Pelvic Floor Exercises for Vaginismus: Strengthening, Relaxation, and Recovery

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional — such as a pelvic floor physiotherapist or gynaecologist — before beginning any new exercise programme, particularly if you have a diagnosed pelvic floor condition.

When most people hear “pelvic floor exercises,” they think of Kegels — squeezing the muscles to build strength. But for women living with vaginismus, the opposite skill is often what matters most: learning to relax those muscles. A comprehensive approach addresses both strength and release, helping you regain voluntary control over muscles that have been operating on autopilot.

This guide covers the anatomy of the pelvic floor, why both strengthening and relaxation are essential for vaginismus recovery, specific exercises you can practise at home, and how to integrate them with dilator therapy for lasting results.

What Is the Pelvic Floor and Why Does It Matter?

The pelvic floor is a group of muscles, ligaments, and connective tissues that stretch across the base of the pelvis like a hammock. These muscles support the bladder, uterus, and rectum, and they play a central role in urinary and bowel control, sexual function, and core stability.

In a healthy pelvic floor, the muscles contract and relax voluntarily. You tighten them when you need to (lifting something heavy, holding in urine) and release them when appropriate (during urination, bowel movements, or penetration).

In vaginismus, this voluntary control is disrupted. The muscles around the vaginal opening contract involuntarily — often in response to fear, anxiety, or anticipated pain — creating a cycle of tension, discomfort, and avoidance [1].

Why Do Women with Vaginismus Have Pelvic Floor Dysfunction?

The relationship between vaginismus and pelvic floor dysfunction is well established in the clinical literature. Clinical reviews identify pelvic floor hypertonicity — chronically elevated muscle tension — as a common feature of the condition [1][2].

Several factors contribute:

Fear-tension-pain cycle: Anticipating pain triggers a protective muscle contraction, which causes the very pain that was feared, reinforcing the cycle
Chronic stress response: Ongoing anxiety or trauma can cause the pelvic floor to hold tension persistently, much like how stress causes shoulder or jaw clenching
Lack of body awareness: Many women have never been taught to identify or consciously control their pelvic floor muscles, making involuntary patterns harder to interrupt
Previous painful experiences: A difficult gynaecological exam, traumatic birth, or sexual trauma can condition the muscles to guard reflexively

Understanding these mechanisms is important because it shapes the approach to exercise: the goal is not simply to strengthen muscles that are already working overtime, but to retrain them to release and respond appropriately.

Why Is Relaxation as Important as Strengthening?

This is perhaps the most counterintuitive aspect of pelvic floor rehabilitation for vaginismus. Traditional Kegel exercises — contracting the pelvic floor — can actually be unhelpful or aggravating if the muscles are already hypertonic [3].

Think of it this way: if you had a chronically clenched fist, the solution would not be to squeeze harder. You would need to learn to open and relax the hand before building functional strength.

For vaginismus, the therapeutic priorities are typically:

Awareness — learning to identify the pelvic floor muscles and sense when they are tense
Relaxation — developing the ability to consciously release tension (down-training)
Coordination — practising contracting and then fully releasing the muscles
Functional strength — building the capacity for the muscles to work through their full range

A pelvic floor physiotherapist can assess where you fall on this spectrum and tailor exercises accordingly. For a deeper understanding of vaginismus itself, see our comprehensive guide on understanding vaginismus.

What Are Reverse Kegels and How Do You Do Them?

Reverse Kegels — also called pelvic floor drops or down-training exercises — are the foundation of relaxation-focused pelvic floor work. Instead of squeezing and lifting the muscles (as in a standard Kegel), you gently lengthen and release them.

How to Practise Reverse Kegels

Find a comfortable position. Lie on your back with your knees bent and feet flat, or sit comfortably on a cushion. Some women find a reclined position or child’s pose helpful.
Begin with a few normal breaths. Let your belly rise and fall naturally.
On an inhale, gently “let go” of the pelvic floor. Imagine the muscles softening, opening, or dropping downward — as if you were about to begin urinating (without actually doing so). Some people find it helpful to visualise a flower opening or an elevator descending.
Hold the release for 5–10 seconds. Breathe normally throughout. You should not be bearing down or pushing — this is a gentle, passive release.
On an exhale, allow the muscles to return to their resting position naturally. Do not actively squeeze.
Repeat 10–15 times per session, 2–3 times daily.

