Why does it hurt to put a tampon in?

Sometimes putting tampons in can be painful.

I don't like to associate things as "good" or "bad", but what I will say is that if you are experiencing this, it does not have to be your normal and there is an explanation and also solutions for this.

Menstruation is honestly not fun already... We don't have to add pain on top of it!

This blog will talk about why I have seen patients have pain when inserting a tampon and what you can do about it. 

Common reasons it hurts to insert a tampon

There are a few different reasons why it may hurt to put a tampon in. I'm going to name a few below. 

1. Pelvic floor muscle tightness or a hypertonic pelvic floor: if your pelvic floor muscles are tightened or shortened, you can have pain when you insert a tampon because the muscles are unable to relax accordingly. I expand more on this below.

2. Irritation of the external tissues: if there is an irritation around the vaginal opening, the tampon could cause mild irritation when it touches that area. Irritation of that tissue can come secondary to things like skin infections, general skin sensitivities, and friction from underwear/clothing.

3. Vaginal dryness: if there is dryness in and around the vagina, a tampon could cause irritation when contacting and moving through the tissue. This can be secondary to things like perimenopause, some medications, and other health conditions.

4. Scar tissue: if you have existing scar tissue from previous trauma, which could have happened during something such as childbirth, you may experience some sensitivity in the area. 

5. How you insert a tampon: your position and how you stand and/or sit to insert a tampon can affect how it feels for the tampon to be inserted. Everyone's anatomy is just a little bit different, so just because one position works for one person doesn't mean it will work for you!

Additional symptom you may notice

Oftentimes, "pain" is not the only symptom that is experienced by patients who have discomfort with tampon insertion.

I've had patients tell me it feels like they are hitting a wall when they insert a tampon, and that they sometimes have burning, tingling, or aching as well. You may notice a collection of these symptoms and determining the why is what matters- because once we know that, we can address everything else downstream.

The role of pelvic floor muscle tightness for tampon insertion

I'd be remiss if I didn't talk more about pelvic floor muscle tightness and the role of the pelvic floor muscles in pelvic pain with tampon insertion in detail.

The pelvic floor has direct influence on the opening of the vagina where you insert a tampon as it is a group of muscles, ligaments, and connective tissues that form the base of your pelvis. They wrap directly around the vagina/vaginal opening.

When you insert a tampon, you need to pass through the tissues that the pelvic floor muscles have an influence over.

That means that if those muscles are tight and they're unable to relax accordingly (whether that is from stress, a history of painful experiences, a nervous system that is on guard, or previous injury), it's pretty easy for that tension to make the vaginal opening tighter, narrower, or completely closed off.

That means inserting a tampon through that area would not feel good.

The effect of the nervous system and when to see a pelvic therapist

One of the main reasons why it's important to address tampon insertion pain as early as possible, if you are noticing it more often than not during your cycle, is because of the nervous system component.

My interest as a pelvic PT is in making sure that you do not have pain, of course. But I also worry about long-term pain and how your nervous system adjusts to that.

One of the side effects of ignoring tampon insertion pain is that our nervous system will actually start to anticipate pain before you even begin the insertion of the tampon. That anticipation will cause a reflexive tightening of the area, which will make insertion that much harder.

...and suddenly we're fighting a battle with reflexive tightness on top of whatever else may be the "root cause" of the insertion pain to begin with.

We call this the pain and tension cycle.

And that's exactly why I would vote for seeing a pelvic therapist sooner rather than later if you are experiencing tampon insertion pain.

That way, we can address whatever is causing the initial pain without having the nervous system take over and then needing to address the reflexive tightness as well.

Please know that there is a solution no matter where you are at in the process.

How pelvic PT helps decrease tampon insertion pain

So what can you expect if you decide to work with a pelvic floor physical therapist to address pain with tampon insertion?

First, we'll do a thorough assessment to figure out what's going on. This will include:

• Discussing your symptoms and medical history as well as how you specifically insert a tampon (and education around how to make that more comfortable)

• Assessing your pelvic floor muscles (both externally and internally, always with your consent)

• Evaluating your posture, breathing patterns, and overall muscle coordination

• Checking for any scar tissue or restrictions that may be present

Based on that exam, I'll create a personalized treatment plan just for you.

Treatment might include:

• Pelvic floor muscle relaxation techniques: Learning how to consciously relax and release tension in your pelvic floor muscles.

• Manual therapy: Hands-on techniques to release tension, improve tissue mobility, and address scar tissue restrictions.

• Breathing techniques: These can help calm your nervous system and reduce muscle tension and allow for muscle relaxation.

• Education: Understanding what's happening in your body and why, and learning strategies related to positioning and breathing for more comfort during tampon insertion.

• Addressing other contributing factors: We might also work on things like constipation or bladder irritation if they seem to be driving your pelvic floor tightness.

• Breaking the pain and tension cycle and nervous system treatment: If your nervous system is expecting pain, breaking this cycle is one of the main goals of pelvic floor physical therapy. We can help retrain your nervous system and your muscles to relax and release before tampon insertion.

Where to find Pelvic PT in Durham

If you're local to Durham, NC or the surrounding areas, I would love to help you figure out what's causing you to have pain when inserting a tampon and create a plan to get you back to being able to use tampons without fear. Pelvic PT can truly help you resolve these symptoms.

I'm here to help, and I'm looking forward to working with you!

To get started, reach out to schedule with me by filling out the contact form located here. You can always view my pelvic therapy rates on my website (transparency first).

Next on your reading list:

1. Sharp pain after being sexually active? What it could be and what to do

2. What’s the best way to treat persistent pelvic pain?

3. Pelvic floor and tailbone pain