Is Your Vagina Too Tight?

Vaginal tightness could be a warning sign of hypertonic pelvic floor.

Three open-faced peach halves are in a row against a blue background.

Illustration by Jaelen Brock

Published: September 19, 2023

Key Points

Vaginal tightness is just one symptom of a condition known as hypertonic pelvic floor dysfunction.
This condition can cause other symptoms, including pain and spasms in the pelvic floor muscles.
It's important to see a doctor or pelvic floor therapist who can help you work on the right things to correct your condition—don't just start doing some Kegel exercises you found online.

Your pelvic floor matters, but it's easy for certain conditions to go unresolved, and the idea of a too-tight vagina doesn't often enter the conversation.

However, hypertonic pelvic floor dysfunction is more common than you'd think.

What is a hypertonic pelvic floor?

"The pelvic floor is the support system of your pelvis, basically a thin layer of muscles that form like a bowl around your pelvic organs and help to control your bladder, bowel and sexual function," said Sameena Rahman, M.D., a Chicago-based OB-GYN and the founder of the Center for Gynecology and Cosmetics.

Your delicate yet mighty network of muscles can malfunction with an overactive pelvic floor, causing the muscles to tighten protectively, unable to relax. This is called hypertonic pelvic floor.

"When these muscles have excessive tone, they become dysfunctional, and it essentially means they are shortened and tightened and can lead to weakness and pain," Rahman said. "The tightening leads to decreased blood flow, resulting in less oxygen going to the muscles, which in turn causes lactic acid to build up along with other inflammatory factors that eventually cause hypersensitivity to pain."

Patients can develop pelvic floor spasms and trigger points in the muscles, leading to shortened, weakened and dysfunctional muscles.

What does a hypertonic pelvic floor feel like?

There is no easy way to describe gynecological symptoms. The feeling of a hypertonic pelvic floor is difficult to define. Some describe a heavy feeling in the pelvic area. Others report incomplete emptying of the bladder, painful sex and tight muscles.

The most common symptom is pain. For Josephina Worrall, a medical translator from Leeds, United Kingdom, that pain wouldn't stop. Worrall developed a hypertonic pelvic floor after pregnancy. She was initially treated for a chronic anal fissure, and doctors were lost when her pain endured.

"The primary symptom is severe pain," Worrall said. "I can also actually feel that my pelvic floor muscles are very tight, and they get noticeably more so with physical exertion or standing for any period of time."

Worrall took control of her journey when two colorectal surgeons and two general physicians left her without answers. After scouring the internet for clues, a story like hers led to an appointment with a women's health physiotherapist who put the pieces together.

"Having this condition has felt both embarrassing and isolating—nobody has heard of it," Worrall said. "Because I look very able-bodied, I feel that people don't necessarily believe me when I talk about the intensity and disabling nature of the pain."

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What Is the Pelvic Floor and Why Does It Matter?: Exercising your pelvic floor now will save you from having to endure serious issues later.

Can High-Waisted Pants Cause Health Issues?: Your favorite flattering pair of jeans could contribute to a slew of health conditions.

When Are Kegel Exercises the Wrong Solution?: If your pelvic floor is tight, this popular physical activity may not be for you.

How can you tell if your pelvic floor is tight or weak?

A weak pelvic floor is typically associated with leaking urine or gas, decreased sensation during sex, finding it more challenging to orgasm, weak glute muscles and difficulty feeling changes during Kegel exercises.

In contrast, signs of a tight pelvic floor are usually associated with difficulties urinating or emptying the bladder, painful sex, constipation, and vulvar burning or pain.

Simple test? Try fully engaging and relaxing your pelvic floor muscles. Can you do it? Remember, a tight floor can also be weak. Seek advice from a medical professional if things don't feel quite right.

Your doctor will take a detailed history to find out if you have symptoms such as painful intercourse or trouble inserting a tampon. They will conduct a physical exam to check how well you contract and relax your pelvic floor muscles. They may do a digital rectal exam to check your rectum and anus.

Is a tight pelvic floor common?

Hypertonic pelvic floor muscle dysfunction is common. As many as 1 in 10 people have a tight pelvic floor, according to Cleveland Clinic.

Your vagina changes throughout your life. Yes, even aging affects pelvic floor muscles. If your vaginal muscles won't relax, it may be time to speak to a doctor.

What are hypertonic pelvic floor symptoms?

