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Painful Intercourse and Vaginal Pain 

You probably think of painful intercourse (what doctors call dyspareunia) as a gynecological problem. So you may be surprised to learn that physical therapy is a big part of the solution. Pelvic floor physical therapy can dramatically reduce or eliminate sexual and vaginal pain. Its safe, gentle techniques help women enjoy pain-free, pleasurable intercourse.

Why physical therapy?

When sex hurts, the culprit can be any of the following:

  • Vaginismus (vaginal tightness caused by fear of penetration)

  • Pregnancy or childbirth

  • Menopause

  • Cancer treatment

  • Vestibulodynia or vulvodynia (pain in the area around the vaginal opening; formerly called vulvar vestibulitis)—either provoked (triggered by touch) or unprovoked (constant)

  • Painful orgasm

  • A gynecological condition—for example, endometriosis

  • A vaginal skin condition—for example, lichen sclerosis

  • A urological condition—for example, overactive bladder

Each of the above can wreak havoc on the pelvic muscles, joints, nerves, tissues, and skin. To guard against more pain, some women subconsciously tighten their vaginal and pelvic floor muscles during sex. Ironically, this “protection” creates more pain—a phenomenon 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 adhesions (scar tissue), relaxes and stretches tight tissue, corrects postural imbalances, restores mobility, melts away painful tender points and trigger points (sore knots that refer pain elsewhere), and tones muscles—restoring the pelvis to health.

What happens during pelvic floor physical therapy?

At Raquel Perlis Physical Therapy, we tailor treatment to your individual circumstances. Your physical therapist may employ any or all of the following:

Manual (hands-on) therapy such as soft-tissue massage, trigger-point release, and myofascial release. We work on your back, pelvis, abdomen, hips, and thighs—and, when you’re ready, inside your vagina.

Exercises to stabilize your core; improve your posture; and stretch and strengthen your abdomen, back, hips, and legs.

Pelvic drops and other exercises to relax and release your pelvic muscles and open the vagina.

Pelvic floor toning exercises—only after your pelvic muscles are relaxed and stretched. Toning or strengthening tight muscles can trigger muscle spasms.

Biofeedback to teach you to control your pelvic floor muscles and properly perform pelvic drops and (when indicated) pelvic toning exercises. These exercises can be tricky and women often do them incorrectly, so training is vital.

Dilation with fingers, tampons, and progressively sized dilators to further stretch and desensitize your vagina.

Ultrasound or cold laser to help heal any vaginal tears or thick, sore scars.

Electrical stimulation (e-stim) to help you isolate, strengthen, and relax very weak pelvic floor muscles.

(Note: Biofeedback, ultrasound, cold laser, and e-stim have are not recommended for pregnant women.)

How can you speed your progress?

Between appointments, you can do therapy at home (even in front of the TV!) to keep your progress on track. This “homework” is vital to your recovery. Depending on your needs, Raquel or Sarah may recommend any of the following:

Hip, back, and leg stretches. (If you work out at a gym, you can add these stretches to your routine.)

Pelvic drops. You can do these “invisible” exercises anywhere, any time—for example, sitting at your desk or standing in line.

Dilators.

Self-massage.

Massage by a partner. We invite your partner to accompany you to an appointment and learn how to massage you gently and effectively.

Portable biofeedback unit or portable e-stim unit, if you’re motivated to use them at home.

How successful is treatment?

After a course of pelvic floor physical therapy, the majority of our patients report a drastic reduction in vaginal pain. Most can start to enjoy pleasurable, pain-free intercourse—some, for the very first time.