After you have experienced painful sex, you may tense muscles around the vaginal entrance out of fear without realizing it. The muscle tension can add to problems with pain. However, you can learn how to recognize and control tension in this muscle group. 

When cancer or its treatment has damaged the lower spinal cord, you may no longer be able to tense and relax the pelvic floor muscles at will. 

Pelvic Floor Certified Physical Therapists

A fairly new special expert in pelvic floor muscle health is the pelvic floor certified physical therapist. Academy of Pelvic Health Physical Therapy (APTA Pelvic Health) awards Certificate of Achievement in Physical Therapy (Obstetric Physical Therapy or Pelvic Health Physical Therapy) to licensed Physical Therapists (PTs) who complete requirements. You can look for a pelvic certified PT in your area with this list. 

We describe some self-help strategies in this handout, but if they are not working for you, seeing a PT is a great next step. Ideally, your gynecologist and PT can work together to help you with problems like painful sex or poor control of bladder or bowel function. 

Muscle Tension 

Tensing the pelvic muscles can be a normal reaction when you expect sexual touching or vaginal penetration to hurt. Unfortunately, muscle tension can make pain worse and, in some cases, can become chronic, causing a dull ache in the pelvis. 

On the other hand, if your vagina is still able to produce moisture and stretch during sexual excitement, tensing and relaxing the pelvic floor muscles in rhythm can increase friction against the penis (or a dilator, vibrator, or sex toy) leading to more pleasure. You may find that tensing and relaxing the muscles helps you reach an orgasm by heightening sensation in the clitoris and outer vagina. 

Kegel Exercises 

Exercises to increase a woman's control over the muscles around the vaginal entrance and urethral opening are called Kegels, named after the gynecologist, Dr. Arnold Kegel, who first described them. Some women learn to do Kegels as part of a class to prepare for childbirth, or as training to control urinary stress incontinence (losing urine when jumping, coughing, etc.). Some sex therapists believe that strengthening the muscles by doing Kegels creates a physical change, helping women reach orgasm (climax) more easily.   

The first step in learning Kegels is to find the muscles surrounding the vaginal entrance so you can learn to tense and relax them at will. 

The muscle around the vaginal entrance is connected to the muscle that you use to stop the flow of urine. Next time you need to urinate, let the flow of urine begin. Notice the sensation of relaxing the muscle. Then, try to stop the flow before your bladder is empty. You are tensing the muscle.  

If you are comfortable touching your vulva, there is a more direct way to check that you are tensing the right muscle.

• Put some extra lubricant on the tip of your finger or on a tampon that has a rounded applicator tip that is smooth and slippery. If you have a set of vaginal dilators, the smallest one should also work well.

• Find a comfortable place to lie down and make sure you have a few minutes of privacy when you will not be interrupted. You can lie back against pillows, or lie on a couch with your head resting on the arm so that you can see what you are doing.

• With your knees bent and legs apart, hold the lubricated finger or tampon at the entrance to your vagina.  It may be easier to see your vaginal entrance if you use your hands to gently spread your inner lips apart.

• Try squeezing the muscle and letting it go loose. You may be able to see movement just inside your vaginal entrance.

• When you feel the muscle is relaxed, slip the lubricated tip of the finger or tampon into your vagina. Then try tensing the muscle. You should be able to feel your vagina move a little, gently squeezing on the finger or tampon.  

A common mistake is to tense all the muscles in your pelvis and stomach instead of just the muscle surrounding the vaginal entrance. Focus just on that area and tense while trying to keep your stomach and thighs relaxed. Keep on breathing slowly in and out rather than holding your breath.   

Practicing Kegels

It helps to spend a few minutes daily practicing to gain full control of muscles surrounding the vaginal opening.

Several different techniques can be helpful: 

• Breathing through your vagina: Lie back on a comfortable surface and focus on your whole body. Take a deep breath, and as you exhale, try to let all the muscle tension in your body flow out. You may want to repeat inhaling and exhaling two or three times until you feel calm and relaxed. Now focus your attention on your vaginal entrance. As you inhale, tense the vaginal muscle, drawing it inwards. As you exhale, let your vaginal muscle go loose. Spend a few moments just allowing your breathing to find its natural rhythm, but tensing and relaxing your vaginal muscles as you inhale and exhale. 

• Tense and relax: You can lie down, sit, or even stand. If you are still having some trouble isolating the muscle, however, it is probably easiest if you lie on your back in a quiet and comfortable place. Focus on your vaginal muscle. Tense it as tightly as you can and count one-two-three. Now let your vaginal muscle go loose. Repeat the tensing and relaxing at least 10 times. If you do 10 sets of Kegels, twice a day, you will probably notice that your muscles feel a bit stronger.   

• Vaginal twitches: When you have gotten expert at the exercises above, try this option: tense your vaginal muscles tightly and release. Tense and release them in a one-two, one-two rhythm, 10 to 20 times. It may be harder to hide this exercise from someone who is watching you, so you may want to do it in privacy! 

Vaginal dilators can also be a useful tool for strengthening your pelvic floor muscles.  If you would like to read more about this, please visit our Iris resource on Vaginal Dilators.