Proven help for painful sex: pelvic floor physical therapy

As a women’s health physical therapist, I see many women devastated by pain during sex. Please know that there is hope, there is help—in most cases, there is even a cure.

You probably think of painful sex (dyspareunia) and vaginal pain (provoked vestibulodynia or vulvodynia) as gynecological problems. So you may be surprised to learn that physical therapy is a big part of the solution.

This isn’t traditional physical therapy, of course. It’s a specialized type called pelvic floor physical therapy, and it’s provided by specially trained physical therapists. Pelvic floor physical therapy can dramatically reduce—even eliminate—vaginal and sexual pain. Its safe, gentle techniques have helped countless women enjoy pain-free, pleasurable intercourse.

Why physical therapy?

When sex hurts, the problem is usually more than skin-deep. The culprit is often a web of interconnected factors involving the muscles, tissues, joints, bones, nerves, and skin.

Compounding the problem, some sufferers subconsciously guard against more pain by automatically tightening their vaginal and pelvic floor muscles during sex. Ironically, the result is muscle spasm and yet more pain. This phenomenon is called secondary vaginismus.

Pelvic floor physical therapy reverses this vicious cycle and unravels the web of pain. It increases pelvic blood flow, releases trapped nerves, and decreases pain sensitivity. It relaxes, balances, stretches, and tones pelvic and vaginal muscles, restoring them to health.

After completing pelvic floor physical therapy, most women feel much better and can begin to enjoy pain-free, pleasurable intercourse.

What happens during pelvic floor physical therapy?

Because each woman’s circumstances are different, each woman’s treatment plan may be different. Here are some general guidelines:

Relax, release, and stretch

* Your physical therapist will use manual (hands-on) therapy—for example, soft-tissue massage, trigger-point release, and myofascial release—to release tightness in your back, pelvis, abdomen, hips, and thighs. When you’re ready, she’ll gently introduce these techniques inside your vagina. Both outside and inside, manual therapy increases blood flow, restores elasticity and mobility, reduces pain sensitivity, corrects structural imbalances, and melts away tender points and trigger points (sore “knots” that refer pain elsewhere).

* Your physical therapist will also teach you pelvic floor exercises, such as pelvic drops, to relax your pelvic muscles and open your vagina. She may use a biofeedback machine to train you to isolate and release your vaginal muscles, and to track your progress. How does biofeedback work? First, you insert a tiny probe into your vagina or rectum (if you can’t insert the probe, your therapist may place sensors on the skin between your vagina and rectum). Then you view your pelvic muscle function via a graph on a monitor. The process is safe and painless.

* If your hips, back, and legs are tight—perhaps from sitting behind a desk every day—your therapist may show you stretches to relax these areas and open your pelvic floor.

* If you’ve had a hysterectomy, C-section, or other pelvic surgery, your physical therapist may use manual therapy techniques to release adhesions (scar tissue). She may also use ultrasound or cold laser to heal and soften any painful vaginal tears or thick, sore scars.


* Your physical therapist may teach you exercises to isolate and tone your pelvic floor muscles. She should introduce these exercises only after your pelvic muscles are relaxed and stretched. Strengthening tight muscles can trigger muscle spasms. Careful instruction is vital, because untrained women often do the exercises incorrectly. Properly performed exercises can improve vaginal muscle tone, promote blood flow to damaged tissues, increase elasticity, and decrease pain sensitivity.  

* Your therapist may use a biofeedback machine to help you locate and control your pelvic muscles and to track your progress.

Dilate and e-stimulate

* Your physical therapist may show you how to insert fingers, then tampons, then progressively sized dilators to further stretch and desensitize your vagina.

* She may also use pelvic floor electrical stimulation (e-stim) to help relieve pain. E-stim strengthens muscles, which then fatigue and relax in some women.

(Note: Ultrasound, cold laser, biofeedback, and e-stim are not advised for pregnant women.)

How can you speed your progress?

Many pelvic floor physical therapy techniques can be done at home, on your own schedule—even in front of the TV. This “homework” will speed and improve your progress. In fact, it’s vital to your recovery.

* Your physical therapist may teach you and your partner massage techniques to do at home, between appointments. If you and your partner are willing, your therapist can show you techniques to do inside your vagina.

* You can certainly do your back, hip, and leg stretches on your own. If you work out at a gym, you can add these stretches to your exercise routine.

* It’s important to do pelvic drops between physical therapy appointments. You can even do these “invisible” exercises while sitting at your desk or kitchen table, or while standing in line at the store.

* You may be able to rent a portable biofeedback unit from your therapist. This small, lightweight device is designed to guide and monitor the pelvic drops and toning exercises you do at home. You may also be able to rent a portable e-stim unit.

* Your therapist may recommend using dilators between appointments. Many women find home sessions enormously helpful.

For more information, visit:

American Association of Sexuality Educators, Counselors and Therapists

American Physical Therapy Association Section on Women’s Health

International Pelvic Pain Society

The International Society for the Study of Vulvovaginal Disease

National Vulvodynia Association

The North American Menopause Society

The V Book: A Doctor’s Guide to Complete Vulvovaginal Health, by Elizabeth G. Stewart, M.D.

The Vulvar Pain Foundation

Raquel Perlis