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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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Testimonial by J.H.

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.

Read more: Testimonial by J.H.

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

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