Pelvic Floor Physical Therapy: What it Is and How it Can Help You

By: Dr. Denise Renye

Unfortunately, painful sex is a common problem for people with vulvas and vaginas. As many as 75% of them will experience pain during sex at some point in their life, according to the American College of Obstetricians and Gynecologists. That’s a lot. And because many people with vulvas accept a certain amount (or any amount) of pain during sex, they may not even question or talk about its presence. In other words, they may not know sex is supposed to be pain-free.

There are numerous reasons why sex may feel painful – vaginal dryness, endometriosis, fibroids, and more. When a patient or client mentions they experience pain during sex, my internal alarm system goes off and I gently inquire about it with curiosity. If the issue is something like vaginismus where the muscles at the opening of the vagina become tightly contracted and penetration becomes almost impossible, or there is urological dysfunction, I may refer my clients to a well-qualified, educated professional such as a pelvic floor physical therapist.

What is the pelvic floor? It’s the muscles and connective tissues that support certain organs in the pelvis, such as the bladder, large intestine, and internal reproductive organs. Everyone has pelvic floor muscles and these muscles hold the organs in place while also providing flexibility to assist with bodily functions like urinating, defecating, and having intercourse. These muscles work with the urethra and the anus. Healthy pelvic floor muscles allow a person to squeeze and relax automatically to perform bodily functions but sometimes the pelvic floor muscles can become too weak or too tight. 

Engaging in pelvic floor physical therapy can increase pelvic blood flow, release trapped nerves, and decrease pain sensitivity. It relaxes, balances, stretches, and tones pelvic and vaginal muscles. This helps not only with bodily waste removal but also makes sex pain-free and pleasurable.

Everybody is unique so pelvic floor physical therapy will vary depending on the person but in general, the physical therapist will support relaxation, stretching, and release. This could include manual (hands-on) therapy such as soft-tissue massage, trigger-point release, and myofascial release to release tightness in the back, pelvis, abdomen, hips, and thighs. When the person is ready, the physical therapist will gently introduce these techniques inside the vagina. There are also often pelvic floor exercises to practice at home such as pelvic drops, massage techniques, and stretches.

Because it can be hard for people to self-diagnose what’s happening with their pelvic floor muscles, I recommend they work with a trained professional. Suggesting tightening exercises if the pelvic floor is already tight, for instance, can cause more damage so I’m hesitant to suggest certain exercises.  

Mostly what I care about is folx keeping in mind two things: sex isn’t supposed to hurt, and if it does, there may be a physical reason as to why. There’s no shame in asking for help and doing so could make all the difference. It’s important in my line of work to have colleagues to refer to who are sex-positive.

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Reference

Cedars-Sinai Staff. “What Women Need to Know About Pain During Sex.” Cedars-Sinai Blog. September 12, 2018. https://www.cedars-sinai.org/blog/pain-during-sex.html#:~:text=Pain%20during%20sex%20is%20a,but%20for%20others%20it's%20persistent.