Endometriosis and Vaginismus

When someone has endometriosis, tissue similar to the tissue that lines the uterus grows outside of it, often causing pain in the pelvis. Over time, the body starts to protect itself from this pain, especially in sensitive areas like the pelvic floor muscles, which are the group of muscles that support the bladder, uterus, and rectum and surround the entrance of the vagina and anus. 

The pelvic floor muscles can tighten up as a protective response to the ongoing pain from endometriosis. This is similar to how our shoulders tense up when we're stressed. If these muscles stay tense for a long time, they can become stiff and overactive, which makes things like sexual activity, tampons, or even gynecological exams very uncomfortable or painful. It can also cause constipation and by association haemorrhoids and fissures. This protective tightening of the muscles is what can lead to Vaginismus.

Vaginismus happens when the pelvic floor muscles spasm or contract in response to any attempt at penetration. It’s the body's way of trying to prevent more pain, but it creates a cycle: the more pain someone feels, the tighter these muscles get, and the tighter they get, the more pain they experience with any kind of touch or penetration.

When pain continues for a long time (like with endometriosis), the nervous system becomes more sensitive. This means the brain and spinal cord are more on alert, almost like turning up the volume on pain signals. So even if the initial pain from endometriosis is managed, the pelvic floor muscles might still be in "guarding mode" and remain tight, which leads to more pelvic pain and symptoms like bladder or bowel issues and painful sex.

In short, pain from endometriosis can cause the pelvic floor muscles to stay tight and overreact, leading to vaginismus. And once this cycle starts, it can be hard to break without proper treatment, like pelvic floor therapy and pain management strategies, to help retrain the muscles and the nervous system to relax.

Dilators are one of the many ways we can encourage the pelvic floor to relax and lengthen and allow things like intercorse to be pleasureale again!