I learned the term “Hulk vagina” from an audience participant when I gave a pelvic health 101 presentation, and guess what… It stuck! Hulk vagina refers to overly active pelvic floor muscles, or excess pelvic floor tension.

As amusing as it is (and — I pray — not offensive to anyone), “Hulk vagina” is actually a misnomer. First, it implies that the vagina is strong/bulky, but we’re actually referring to the muscles that surround the vagina (not the vagina itself). Secondly, “Hulk vagina” suggests STRENGTH, but overactive pelvic muscles are simply that: overly active. Often, the muscles aren’t truly “strong” (i.e. effectively and efficiently able to do what they’re supposed to do)… Rather, their “strength” (read: hyperactivity) is misused and the muscles end up TENSE and STUCK.

They might be “strong” in the sense that the muscle fibers are firing, but they’re NOT doing their job. They’re simply “on”— overly “on,” in fact — and are unable to turn off.

What is a "hulk vagina," and how do I know if I have it? | Overactive pelvic floor muscles | #womenshealth | FemFusion Fitness

I encountered many hulk vaginas when I was in clinical practice as a women’s health physical therapist.

Vaginismus is an extreme example of this situation.

Before I go on: please know that I am ABSOLUTELY NOT making fun of — or making light of — vaginismus when I refer to “Hulk vagina;” rather, I hope to catch people’s attention and bring some AWARENESS to the conditions of vaginismus and pelvic floor hyperactivity.

Vaginismus is when the muscles that surround the vagina involuntarily or persistently contract when vaginal penetration is attempted. These contractions can prevent sexual intercourse (or make it very painful), and — understandably— it’s an incredibly frustrating condition! You can read my article about dyspareunia (when sex hurts) here, but a primary take-home message is that women with vaginismus should NOT be doing kegels. Rather, they should seek the care of a women’s health physical therapist. Techniques such as manual therapy, EMG biofeedback, and various methods of pelvic floor “down-training” must be done BEFORE beginning any type of “up-training” (or strengthening) program.

Do you have a Hulk vagina?

Even if you don’t have vaginismus, if you have any of the following conditions then you might have overly active pelvic floor muscles:

  • difficulty with evacuation (bowel movements and urination)
  • frequency of urination and the sensation that your bladder is always partially full (caused by the pelvic floor muscles being so tense that they don’t allow the bladder to fully release)
  • generalized pelvic pain/discomfort, including pain with intercourse
  • the feeling that “no matter how many kegels I’m doing, it’s not helping my incontinence, prolapse, etc…” (because in actuality, kegels are exacerbating an already overactive pelvic floor)

Check-in: Are you able to relax your pelvic floor?

Try a kegel. My favorite visualization is to picture your pelvic floor as an elevator. Close the imaginary elevator doors (i.e. squeeze your pelvic floor muscles around your vagina and anus) and then lift the “elevator” up to the third floor. Next, allow the “elevator” to descend (i.e. relax/release your pelvic floor contraction), and then open the “elevator” doors all the way (completely relax the pelvic floor).

Check in with yourself! Were you able to sense a difference between the contraction and relaxation phase? Could your “elevator” go up AND down?

When working on isolated pelvic strength such as kegels, or gradually progressive functional pelvic strengthening such as this progression for hiking, you must be aware of two things: the resting tension of your pelvic muscles, and the ability of your pelvic floor to contract AND relax.

If you feel that your resting level of tension is high (i.e. your bottom is always slightly clenched, or you stand with your butt tucked under), or if you can’t sense a difference between the contraction and relaxation phase of your kegel, then you might have an overly active pelvic floor… Or as we’ve been saying today, a “Hulk vagina.”

Supple and responsive pelvic floor muscles are the goal (not just “strong”).

You want your pelvic floor to be able to quickly and effectively contract, but also to fully and completely RELEASE after contraction. You want them to be sufficiently relaxed (when at rest) so that they DON’T cause discomfort, muscle fatigue, painful sex, etc. Furthermore, you want to position your body (via good posture) such that your pelvic floor muscles are always at the right level of “on” to SUPPORT your pelvic organs and be able to quickly turn “extra on” when needed, for example:

There’s a FINE BALANCE that needs to be established.

If you feel that your pelvic muscles are overly active and “Hulk-like,” seek help of a women’s health physical therapist. There is HELP! If you’re looking for a place to start learning how to relax/release on your own, read this blog post from my archives: Pelvic Drop to Relax the Pelvic Floor.

I also love hip circles and other forms of flowing, multi-planar movement for people with overactive pelvic floor muscles. Why? Because hip circles simultaneously stretch AND strengthen… They both lengthen AND tone the muscles of the pelvic floor and the entire hip and core region. Click below to read 10 reasons hip circles rock!

10 reasons hip circles rock! | FemFusion Fitness

You can also learn about alternative techniques for relaxing the pelvic floor (and reduce pain related to excess tension) using essential oils.

If you have questions about “hulk vagina” (or anything else), feel free to contact me. I cannot answer individual medical questions via email… You’ll need to see a medical professional for personalized advice. However, I’m happy to provide basic info and suggestions. And if you’re looking for a women’s health physical therapist in your area, click here for a women’s health PT locator.

Sending lots of relaxed pelvic health love your way,

Dr. Bri, PT, DPT - FemFusion Fitness