It happens: We trip, we bend over wrong, we pull a muscle and we need to seek help for the pain. For these types of blunders and pain, we often seek a doctor’s advice, leading to things like treatment or physical therapy. If it’s standard to seek help and rehabilitation for something like a pulled sprained ankle, why aren’t we aren’t talking about rehabilitation of our pelvic floor muscles when there’s an issue? More likely than not, you may not know what your pelvic floor is or it’s essential functions. Even more unknown is the world of pelvic floor physical therapists, and the incredible work they do—specifically for women.
Women’s Pelvic Floors
Women’s pelvic floor muscles—technically called the pubococcygeus muscles—are dynamic muscles that are activated during bodily elimination functions and sex. The pelvic floor is like a hammock stretching from your pubic bone to your tailbone and side to side, connected to muscles in your abdomen and back. Supporting your bladder, bowel and uterus, these muscles can become too tight or too loose, commonly from injury or age . Tight, shortened muscles can spasm and cause significant pain and discomfort during sex, daily life, or events such as inserting a tampon. Painful sex caused by pelvic floor dysfunction is one of many conditions that cause pain, clinically termed dyspareunia.
Luckily, there are professional solutions to painful sex. As we like to reiterate, painful sex is not normal—and that’s where a pelvic floor physical therapist may be a good solution.
What is a Pelvic Floor PT?
A pelvic floor physical therapist is a specialized physiotherapist. The therapy itself has been casually referred to as “Vagina Pilates” as the muscles are targeted through repeated contraction and release exercises . After an evaluation, your pelvic floor therapist will provide a pelvic exercise regime which may include various muscle relaxation and contraction techniques. A pelvic floor PT may recommend additional therapy aids such as dilators, toys, or specialized serums and lubricants.
For pain associated with tight muscles, a trained therapist uses their hands to perform external and internal manipulations of the muscles. These muscles are reached through the vagina or rectum . With patience and repetition, routinely working on these muscles can show a significant decrease in dysfunction.
Why Visit a Pelvic Floor PT?
There are two main problems that can occur with the pelvic floor muscles when experiencing pain. They may be too weak, which means the muscles are hypotonic . This can result in loss of bladder control and organs that sit lower than they should, as your pelvic floor muscles can’t support them. Commonly, this can occur as a result of pregnancy, menopause, or injury to the pelvic floor.
The second main problem is when the muscles are too tight, clinically called hypertonic . When your pelvic floor muscles are hypertonic, it can result in chronic pelvic pain, inflammation and painful sex. This condition can only be identified with a focused internal exam and is often missed by doctors due to their focus on organ function vs. muscle function .
On the flip side, there could be several reasons you’re having painful sex, and it may not involve the pelvic floor muscles. The only way to know for sure is through a medical examination that may include visiting a pelvic floor therapist.
What to Expect During Your First Visit
A pelvic floor therapist will perform an internal exam to determine how your muscles are working; if they are too tight or too loose. Routinely, the therapist will insert a gloved finger in your vagina or rectum in order to test how your pelvic floor muscles are activating . The therapist will use one finger to feel the muscles wrapping around the vaginal canal.
You may then be asked to do things like cough, squeeze as if holding pee, squeeze like holding in gas and then to do a Kegel . The use of biofeedback machines, a small sensor inserted into the vagina to measure muscle tone, is also common practice . If you prefer, your therapist may offer you a mirror so you can better understand the muscles and techniques involved.
How to Prepare For Your Appointment
Appointments typically run about an hour, with the initial exam being the longest. The thought of any associated pain and discomfort can make many women very anxious and the thought of repeated vaginal examinations can make some uncomfortable.
If you are seeing a pelvic floor therapist for hypertonic muscles and painful sex, these painful symptoms could be amplified at the beginning of your treatment process . The stretching and relaxation exercises can initially be uncomfortable, so we recommend a good water-based, pH balanced serum.
What Happens Next
The therapist may recommend internal exercises, massaging and manipulation techniques that should then be practiced at home in between appointments .
- You may be advised to invest in a set of dilators with the goal being able to insert that largest dilator with no pain. Using a lubricant will make this practice much more tolerable and greatly reduce discomfort.
- Treating painful sex typically requires 6 to 8 sessions spread over the course of several weeks.
How to Find a Pelvic Floor Physical Therapist
As more women become aware of just how common pain and discomfort during sex can be, they are becoming more aware of the benefits of pelvic floor therapy.
Due to the intimate nature of the exam and therapy, women want to find a pelvic floor PT they trust and feel comfortable with. When looking for a therapist, a great place to start is to check out the American Physical Therapy Association and the International Pelvic Pain Societydatabase . Heather Jeffcoat DPT from Femina PT is a wonderful resource for education and intimate solutions, offering support in her book “Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve”.
Pelvic Pain is Diverse
Once you have your names: review their websites, reviews, and reach out to set up a consultation. Some women opt not to have an exam on their first visit, which is normal! Instead of an internal exam, you may be more comfortable meeting to discuss your case history, symptoms and learn more about your pelvic floor therapist and the process.
Not all pelvic pain is created equal, meaning you may have to seek treatment beyond a pelvic floor PT. After seeking guidance, you may be referred to pelvic pain specialists, such as Dr. Tayyaba Ahmed & Dr. Sonia Bahlani. These renowned pain specialists help treat a multitude of pelvic pain conditions that may or may not involve the pelvic floor muscles such as clitoral pain, arousal disorders, endometriosis, and more.
Seek Help for Dysfunction
Pelvic floor dysfunction is more than a physical condition, it can affect your entire life. When we aren’t feeling good with ourselves or are in pain, it translates to our state of wellbeing, our relationships, and can trickle into things like our jobs or hobbies. Although many women who experience this physical and emotional strain want to be able to have sex and life without pain, the fear and embarrassment of their conditions can keep them from seeking treatment. We are changing that narrative, one empowered, supportive, strong woman at a time!
Pelvic floor PT’s are here to help and validate your experience. Although painful sex and dysfunction of the pelvic floor are not normal, it’s normal in a pelvic floor PT’s world to help you in your journey.