Vaginismus and fertility: Can vaginismus affect your ability to get pregnant?
An interview with Courtney and Apaarna from Cornerstone Physiotherapy
On EP45 of My Fertility Podcast welcome to this special pelvic health and physiotherapy discussion. Today, Courtney and Aparna are joining us from Cornerstone Physiotherapy in Richmond Hill, Ontario. Courtney has been a physiotherapist for over 15 years, with 10 of those years specializing in pelvic physiotherapy. Aparna also specializes in pelvic health and treats both male and female patients with a range of pelvic floor conditions.
Welcome, both of you!
Courtney & Aparna: Thank you for having us!
About Cornerstone Physiotherapy
Let’s start by learning about Cornerstone Physiotherapy. What kind of treatments do you offer?
Courtney and Apaarna: Cornerstone Physiotherapy started in 2008 in downtown Toronto and has since expanded to seven clinics across the Greater Toronto Area. We are physiotherapist-owned and operated, and our primary focus is physiotherapy. However, we also offer services like massage therapy, occupational therapy, dietetics, and pedorthics.
All of our physiotherapists are trained in musculoskeletal (MSK) treatment, which involves treating muscles, bones, and ligaments for conditions like sprains, total knee replacements, and back pain. Additionally, we have specialized programs in vestibular physiotherapy (dizziness and vertigo treatment), long COVID rehabilitation, and pelvic physiotherapy.
One thing that sets us apart is our model of care: one-on-one patient sessions, private treatment rooms, and a strong emphasis on mentorship and professional growth.
What is Pelvic Physiotherapy?
Many people, including healthcare practitioners, don’t fully understand pelvic physiotherapy. Can you explain what it is and who benefits from it?
Courtney and Apaarna: Pelvic physiotherapy is a specialized branch of physiotherapy focused on the pelvic region, including the pelvic floor muscles, ligaments, and connective tissues. It requires advanced postgraduate training, so not all physiotherapists practice this specialization.
Pelvic physiotherapists treat a variety of conditions, including:
- Urinary incontinence (loss of bladder control)
- Pelvic pain
- Sexual dysfunction
- Pelvic organ prolapse (when pelvic organs drop due to weak muscles)
The assessment determines whether a patient’s symptoms are due to muscle weakness, tightness, or other dysfunctions. Treatment is highly individualized, and while internal examinations are common, they aren’t always necessary at the start.
What is the Pelvic Floor and Why is it Important?
Before we dive deeper, can you define the pelvic floor and its significance?
Courtney and Apaarna: The pelvic floor is a group of muscles that are both external (in the vulva) and internal. These muscles serve multiple functions:
- Support: Acting like a hammock at the bottom of the pelvis, supporting organs like the bladder, uterus, and rectum.
- Continence: Helping control urination and bowel movements.
- Sexual function: Contributing to sexual sensation and orgasm.
- Fluid regulation: Assisting in managing circulation and swelling in the pelvic area.
What is Vaginismus?
One major topic today is vaginismus. Can you explain what it is and how it’s treated?
Courtney and Apaarna: Vaginismus is when the pelvic floor muscles involuntarily tighten around the vaginal opening, making penetration painful or impossible. The severity varies—some individuals can tolerate some insertion with discomfort, while others feel like there’s a barrier preventing penetration altogether.
There are two types:
- Primary vaginismus: Pain or inability to insert anything from the first experience, whether it’s a tampon or intercourse.
- Secondary vaginismus: Occurs after a period of pain-free penetration but develops due to trauma, medical procedures, childbirth, or emotional stress.
Treatment focuses on pelvic floor awareness, breathing techniques, pain education, and progressive desensitization using external touch, internal examination, and dilator therapy. The goal is to teach the muscles to relax and normalize responses to touch.
Seeking Help for Vaginismus
How does someone differentiate vaginismus from other causes of painful intercourse?
Courtney and Apaarna: A family doctor is a good starting point to rule out infections, STIs, or hormonal issues like genitourinary syndrome of menopause (GSM), which results from estrogen loss. If medical causes are ruled out and pain persists, a pelvic physiotherapy assessment can identify muscle-related issues.
Addressing Fear and Embarrassment
Many patients feel ashamed or hesitant to seek help. How do you address these fears?
Courtney and Apaarna: We provide a safe, supportive, and judgment-free environment. We remind patients they are in control of the pace and emphasize small victories. Open communication is key, and even tolerating external touch is a big win for many patients.
What Happens in a Pelvic Physio Appointment?
Can you walk us through a first pelvic physio appointment?
Courtney and Apaarna: The session lasts one hour and starts with a detailed conversation to understand symptoms, fears, and goals. We explain the pelvic floor using models before any physical examination.
Physical assessment begins externally—often on the inner thighs—before progressing to the vulva and, if comfortable, internal muscles. We move at the patient’s pace, ensuring a pain-free approach.
Do You Need to Shave for a Pelvic Physio Exam?
Let’s settle this —do you care about leg or pubic hair?
Courtney and Apaarna: Absolutely not! We don’t care about shaving or grooming. Your health is what matters.
Partners and Their Role in Treatment
How can partners support someone undergoing treatment for vaginismus?
Courtney and Apaarna: Partners can play a vital role emotionally and physically. We encourage them to attend sessions, learn about the condition, and participate in desensitization exercises. Trust-building is crucial, and partner involvement can improve outcomes.
Pelvic Physio for Erectile Dysfunction
I recently learned that pelvic physiotherapy can help with erectile dysfunction. Can you explain how?
Courtney and Apaarna: Yes! Many men don’t realize they have a pelvic floor, but tight or weak pelvic muscles can contribute to erectile dysfunction. Treatment includes muscle relaxation, awareness training, and strengthening exercises to improve blood flow and sensation.
Cost and Booking an Appointment
How can someone book an appointment with you? And what are the costs?
Courtney and Apaarna: No doctor’s referral is required, though some insurance plans may request one. Unfortunately, pelvic physiotherapy isn’t covered by OHIP, but many extended health benefits cover it.
- Initial assessment (1 hour): $150
- Follow-up sessions (30 minutes): $90-$100
Appointments can be booked online or by phone.
Any final messages?
Courtney and Apaarna: If you’re struggling with pelvic pain or vaginismus, you are not alone. Many people delay treatment due to fear, but help is available, and treatment is highly effective. Take the first step toward healing—your future self will thank you!
Thank you both for this enlightening discussion! We look forward to having you back to explore pelvic physiotherapy for pregnancy and postpartum care.
Courtney & Aparna: Thank you! We’d love to come back!
This episode was released February 2025.