Signs of tight pelvic floor muscles vary and aren't always universal. Potential symptoms include the following:

Pain or pressure in the pelvic area, lower back or hips. It could also originate in one location, such as the bladder, or flare up during specific activities, such as during sexual activity or bowel movements.
Hypertonia, or hypertonic musculature. Too much muscle tone in an area can feel stiff or difficult to move.
Hypertonic contractions. Continuous contraction and release of dysfunctional pelvic floor muscles is a sign of the condition.
Sexual pain. Some people experience pain during or after sexual penetration.
Vulvar, clitoral, and vaginal pain and burning.
Inability or difficulty achieving orgasm.
Constipation. This is difficulty starting a bowel movement and feeling like you're unable to empty.
Bladder issues. These include bladder pain, frequent urination, urinary urgency or pain while urinating. Difficulty starting or maintaining a urinary stream.

What is hypertonic pelvic floor treatment?

"First-line treatment is always pelvic floor physiotherapy, best performed with a well-trained therapist that can use manual manipulation, massage, trigger-point injections, biofeedback and other techniques to release the pelvic floor of its tension," Rahman said. "Botulinum toxin works in the pelvic floor by causing muscle relaxation."

While physical therapy plays the most crucial role, vaginal wands and vaginal dilators can help to ease the tension. Other ways to help your pelvic floor include implementing relaxation techniques like meditation and mindfulness.

Medications that promote muscle relaxation, reduce inflammation and ease nerve pain can help. Vaginal creams or suppositories used at night encourage muscle relaxation.

Avoid treatments inspired exclusively by Dr. Google. Physical therapists who specialize in pelvic floor health will tell you which exercises to focus on and which to avoid.

"It is very important for people to understand that it may relapse and recur, so maintaining healthy habits and having a toolbox of strategies to help prevent pain if it starts to worsen is very helpful," said Victoria Scott, M.D., a Los Angeles-based female pelvic medicine and reconstructive surgeon, and medical advisor for Flo Health.

Can you get corticosteroids or Botox for tight pelvic floor muscles?

"If you have an area of the pelvic floor that is particularly tight and painful and does not respond to pelvic floor physical therapy, we can inject it with corticosteroids or botox to help the muscles relax," Scott said.

A trigger-point injection is performed in a clinic or operating room while under sedation. This treatment is applied to patients with associated nerve pain or damage, such as the central nerve innervating the pelvis.

Are there any hypertonic pelvic floor exercises or stretches to help?

Exercises for the hypertonic pelvic floor are plentiful; however, you'll want to speak to your doctor before beginning. You don't want to choose the wrong exercise and potentially make the problem worse.

A great beginner option could include a low-impact yoga routine. Beneficial poses and exercises include the following:

Cat cow
Pelvic tilts
Happy baby
Child's pose
Deep diaphragmatic breathing
Pigeon pose
Kneeling hip flexor stretch
Seated adductor stretch
Lumbar knee rotations

"The pelvic floor exercises do not take long, depending on the severity of your condition," said Courtney-Jane Morren, BS.c., a London-based pelvic health and musculoskeletal physiotherapist. "It may only take two to five minutes to complete a few times per day. Regular engagement with the exercises is key to continue building strength."

Can sex help hypertonic pelvic floor?

Sexual activity won't necessarily help. Penetrative sex could be more difficult for some people with pelvic floor dysfunction. However, it could be a worthwhile experiment.

"Great consensual sex can help a lot of conditions, including hypertonic pelvic floor," Morren said. "The involuntary contractions that occur during orgasm give way to muscle and brain relaxation, both of which help hypertonic pelvic floor."

Do Kegel exercises make a tight pelvic floor worse?&

Kegel exercises have been marketed as the catch-all cure for all vaginal health issues, but they aren't appropriate for every case.

"You do not want to do Kegel exercises when you have a tight pelvic floor," Scott said. "Some women with a tight pelvic floor can also have a weak floor that needs to be strengthened over time, but you want to start with relieving the tension first.

"It is important to do this under the supervision of a pelvic floor physical therapist to ensure the tight pelvic floor is adequately treated before you start to work on strengthening."

Does hypertonic pelvic floor affect your period or pregnancy?

"A hypertonic pelvic floor does not impact periods, but you may find that your pelvic pain flares around the time of your period if you have endometriosis, or if there is a hormonal component to your pelvic pain," Scott said.

Some anecdotal evidence suggests that the tightness makes period cramps more painful.

How can you reduce your risk of hypertonic pelvic floor?

"Many people hold stress in their pelvic floor muscles in the same way they hold stress in their shoulders and neck, so making sure you include daily activities for stress reduction in your life is important," Scott said.

The best preventive option is monitoring pelvic floor health. This condition can take time to develop. Clothing choices make an impact. It might be time to retire your favorite high-waisted pants for something a little less constricting.

Other amplifying factors include the following: