Vaginal tightness can be caused by vaginal atrophy, vaginal scarring, pelvic floor muscle spasms (vaginismus), or a combination.
Vaginal atrophy is thinning and dryness of the vaginal tissues. It happens when estrogen levels drop during and after menopause or because of cancer treatments -- such as hormonal therapy -- that lower estrogen levels. Vaginal dryness can cause pain or burning at the vaginal opening and pain on penetration. The vagina may also feel like it is tight.
There are several ways to help deal with vaginal tightness and lessen penetrative pain or discomfort, whether with pelvic exams, vibrators, or intercourse. Here are some ideas:
- Bearing down. This is the opposite of a Kegel exercise -- pushing gently as though you are having a bowel movement or coughing.
- Daily massage of your vaginal opening with oil. Lynn Wang, M.D., sexual health specialist at Lankenau Hospital in Wynnewood, PA, says, “Different oils have different properties, but unfortunately, these aren’t well studied for vulvovaginal atrophy. Nevertheless, commonly recommended oils are vitamin E, mineral oil, and coconut oil. I tend to recommend organic sunflower oil, for its skin healing properties.” You can incorporate vaginal massage into your daily routine by putting 2-3 drops of oil onto the pad of your thumb. Then, insert your thumb about 1-2 centimeters into your vagina, focusing on the outer, bottom half of the vagina and gently massaging the oil into your skin for 10–15 seconds. This technique targets the most problematic area for most women with vulvovaginal atrophy. One important note: Oils should not be used with latex condoms, as they can lead to condoms breaking.
- Vaginal dilators are graded-sized vaginal inserts, usually made of plastic or silicone, that help lengthen and widen the vagina and its opening. They can also help stretch any vaginal scar tissue that may contribute to pain and discomfort during vaginal intercourse. (Scarring may be caused by pelvic surgery, radiation, or trauma and injury). Learn more about vaginal dilators and how to use them.
- Vibrators: Many women use vibrators regularly. Using vibrators can increase pleasure whether alone or with a partner. Using a lubricated vibrator also may help maintain vaginal health and prevent or reverse vaginal narrowing .
- Physical therapy to help treat pelvic floor spasms (vaginismus): Pelvic floor physical therapists have specialized training in the treatment of vaginismus and other issues that may contribute to pelvic floor dysfunction, including chronic pelvic pain or incontinence. In this technique, a physical therapist helps relax and stretch vaginal muscles through gentle exercises and massage. The physical therapist will also teach you exercises to do at home to help strengthen your pelvic floor. Visit the American Physical Therapy Association’s section on Women’s Health to find a physical therapist in your area.
Laser treatments: You may have heard of vaginal laser treatments to help treat vaginal atrophy. The manufacturers of these energy-based devices say the procedure helps blood flow return to the vagina, promoting healthy tissue growth.
However, on July 30, 2018, the U.S. Food and Drug Administration (FDA) issued a warning about energy-based devices used to treat vaginal conditions and symptoms related to menopause, urinary incontinence, or sexual function. Currently, no vaginal laser device or procedure is cleared or approved by the FDA to treat any of these vaginal issues. The FDA is concerned that the safety and effectiveness of the devices hasn’t been proven in scientific studies and that using the devices could lead to serious side effects, including vaginal scarring and burns. Much more research and long-term follow-up is needed to futher understand how safe and beneficial this technology really is.