Lifelong vaginismus is a condition where a person experiences pain or difficulty with vaginal insertion from the first attempt. This could include the insertion of a tampon, gynecologic speculum, finger, penis, or sex toy. Many patients report, "I always had trouble with tampons" and may avoid using them altogether. They might also avoid pelvic exams and face significant challenges with receptive sexual activity.

Pelvic trainers, also known as dilators, vaginal trainers, or accommodators, can be effective tools for addressing lifelong vaginismus. However, as a pelvic health clinician, you may have noticed that some patients reach a plateau, getting "stuck" at a certain size trainer. Lifelong vaginismus is believed to be due to uncontrolled spasms of the pelvic floor muscles surrounding the vaginal opening. These spasms can hinder the insertion of progressively larger trainers and are not easily managed through passive stretching alone.

Instead, combining passive stretching with techniques like breathing and contract-relax exercises can be beneficial. Using muscle contractions may seem counterintuitive, but they can effectively promote muscle relaxation and control. Let's explore four scientific perspectives on how this works.