How much do you actually know about what the pelvic floor is - and what it needs from you?
Jo Gipson is a pelvic health physiotherapist (Instagram @jogipsonphysio, jogipsonphysiotherapy.com) who works with people experiencing vulvodynia, vaginismus, and other pelvic pain conditions. This is part one of a two-part series. In this episode, Jo covers the fundamentals: what the pelvic floor is, why it matters for these specific conditions, and why the standard advice about it - primarily "do your Kegels" - misses the point for most people with hypertonic presentations.
Pelvic floor anatomy: what it is and why it matters here
The pelvic floor is a group of muscles, connective tissue, and nerves spanning the base of the pelvis. It supports the pelvic organs, manages pressure changes in the abdomen, plays a role in bowel and bladder function, and is integral to sexual function. For people with vulvodynia and vaginismus, it is often chronically hypertonic - held in a state of excess tension - which contributes directly to pain and to the involuntary muscle contraction that characterises vaginismus.
Understanding the pelvic floor as a set of muscles that can be overly tight, just as shoulder muscles or jaw muscles can be, changes the framework for treatment. It means the goal is often not strength but relaxation, coordination, and range of motion - the ability to both contract and fully release. This fundamental reframe is what this episode builds on.
"When the pelvic floor is relaxed at the bottom of the pelvis, you can imagine a bowl sat on a table. But often we find that when the muscles become too tense or overactive, it's almost as if that bowl has lifted and become inverted - so the muscles are no longer supporting from below but creating tension instead."
The Kegel myth: why more contraction isn't the answer
The Kegel exercise has a legitimate place in pelvic floor rehabilitation - for people with weakness, with prolapse risk, or with incontinence driven by under-active muscles. For people with vaginismus or vulvodynia, however, where the presenting issue is chronic hypertonic tension, adding more contraction to the system is not only unhelpful but can worsen symptoms. Jo is direct about this: the recommendation to do Kegels, which most people with these conditions will have received at some point, is frequently the wrong advice.
Downtraining - learning to consciously release the pelvic floor, to breathe into it, and to bring resting muscle tone down - is what most people with these conditions actually need. Jo explains how this is assessed in physiotherapy and what the experience of a hypertonic versus a normally toned pelvic floor actually feels like from the inside, which helps people begin to develop the body awareness needed for therapeutic work.
"Often people talk a lot about kegels and having strong muscles, and they only really talk about them during pregnancy. But it's really important that these muscles behave like any other muscle - and for most people with vaginismus and vulvodynia, the goal isn't strength. It's learning to release."
Why both relaxation and coordination matter
A common oversimplification of pelvic floor treatment for vaginismus is that the goal is pure relaxation - just get the muscles to stop contracting. Jo offers a more nuanced picture: a healthy pelvic floor is not permanently relaxed but is able to respond dynamically, contracting when needed and releasing fully at rest and during sexual activity. The goal of physiotherapy is not a permanently slack pelvic floor but a coordinated one that can respond appropriately.
This distinction matters because it changes the long-term picture of what recovery looks like. It's not about switching the pelvic floor off permanently - it's about restoring normal range of motion and voluntary control. Understanding this prevents the kind of overcorrection that can happen when someone takes the "just relax" message too literally.
"When we're thinking about penetration - whether it's tampon, speculum for a smear test, et cetera - dilators can be a really good tool. And I know that's something that a lot of people use for self-treatment. But they work very differently within a physiotherapy programme than as a standalone intervention."
Practical treatment approaches: from breathwork to dilator use
Jo describes the typical sequence of pelvic floor physiotherapy for vaginismus and vulvodynia: beginning with breath work to create a connection between respiratory and pelvic floor function, moving through manual techniques and internal assessment when appropriate, and progressing to dilator work as part of a graded, guided process rather than a self-directed homework assignment.
The dilator conversation is particularly useful. Jo is clear about what dilators can and can't do on their own - they are a tool that becomes useful in the context of the broader physiotherapy work, not a standalone treatment. Understanding where they fit in the sequence, and what the physiotherapy provides that dilators alone don't, helps people use them more effectively and with less frustration.
