Vaginismus is a complex condition involving involuntary contraction or clenching of the pelvic floor muscles which prevents vaginal penetration. Vaginismus can be associated with pain in the vagina, pelvis, low back, and hips, and is often a highly distressing condition.
Due to the physiological processes that are often associated with vaginismus, the walls of the vagina itself may become fragile and bleed.
This can occur because of clenching in the pelvic floor muscles causing compression on the nerves and blood vessels of the vagina thus causing the walls of the vagina to be thinner and receive less circulation.
Additional causes can include hormone changes associated with being post- partum, breastfeeding, and peri menopausal. Cancer treatments including surgery, chemotherapy, radiation, and hormone suppression therapy can also result in these changes to the vagina.
This thinning and lack of moisture in the vagina can result in small amounts of bleeding or spotting with use of vaginal dilators or during intercourse. Small amounts of bleeding can be remedied using the following techniques, however heavier bleeding (more than a teaspoon) requires follow up with a doctor.
There are many different types of lubricant on the market and each person has unique needs and desires when it comes to the ingredients and attributes of a lubricant.
Water based lubricants are best when working with medical grade silicone dilators. Some people prefer to use organic or natural oils such as coconut or avocado oil because they prefer the consistency.
One mistake that many people with vaginismus make is not using enough lubricant when using their dilators or when having sex.
When using dilators be sure to use at least 1-2 tablespoons of lubricant on the first 1-2 inches of the dilator and prime the vulva and vaginal canal by gently placing lubricant on them before using the vaginal dilator.
Additionally, you help provide moisturization to the inside of the vagina by loading a vaginal lubricant into a suspension syringe and pressing the lubricant up and into the vaginal canal multiple times per day.
Some people find it is easiest to keep the lubricant and suspension syringe in their personal bathroom and use it to apply lubricant after using the toilet, or in their purse or backpack if they are out of the home for the day.
You can gently improve mobility of the vaginal walls using a smooth medical grade silicone dilator and the clock technique. Often the walls of the vagina will bleed when they are dry and thin and experience friction.
Many people with vaginismus us vaginal dilators or trainers to help train their body for pain free penetration, however many are unclear on how to use their trainer.
Using the dilator in a gentle manner while practicing deep and even breathing techniques is beneficial and helps to protect the vaginal skin. Using the clock technique while using a dilator can be beneficial as well.
This involves envisioning the vaginal opening as a clock. To begin, place the dilator into the vagina at 1 inch depth and then gently press downward at the 6 o’clock position, holding pressure as if you were checking a tomato for ripeness for 30 seconds.
Then lift the dilator and repeat in the 7 o’clock position, moving through all positions on the clock. Many people find discomfort at the 12 o’clock position due to the location of the urethra and it is generally a good idea to skip this position.
The clock technique is beneficial as a warmup before a dilator training session wherein the vaginal dilator is used at full depth, or as a its own training plan when the walls of the vagina are more fragile.
If you notice bleeding after using a vaginal dilator or other stimulation such as intercourse, take one to two days off before returning to activity to allow your body to heal and restore.
During this time, you can apply a cream or balm onto the vulva to help ensure moisturization and assist with healing the outside of the vagina.
Some people with vaginismus who experience bleeding can benefit from a compounded cream to help optimize the health of their vaginal tissue. These creams range from organic to those that include estrogen and other hormones to help improve vaginal health.
Estrogen creams can be a great tool to improve flexibility of the vaginal walls in some people. Hyaluronic acid is another ingredient used in compounded creams that is known to improve moisture to the skin and tissue.
Small amounts of bleeding with vaginismus may be remedied by providing adequate moisturization and gentle improvements in flexibility of the vaginal tissue. If bleeding persists be sure to see your health care provider as further medical treatment or testing may be warranted.