Vaginismus or a tight pelvic floor – what’s the difference?

Maybe sex is painful for you. Perhaps inserting a tampon feels impossible. Or maybe you notice your body automatically tensing up when you’re having a gynaecological examination.

While looking for answers to why you are experiencing pain, you may have come across the terms vaginismus and a tight pelvic floor. But what do they actually mean – and what’s the difference?

What’s the difference between vaginismus and a tight pelvic floor?

Vaginismus and a tight pelvic floor – also known as an overactive pelvic floor – can seem quite similar. They involve the same muscles, and both can cause pain and discomfort in the pelvic area. The main difference is how and when the muscles tighten.

With a tight pelvic floor, the muscles tend to stay tense constantly, which can cause pain and discomfort in everyday life.

With vaginismus, the pelvic floor muscles tighten involuntarily in response to penetration – for example during sex or when trying to insert a tampon.

The two can also overlap. Many women with vaginismus also have a tight pelvic floor. But having a tight pelvic floor doesn’t necessarily mean you have vaginismus.

What is a tight or overactive pelvic floor?

A tight or overactive pelvic floor means that the muscles are working too much and have difficulty relaxing.

Instead of tightening only when they need to, the muscles stay tense much of the time. This can cause ongoing tension in the pelvic area, as well as pain, burning or discomfort. For some, it can also affect the bladder and bowels, making it harder to empty them completely.

If the muscles stay tense for a long time, they can become overworked and develop tender, tight areas known as trigger points. This can make the pain more persistent.

There can be several reasons why the pelvic floor becomes overactive – for example ongoing pain, childbirth, stress, trauma or simply a habit of tensing the body without realising it. Certain sports can also play a part. Horse riders, for example, often engage their pelvic floor while riding, and for some, that tension can become persistent enough to cause symptoms.

Some women only realise how tense their pelvic floor is when they try to do pelvic floor exercises. What they thought was a contraction turns out to be the moment they finally relax and let go of the muscles.

What is vaginismus?

Vaginismus is a condition where the pelvic floor muscles tighten or spasm when penetration is attempted. It’s an involuntary response that happens automatically and is usually difficult to control. The muscles around the vaginal opening tighten, making penetration feel difficult or even impossible – almost as if your body is “closing off”.

For some, it’s painful. Others mainly feel resistance or as though their body is tensing against penetration. It can happen during sex, when inserting a tampon or during a gynaecological examination. In some cases, even the thought of penetration can trigger the response.

It’s important to know that vaginismus isn’t about whether or not you want to have sex. Many women with vaginismus still experience sexual desire, become aroused and have orgasms. But the body can still respond by tightening involuntarily.

Vaginismus is often linked to the body trying to protect itself. If your body expects something to hurt, it may tense up in response. This can happen after previous pain or discomfort, but sometimes the fear of pain alone is enough to trigger the reaction.

Both vaginismus and a tight pelvic floor can affect your quality of life

Whether you have vaginismus or a tight pelvic floor, the effects can go beyond the physical symptoms.

Pain and discomfort in the pelvic area can take up a lot of mental space. For some women, it affects their sex life and desire for intimacy. For others, it can mean living with a constant sense of tension or uncertainty about what’s happening in their body.

It can also bring feelings of guilt or shame. During sex, for example, you may worry about disappointing your partner. And for many women, it can be difficult to talk about.

But you’re far from alone, and there are ways to get help and work with both the tension and the pain.

How is a tight pelvic floor treated?

With a tight or overactive pelvic floor, the aim is to help the muscles relax again. This can include:

• Breathing exercises that allow the pelvic floor to move naturally with your breath.
• Relaxation exercises and exercises that help you become more aware of when you’re holding tension in your body.
• Manual treatment from a pelvic health physiotherapist to help release tight and tender areas in the muscles.
• Advice on toilet habits to help you avoid unnecessary straining.

For many, small changes in everyday life can also help. This could mean paying attention to how you sit and breathe, or simply starting to notice when you tense your body without realising it.

How is vaginismus treated?

Relaxation is also an important part of treating vaginismus, but the focus is usually more specifically on the body’s response to penetration.

This is typically done slowly and gradually, giving your body time to become comfortable with touch and penetration. This can include:

• Exploring touch yourself to gradually feel more comfortable with sensations in the area.
• Using vaginal dilators in different sizes to gradually become more comfortable with penetration.
• Practising breathing and relaxation while working with touch.

It can also be helpful to work with a pelvic health physiotherapist who has experience with pelvic floor problems and pain during penetration.

When should I seek help?

Pain or discomfort from vaginismus or a tight pelvic floor is reason enough to get it checked. If sex is painful, penetration is difficult, or you regularly feel tension or discomfort in your pelvic area, it’s a good idea to seek help. You shouldn’t have to accept being in pain, whether it comes and goes or is there all the time.

The same applies if your symptoms are affecting your everyday life, your desire for intimacy or how comfortable you feel in your body. Or simply if you’re unsure about what’s going on.

Getting the right guidance can help break the cycle of tension and pain. And with the right help, many women find that their symptoms improve.