – in our expert opinion – by the level of anxiety present but rather by the level of vaginal function: what vaginal penetration/s are limited or non-existence. Vaginismus is a functional condition that calls for a functional intervention.