Biofeedback and physical therapy may be used to treat vestibulodynia (VVS). Both are tools to help reduce muscle spasm that may be causing the pain or that is a result of the pain. These tools are especially important if vaginismus is present. Vaginismus is often a “learned” response to pain when a woman tenses her vaginal muscles in anticipation of vaginal or vulvar contact that she expects to hurt her. Physical therapy (as applied by highly specialized physical therapists), uses focused massage to achieve the same thing. The time required for physical therapy and biofeedback as well as the frequency of visits will vary with each person but for these approaches to succeed, the patient must make a serious commitment to putting in the time and effort required.