Hypertonic Pelvic Floor Muscle Dysfunction

Content written by Irwin Goldstein MD


This condition, is also know as vaginismus is when the muscles that surround the vagina (also the bladder and anus) are in spasm. This causes pain at the vulvar vestibule which leads to pain upon penetration. A 10% increase in muscle tone of the pelvic floor muscles causes a 50% decrease blood flow and oxygen going to these muscles. This leads to a build-up of lactic acid in these muscles which causes the muscles to be sore.


There are many causes of tight muscles, including anxiety, stress, low back pain, injury to the hip, discrepancy in the length of legs, sacro-liliac joint dysfunction, “holding urine,” and exercises such as Pilates that emphasize “core-strengthening.”


Pain upon penetration, soreness, “pressure in the vagina,” pain upon sitting, tightness, throbbing, aching, stabbing, “spasm, ” urinary frequency, hesitancy, incomplete emptying, constipation, rectal fissures, generalized vulvar burning.


Diagnosis can be made by a physician or physical therapist trained in assessing the pelvic floor muscles (most gynecologist do not know how to do this).  Electromyography (EMG) and perineometry are two additional tests that can be used to confirm the diagnosis.


Treatment options include: pelvic floor physical therapy by womens’ health physical therapists (www.womenshealthapta.org), muscle relaxants such as diazepam, warm baths, hypnosis, meditation, Yoga, biofeedback, and injections of Botox.