Having my first ever appointment in 2 weeks for vaginismus! What should I expect?
This blog post is part of our monthly knowledge drop! Each month for our newsletter, the Lady Blurb, we'll share answers to some questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
Submitted question: I’m having my first ever appointment in 2 weeks for vaginismus! What should I expect?
First of all, I am SO happy to hear you are taking that first step. It can be intimidating to schedule that first pelvic floor physical therapy appointment, particularly for those experiencing pelvic pain and sexual pain. I just did a little happy dance for you but I know that this first step can be scary, exciting and leave folks feeling really vulnerable. While every clinic and provider do things a little differently, let me talk you through what an initial evaluation for vaginismus looks like with our pelvic floor physical therapists in our clinic at Lady Bird PT. We also work with people experiencing vaginismus virtually, but we’ll focus on in-person visits for this question.
Before you come in for your first visit:
Before you come in for your first visit, we send you paperwork. That paperwork includes all the boring but necessary consent and privacy forms, but it also includes a pretty detailed survey about your pelvic health. It asks questions about bladder and bowel function, pelvic pain and activity level. The survey also asks detailed questions about your sexual health. Those questions can include whether you experience pain with sexual activity or attempted penetration, where that pain is and when it started. These forms can also include questions about your ability to orgasm and if your sexual sensation has changed over time. They also include open ended sections where you’re able to provide more details, if you’d like. While you’re never required to answer questions that make you uncomfortable, your answers to these questions help us get a better sense of what’s going on before we even see you.
Once you arrive to the office for your first appointment:
Once you arrive for your first appointment and our lovely folks in the front office makes sure we have all the information we need from you, your PT will pull you back to a private treatment room. The first 20 minutes or so of your appointment will be you chatting with your physical therapist, telling them about the symptoms you experience. They’ll ask more detailed questions to get an even clearer picture of what you’ve been experiencing before they talk to you about what they’d like to examine. Our physical therapists will always let you know what it is they’d like to physically assess and what you can expect before stepping out of the room to let you change, if that’s appropriate.
The physical exam can include a bunch of different assessments, depending on your specific symptoms and what your PT feels needs to be prioritized during your first visit. It can include looking at how your back and hips move and how your belly feels. They may assess your abdominal muscle tone, how your bladder and uterus move. They may also want to look at your balance and the way you walk, as well as the tone of the muscles in your inner thighs and glutes. For vaginismus specifically, your PT will likely recommend a pelvic exam. The pelvic exam can be done internally or externally and is never meant to provoke significant pain. If an internal vaginal exam is performed, it’s done with a gloved, lubricated finger. If it hurts, we use less pressure, less depth, or we focus somewhere else. If you’re unable to tolerate finger insertion or prefer not to attempt an internal exam, your PT may start with an external pelvic exam where they feel the muscles through your labia, perineum and between your glutes. If you prefer to avoid a pelvic exam altogether, they will start their examination elsewhere.
While a pelvic exam does offer us important information about what’s causing your symptoms, pelvic exams are never required. I’ve treated patients experiencing pain with sex without ever look at their vulvas. What’s most important is getting you the care that you need, in the way that feels safe for you.
After your physical examination:
If your physical therapist has time during this appointment, they may do some hands on work on the muscular restrictions that they find. Your physical therapist will end your session by explaining what they found during their physical exam and how their findings may be contributing to the symptoms you experience. They’ll walk you through your homework, what your plan for PT looks like and what you should expect to see over the coming weeks and months. During each follow up appointment, your physical therapist will use hands on techniques to address the tissue contributing to your pain, assess your home program and make adjustments as needed. Your PT may also be communicating with other members of your medical team between visits.
By the time you leave that first visit, you should have a deeper understanding of what’s contributing to your pain, what your PT can do to help and what you can do on your own at home to help yourself meet your goals.
I hope that helps!
To schedule a virtual or in-person appointment at Lady Bird Physical Therapy, send us a message here!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.