Hypertonic Pelvic Floor Muscle Dysfunction

This condition is also known as vaginismus 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).

Treatment options include: pelvic floor physical therapy, muscle relaxants, warm baths, behavioral health approaches and Botox.

The pelvic floor muscles, also known as the levator ani and coccygeus muscles, support the internal organs and pelvis, help to maintain urine and fecal continence, and are involved in sexual function. Pelvic floor muscle dysfunction (PFMD) is used to describe when there is abnormal tone, pain, shortening, spasm, discoordination, weakness, or impaired contractile properties within the pelvic floor muscles. PFMD can be subcategorized as either being high-tone of low-tone.

High-tone pelvic floor (HTPF) muscle dysfunction is used to describe the pelvic floor muscles when there is pain, spasm, shortening and/or tightness at rest. Myofascial trigger points and tender points within the pelvic floor musculature can also be found in cases with HTPF. HTPF is usually present in women suffering from pelvic and sexual pain syndromes. HTPF muscles feel thick, taut, hypertrophied, and resist passive stretch. Low- tone pelvic floor (LTPF) muscle dysfunction describes the pelvic floor muscles when there is weakness, poor recruitment upon attempted contraction, laxity, or lengthening at rest. LTPF is commonly found in women suffering from incontinence, childbirth trauma, low back pain, pudendal denervation, orgasm dysfunction, pelvic organ prolapse, and genetic hypermobility syndromes. The muscles feel atrophied or thin, loose, and the vaginal vault may feel wider. Upon palpation there is usually absent pain of the pelvic floor muscles.

If a diagnosis of hypertonic pelvic floor muscle dysfunction is made then treatment can consist of pelvic floor physical therapy (by trained womens’ health physical therapists,), muscle relaxants, biofeedback, and Botox injections.

Sex therapy and/or cognitive behavior therapy can be useful in women who feel that anxiety or other psychological issues play a significant role in their dyspareunia.