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the look on your face when inserting a tampon is painful
Illustration by Josh Christensen
As Ashley Broadwater was researching an article she was writing for the website Giddy on the vasovagal repsonse and why inserting a tampon is painful, she reached out to me for my opinions on the causes of and solutions for this common issue. Here is a brief synopsis of the article along with a link to the full article below.

Heather Jeffcoat, DPT

Find Out Why Inserting a Tampon is Painful

Feeling dizzy and nauseous after putting in a hygiene product? Doctors have some theories.

As mentioned throughout our website, there are a multitude of potential causes of painful penetration, some with overlapping symptoms. A proper diagnosis will always include a deep dive into the background issues that led to the condition, including both physical and emotional causes. And when these issues coincide they can lead to what is called a "vasovagal response":

A vasovagal response is when a bodily trigger causes you to faint.

For people with a sensitive cervix, this reaction is caused by the tampon touching the cervix," said Somi Javaid, M.D., a board-certified OB-GYN in Ohio and one of three founders of HerMD, a female-founded healthcare startup.

Symptoms of this type of episode include paleness, nausea, sweating and, yes, fainting. Treatment for a vasovagal episode can include trigger avoidance or medication.

If any of the above rings true, you may have what is known as a "friable cervix". Causes may include:

  • Sexually transmitted diseases (STDs)
  • Vaginal atrophy
  • Hormonal imbalance

Firast things first of course, consult with your physician or gynecologist if you suspect any of the above to be the case.

Your sympathetic nervous system was engaged

When faced with imminent physical danger, the human body’s sympathetic nervous system triggers our "fight-or-flight" response. The sympathetic nervous system is a normally harmonized network of brain structures, nerves and hormones that, if thrown off balance, can result in serious complications. Click here for a full explanation of the sympathetic nervous system at LiveScience.com.

If your body perceives inserting a tampon as a threat, it will engage our sympathetic nervous system, which may produce the physical effects. Putting something inside you—especially in your vagina, where you may have experienced trauma, pain or shame around penetration—could feel foreign or nerve-wracking.

People who experience chronic pelvic pain or high levels of depression and/or anxiety are more likely to have sensitive nervous systems, too. In other words, inserting a tampon may be perceived as painful, even though it is a non-painful stimuli.

You have toxic shock syndrome

Toxic shock syndrome (TSS) is a less likely cause, but it's best to ascertain if you have it.

Although more rare these days than when it first hit the news in the 1980s, toxic shock syndrome is still one possible reason why inserting a tampon is painful. It has been linked to everything from glyphosate in the (non-organic) cotton used to make tampons, to exposure to dioxins and other manmade chemicals including fragrances.

It's also important to rule out toxic shock syndrome with your physician, as that can also make you feel hot due to a fever but has other potentially life-threatening symptoms of diarrhea, widespread sunburn-like rash, dizziness or fainting, headaches and bloodshot eyes.

How to keep tampon insertion from disrupting your life

Once TSS has been ruled out, to get at the root of what can help you avoid the effects of the nervous system, a team of providers may be necessary. If you experience pain, a pelvic floor therapist, pain management physician and/or acupuncturist may need to be on your team to reduce or get you out of your pain cycle. If you don't feel pain, a psychotherapist or pelvic floor physical therapist can help with anxiety and nervous system regulation.

Change the tampon you use and how you insert it

Trying different brands and/or sizes may give better results, and you might also try switching up how you insert the tampon.

We recommend inserting the tampon in a different position; for instance, laying down or sitting on the toilet and bearing down to try to make the dizziness go away. Having a fan blowing nearby may help, too.

Try 'rainbow breathing'

One essential function that can help reduce your feelings of anxiety or other unregulated nervous system effects is deep, lateral breathing, sometimes called 'rainbow breathing' in the pediatric population.

To use this breathing technique:

  • Get into a comfortable position.
  • Inhale as deeply as is comfortable for you. Feel your rib cage expand forward, to the sides and back.
  • As you inhale, reach your arms overhead, then bring them down to your sides as though you're making a rainbow with your arms.

Hopefully this article has shed some light on the causes of painful penetration and why inserting tampon is painful. Click here to read the original article at Giddy.com, and use this simple contact form if you'd like to make an appointment at one of our offices.

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I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

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I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

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My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

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A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

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