Common Mistakes

Bearing down too forcefully — reverse Kegels should feel gentle, not effortful
Holding your breath — always maintain relaxed, rhythmic breathing
Expecting immediate results — muscle retraining takes time; consistency matters more than intensity

How Does Diaphragmatic Breathing Support the Pelvic Floor?

The diaphragm and the pelvic floor are anatomically and functionally connected — they move in concert with every breath. When you inhale deeply using your diaphragm, the pelvic floor naturally descends and relaxes. When you exhale, both the diaphragm and pelvic floor gently lift [4].

This connection makes diaphragmatic (belly) breathing one of the most effective tools for pelvic floor relaxation.

Diaphragmatic Breathing Technique

Lie on your back or sit comfortably. Place one hand on your chest and one on your belly.
Inhale slowly through your nose for 4 counts. Your belly should rise while your chest stays relatively still.
Exhale slowly through your mouth for 6 counts. Your belly falls gently.
As you inhale, visualise the pelvic floor softening and descending.
Practise for 5–10 minutes, once or twice daily.

Over time, this breathing pattern becomes automatic and serves as a powerful tool to use before and during dilator sessions, intimate moments, or any situation where pelvic floor tension tends to spike.

What Stretches Help Release Pelvic Floor Tension?

Specific stretches target the muscles of the hips, inner thighs, and lower back — all of which connect to and influence the pelvic floor.

Happy Baby Pose

Lie on your back and draw your knees toward your chest. Hold the outer edges of your feet and gently pull your knees toward your armpits. Rock gently side to side if comfortable. Hold for 30–60 seconds.

Deep Squat (Malasana)

Stand with feet slightly wider than hip-width. Lower into a deep squat, keeping your heels on the floor (use a rolled towel under your heels if needed). Press your elbows against your inner knees and lengthen your spine. Hold for 30–60 seconds.

Child’s Pose

Kneel on the floor, bring your big toes together, and sit back on your heels. Extend your arms forward and rest your forehead on the ground. Breathe deeply, directing each breath into the pelvic floor. Hold for 1–2 minutes.

Butterfly Stretch (Reclined)

Lie on your back and bring the soles of your feet together, letting your knees drop open. Place pillows or blocks under your knees for support. Rest here for 2–3 minutes, focusing on deep breathing.

Piriformis Stretch

Lie on your back with knees bent. Cross your right ankle over your left knee. Gently pull your left thigh toward your chest until you feel a stretch in the right buttock. Hold for 30–60 seconds, then switch sides.

How Can You Combine Pelvic Floor Exercises with Dilator Therapy?

Pelvic floor exercises and dilator therapy are complementary — each enhances the effectiveness of the other. Many pelvic floor physiotherapists recommend integrating the two into a single practice session.

A Suggested Combined Routine

Warm up with diaphragmatic breathing (5 minutes) — calms the nervous system and begins releasing pelvic floor tension
Perform 2–3 stretches (5–10 minutes) — choose from the stretches above, focusing on areas that feel tight
Practise reverse Kegels (5 minutes) — reinforce the conscious ability to release the pelvic floor
Begin your dilator session — start with the smallest comfortable dilator size and progress only when ready. Use plenty of water-based lubricant and maintain the breathing pattern throughout
Cool down with a few minutes of relaxed breathing — allow the body to settle

The Petala 5-Pack includes five graduated silicone dilators designed for this kind of progressive, integrated practice. Its companion app provides guided sessions, progress tracking, and personalised reminders to help build and maintain consistency.

For detailed guidance on selecting the right dilator size to start with, see our dilator size guide.

What Does a Weekly Routine Look Like?

Consistency is more important than duration. A realistic weekly schedule might look like this:

Daily (10–15 minutes):

Diaphragmatic breathing: 5 minutes (morning or before bed)
Reverse Kegels: 10–15 repetitions

3–4 times per week (20–30 minutes):

Stretching routine: 10 minutes
Dilator session: 10–20 minutes (including warm-up breathing)

Weekly (optional):

Yoga or gentle pilates class — many poses naturally promote pelvic floor awareness and relaxation
Warm bath with Epsom salts — promotes overall muscle relaxation

Adjusting Over Time

As you progress:

You may gradually introduce gentle contract-and-release cycles (a light Kegel followed by a full release), building coordination
Dilator sessions may become shorter as comfort increases
Some women find they can eventually maintain their gains with 2–3 sessions per week rather than daily

When Should You Seek Professional Guidance?

While the exercises in this article are safe for most women, working with a pelvic floor physiotherapist is strongly recommended — especially if:

You are unsure whether your pelvic floor is hypertonic (too tight) or hypotonic (too weak)
You have been diagnosed with vaginismus, vulvodynia, or another pelvic pain condition
You experience pain during any of the exercises described above
You have recently had surgery, childbirth, or a significant pelvic health event
You have been doing Kegels regularly without improvement — or with worsening symptoms

A qualified physiotherapist can perform an internal assessment, identify specific trigger points, and create a programme tailored to your needs. If you are unsure whether professional help is right for your situation, our guide on when to see a doctor can help you decide.

Frequently Asked Questions

Can Kegels make vaginismus worse? Yes, in some cases. If your pelvic floor is already hypertonic (chronically tight), standard Kegel exercises can increase tension and exacerbate symptoms. This is why a proper assessment by a pelvic floor physiotherapist is so valuable — they can determine whether you need to focus on relaxation, strengthening, or a combination of both.

How long does it take to see results from pelvic floor exercises? Some women notice improved awareness within a few weeks of consistent practice, while meaningful symptom change often takes longer. The timeline varies significantly between individuals.

Can I do pelvic floor exercises during my period? Yes. There is no medical reason to avoid gentle pelvic floor exercises during menstruation. Some women find that relaxation exercises and stretches can actually ease period-related pelvic discomfort. However, listen to your body — if you feel more comfortable skipping a day, that is perfectly fine.

Do I need any equipment for pelvic floor exercises? No special equipment is needed for the exercises described in this article. A yoga mat, a few cushions or pillows for support, and a quiet space are sufficient. When you are ready to incorporate dilator therapy, a graduated set of medical-grade silicone dilators — such as the Petala 5-Pack — is recommended.

What is the difference between a reverse Kegel and bearing down? A reverse Kegel is a gentle, controlled lengthening and release of the pelvic floor muscles. Bearing down (as if having a bowel movement) involves forceful pushing using abdominal pressure. Reverse Kegels should feel soft and passive — if you feel strain or effort, you are likely pushing too hard.

Conclusion

Pelvic floor exercises for vaginismus are not about building strength in the traditional sense. They are about restoring balance — learning to release muscles that have been held tight, developing awareness of unconscious patterns, and gradually rebuilding the confidence and control that vaginismus can take away.

Combined with graduated dilator therapy, breathing techniques, and appropriate stretches, a consistent pelvic floor routine can be transformative. Progress may be gradual, but it is real — and every session is a step toward recovery.

When you are ready to begin or continue your dilator therapy journey, the Petala 5-Pack is designed to integrate seamlessly with pelvic floor rehabilitation — with graduated sizes, body-safe silicone, and a companion app to guide you through each session.

References

[1] Chalmers, K. J. (2024). Clinical assessment and management of vaginismus. Australian Journal of General Practice, 53(1-2), 37–41.

[2] Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (2004). Vaginal spasm, pain, and behavior: An empirical investigation of the diagnosis of vaginismus. Archives of Sexual Behavior, 33(1), 5–17.

[3] Rosenbaum, T. Y. (2007). Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. The Journal of Sexual Medicine, 4(1), 4–13.

[4] Hodges, P. W., Sapsford, R., & Pengel, L. H. M. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics, 26(3), 362–371.