How does Sexual Pain from Tight Pelvic Muscles Develop?
A woman who experiences repeated episodes of painful intercourse may develop a habit (perhaps even unwittingly) of contracting her pelvic floor muscles in anticipation of pain. Her ability to concentrate on the pleasurable sensations of sex may be affected, and often her sex drive will decline. This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted muscles, all of which may increase unpleasant friction in the vagina during sex. Emotional anxiety, which often results from painful sex and the resultant effects of this on the sexual relationship, may increase a woman’s perception of pain as well.
How can Physical Therapy Help Sexual Pain?
Physical therapists are trained to provide treatment to restore function, facilitate movement, and relieve pain, and this applies to the treatment of pelvic floor disorders as well. With the help of specially trained physical therapists, pelvic floor physical therapy may be very useful in the treatment of physical problems with bowel, bladder, and sexual function. Particular techniques that may be utilized for treatment include behavioral therapy, home exercises, general and pelvic floor exercise, and relaxation techniques, manual therapy, pelvic floor biofeedback, and low current electrical stimulation of the pelvic region (see side bar for more details).
What can I Expect to Occur during My First Visit with a Pelvic Floor Physical Therapist?
The physical therapist will most likely take a history and do an evaluation. The therapist might also observe how you breathe, touch to find areas of muscular tightness or tenderness, and evaluate abdominal organs using light touch on the belly. The exam will include assessment of the mobility and integrity of the skin, muscosa, and soft tissues in that area, including the hymenal tissue. The internal examination may be deferred according to the anxiety level of the patient.
Talli Rosenbaum is the only pelvic floor physiotherapist who is also an AASECT certified sex therapist and individual and couples therapist.