NHM @DPH

PHYSIOTHERAPIST

Dr. M . Manimozhi PT,

Pelvicfloor Rehab Specialist
ATTUR HUD
KARIPATTI GPHC
 VAGINISMUS
ROLE OF PELVIC FLOOR REHAB PHYSIOTHER APIST IN SEXUAL DYSFUNCTION

Vaginismus is a type of sexual dysfunction, It

occurs when the vaginal muscles involuntarily
or persistently contract. While it doesn’t
interfere with sexual arousal, it can cause pain
during sexual intercourse, making penetration
difficult.
VAGINISMUS
 Statistics of Vaginismus in worldwide

From the Year X axis 1980 to 2019 for the Y axis 20 to 180
Graph of publications about vaginismus and female sexual disorders by years
 CAUSES of VAGINISMUS
Childbirth injuries, such as vaginal tears.
Prior surgery.
Physical psychological and sexual issues.
Bladder infections.
UTI.
Yeast infections.
Anxiety disorders.
Fear of sex or negative feelings about sex, perhaps
due to past sexual abuse, rape or trauma.
Hypertonous of pelvic floor muscles.
 Types of vaginismus
Vaginismus is classified into two types:

 primary vaginismus: 
when vaginal penetration has never been achieved.

 secondary vaginismus: 

when vaginal penetration was once achieved, but is no

longer possible, potentially due to factors such as
gynecologic surgery, trauma, or radiation
 VAGINISMUS MUSCLE DYSFUNCTION

 This means the inability of the pelvic floor

muscle to relax completely.
 It can be due to spasm of the pelvic floor
muscles or due to certain visceral pathologies
like endometriosis.
 Pain may be localized to the suprabubid area,
vaginal. Coccy, lower sacrum, rectal pain and
pelvic discomfort.
PudendalNeuralgia:
It can cause pain, irritation and spasam of muscles. Sensory symptoms may
extend till groin. Abdomen legs and buttocks. Discomfort wearing tight clothes.

Vaginal atrophy: 
Lack of estrogen after menopause makes the lining of the vagina thinner and
drier (vaginal atrophy).

 Vulvar vestibulitis (provoked vestibulodynia): 

This condition causes painful sex (dyspareunia). People may have pain from
initial penetration throughout the entire experience symptoms of vaginismus.
 Discomfort or pain during vaginal penetration.
 Inability to have sex or have a pelvic exam due to vaginal muscle spasms or pain.
 Painful intercourse.
 Assessment by Pelvicfloor rehab
Physiotherapist
SUBJECTIVE ASSESSMENT:
 Every Assessment starts with taking proper history and
asking about the chief complain.
 The subjective assessment should include, Name, Age,
Occupation, Lifestyle,Habit, Chief complain
 History related to childbirth, urine leak, perineal injury,
surgery, sexual activity, pelvic organ prolapse should
taken in detail.
 Any other history related to chronic low back pain
especially which is not responding to treatment should
also be noted.
OBJECTIVE ASSESSMENT
 It starts with observation.
 Posture
 Gait
 Perineal observation
 
PERINEAL OBSERVATION
 The perineal observation can be further divided into Static observation
and Dynamic observation
 The static observation consists of ,
 
 Observation of skin
 Identification of the structures and their symmetry
 Scar, oedema, redness
 Episiotmy
DYNAMIC OBSERVATION
 
 The dynamic observation consists of,
 
-contraction and relaxation of pelvic floor muscles
-movement of clitoris and perineal body, anal wink
-observation of PFM during coughing-Bulge, Drop etc.
 
Perineal movement
Contract PFM
 Perineal elevation inward movement of perineum, vulva &
anus. Relax PFM.
 
 Perineal descend downwards & opening movement of perineum.
 
Don’t forget to look for accessory muscle movement during contraction
and relaxation.
OBJECTIVE ASSESSMENT
 Trans Vaginal Assessment:
before starting the transvaginal examination it is
important to study the state and national laws.
Indication:

 Vaginal laxity.

 Incontinence.

 Pelvic pain.

 Prolapse.

 H/O Sexual dysfunction.

Contraindication:

 Absence of patient’s written consent

 6-weeks post partum & post surgery
 severe vaginitis & Infection
 Menstrual
 Pregnancy (Relative contraindication)
 Sexual abuse
 Sever Pelvic pain
 Age <18 & Paediatric patients,
Oxford Grade Scale
Grading according to Het’s SERF Assessment
 S= STRENGTH / RELAXATION (+3/-3)

 E= ENDURANCE (How many seconds hold) (10sec)

 R= REPETITION 10/10

 F= FAST TWITCH MUSCLE MOVEMENT (8-9 /10 SEC)

Het’s ASSESSMENT Scale/MMT

STRONG UPWARDS AND INWARDS
GRADE 3
PULL AGAINST RESISTANCE

CONTRACTION
GRADE 2 GRIP WITH COMPLETE CIRCUMFERENCE

GRADE 1 MILD CONTRACTION (FROM ANY SIDE)

0 GRADE 0 BASE LINE TONE

GRADE -1 INABILITY TO PENETRATE

SYMPTOMATIC PENETRATION
 
GRADE -2 (PAIN, TIGHTNESS, DISCOMFORT OR ANY OTHER
RELAXATION
SYMPTOM)

ASYMPTOMATIC PENETRATION
GRADE -3
(EASY PENETRATION)
 PERFECT SCALE
  P- Performance

 E- Endurance

 R- Repetition

 F- Fast

 ECT- Every Contraction Timed.

NON-INVASIVE TREATMENT for VAGINISMUS

THE MOST IMPORTANT STEPS
 Patient Education
 Muscle Identification
 Movement Awareness
 Muscle Activation
 Treatment plan
 TREATMENT FOR VAGINISMUS DYSFUNCTION

 As we have seen earlier the hypertonus

dysfunction occurs due to pelvic floor muscle
tightness.
 So the most important thing in this protocol will be to
focus on sustained relaxation of the pelvic floor
muscles.
 Patient may need some pain relieving treatment and
bio feed back for proper understanding of the muscles
FOR PAIN RELIEF AND BIOFEED BACK
 Modalities like Vulvar US, IFT, Heat therapy or
cryotherapy can be used for pain relief.
 IFT & US
 IFT can be used for the pain relief as it is used for other
areas.
 The placement will be two electrodes on the medial
1/3rd of inguinal ligament on each side and other two
electrodes near the ischial tuberosity.
 US can be given to the vulvar area or the Mons if they
are painful, use the water bag method.

VAGINAL DILATORS
 Stretches
• Adductors.
• Hip Flexors.
• Piriformis.
• Happy baby pose
• Breathing exercise for relaxation.
• Hipcurling
• Puppy pose.
• Pigeon pose.
• Lateral stretch.
• Glutei rolls.
• Butterfly stretch.
• Straddle stretch.
• Relaxed squat.
• Spinal twist.
• So a proper stretching of these muscles will help the
patient to reduce the heaviness in the whole pelvis..
 BENEFITS OF RELAXATION OF PFM.
 It relives your back pain,
 It helps you relive from painful sex such as Dysperunia and
vagisnimus.
 It increase blood supply and oxygen to the pfm, moreover,
increase your sexual health.
 Increase pleasure and reduces pain during sex.
 Making the childbirthing process easier and decreases chnces
of incontinence after childbirth.
 Makes passing urine and feces through the body easier.
 Prevents pelvic floor prolapse.
 Help to treat urinary incontinence
 Strengthen and support for your baby during pregnant.
THANK YOU