Every week, Renova members send their questions to Nasim, and she answers them in a live Q&A. This week's questions covered how vaginismus is graded, how to prepare your body before dilator work and how to manage an endometriosis flare at home.
Below are the questions members asked, with Nasim's answers. Each question has been rewritten without names or personal details. This is general education, not medical advice, so talk to your doctor about what fits your situation.
Key Takeaways
Fatigue is a common endometriosis symptom, especially in the days before your period.
During a flare, focus on lowering inflammation, keeping your bowels regular and moving gently.
Vaginismus is graded by how your body responds to an exam, not only by how tight the muscles are.
Many women stall with dilators because they are handed a set and told to start without preparing the nervous system first.
Creating a calm, comfortable setup before dilator work helps your brain link that moment with safety.
Is Fatigue a Symptom of Endometriosis?
Yes. Fatigue is a common endometriosis symptom, and it often gets worse the closer you get to your period. Some days your energy can be very low, and getting out of bed takes real effort.
This is part of living with endometriosis. Needing more sleep or rest on those days is normal, so plan lighter days around your cycle where you can.
What Symptoms Can Endometriosis Cause Besides Painful Periods?
The best-known signs are heavy periods and severe, debilitating cramping and pain. Endometriosis can also affect other parts of your body:
Bowel: digestive and bowel symptoms
Bladder: urinary symptoms
Whole body: fatigue, inflammation, muscle aches and pain
If you have these alongside the hallmark symptoms, or endometriosis runs in your family, Nasim's free Understanding Endometriosis guide helps you connect the dots and bring them up with your doctor.
How Can You Manage an Endometriosis Flare at Home?
Keep up with the medical treatment your doctor recommended. Alongside it, focus on lowering inflammation and reducing tension, especially as your period gets closer.
Food: cut back on sugar and artificial sweeteners. Eat plenty of cruciferous vegetables, such as broccoli, cauliflower, cabbage and Brussels sprouts, which help your body break down estrogen.
Bowels: aim for regular bowel movements with enough fibre, good hydration and a footstool in the washroom to help your pelvic floor relax.
Gentle movement: pain and fatigue can limit what you do, but try not to stay still all day. Gentle stretches help, as does lying with your legs up the wall and slowly tilting your pelvis forward and back.
Breathing and body scanning: do your breathing exercises and body scans more often during a flare, and let your pelvic floor relax each time.
The goal is to reduce tension all over your body and keep inflammation as low as you can.
How Is Vaginismus Graded?
Clinicians often use the Lamont grading system, which has four grades. Pacik later added a fifth. Each grade describes how your body responds when an exam is attempted:
Grade 1: the pelvic floor muscles are tight, and there is some anxiety, but with reassurance and feeling safe, an exam is possible.
Grade 2: the muscle tension and spasm are the same, but reassurance does not help, so the exam cannot go ahead.
Grade 3: the pelvis and buttocks lift off the exam table, and an exam is still not possible.
Grade 4: along with the lifting, the thighs close and the body pulls away and guards strongly.
Grade 5 (Pacik): anxiety becomes so intense that it can turn into a strong fight or escape response, even with a trusted practitioner in the room.
Why Does the Grade of Vaginismus Matter?
The grade tells your practitioner which treatment approach is realistic for you. It also shows that vaginismus is not only about tight muscles. Muscle spasm is present at every grade. What changes is how your body and brain respond to anything coming close.
This is why many women with vaginismus never seek help. Even at a milder grade, the idea of a practitioner getting close can feel so daunting that it stops them from getting care.
A gradual program you follow at home, like Renova's Pleasure Path course, lets your nervous system calm down step by step. You become comfortable with touch and self-assessment at your own pace, without anyone else in the room.
Why Don't Dilators Work for Some Women With Vaginismus?
Often, women are given a set of dilators and told to work up through the sizes on their own. Even women with milder vaginismus can hit a point where they cannot continue. Many never start, because bringing anything close to the vaginal entrance feels too intimidating, let alone inserting it.
Nasim's approach prepares your nervous system before dilator work begins. Not every pelvic floor physiotherapist works this way, but it has helped many women get past that plateau and reach their goals, including comfortable intimacy.
As you work through each step, notice how your body responds. If you feel hesitation or guarding, give yourself more time before moving on. Gentler starting steps are there for exactly this reason.
How Do You Prepare Your Body Before Starting Dilators?
Create a relaxation space: a calm, comfortable setup that helps you feel safe, relaxed and reconnected with your body. In Pleasure Path, this is called your relaxation bubble.
Explore what brings you calm and pleasure, without rushing ahead.
Ask yourself what you want more of in your life that brings you joy and calm.
Spend time in it often, even before bed.
Keep small parts of it around you during the day.
The aim is for dilator work to feel like a spa session or me time, not a chore. When your brain already links that setup with calm, you notice a real difference once you begin.
Do You Have to Create a Relaxation Space Before Dilator Work?
You don't have to do anything. But if you keep repeating what you have always done, nothing changes.
Conditioning your brain to feel calm and safe in that space is a big part of retraining the connection between your brain and your pelvic floor. Don't treat it as an optional extra to do later. Start as soon as you can and spend as much time with it as possible before you reach dilator work.
