MONTREAL PHYSIOTHERAPY – PELVIC FLOOR PHYSIOTHERAPY

Pelvic Floor Physiotherapy to Relieve Pain During Sex: Treatment for Dyspareunia and Vaginismus

Written by Nathalie and Yuxin

Some women experience pain or burning during vaginal penetration, whether during intercourse, with one or two fingers, or even when inserting a tampon. Doctors often recommend using a lubricant. If lubrication does not help, however, further investigation may be needed. The problem may be dyspareunia.

Why Does It Hurt?

• Difficulty relaxing: The pelvic floor muscles surrounding the vagina are unable to relax as they should to allow penetration by a penis or fingers.
• Increased muscle tone or reduced length and flexibility: The pelvic floor muscles or skin may be too tight. During intercourse, the tight muscles are stretched, much like stretching a very tight thigh muscle to do the splits. Overstretching a tight structure can cause pain.
• Sensitivity in the vestibule (vestibulodynia): The vestibule is located at the vaginal opening. It has many nerve endings that may overreact to touch, amplify the signal and interpret it as pain or burning.
• Changes in soft tissue health: The vaginal lining may become dehydrated and lose its ability to stretch and tolerate friction from a penis or finger.

The Difference Between Dyspareunia and Vaginismus

Dyspareunia is a general term for pain during intercourse. Vaginismus is a type of dyspareunia that involves psychological factors in addition to pain. For example, fear of having someone else touch your body can cause significant distress and stress. The pelvic floor muscles may contract involuntarily rather than relax during sexual activity.

The Role of Pelvic Floor Physiotherapy

• A pelvic floor physiotherapist has specific training to assess pelvic floor conditions.
• Here Is What Happens During an Initial Assessment:
• A discussion of your symptom history, along with general questions about urinary, sexual and bowel function and pelvic organ support.
  An assessment of your breathing technique.
• External observation and palpation to assess pelvic floor muscle contraction, relaxation and tone.
• An internal vaginal examination using one or two fingers to assess pelvic floor muscle contraction, relaxation and tone.
• Some patients, particularly those with vaginismus, may not feel comfortable allowing observation or palpation during the first session. In these cases, the therapist may guide the patient through a self-assessment.

Pelvic Floor Physiotherapy Treatment:

During the first session, your pelvic floor physiotherapist will recommend a treatment plan and provide initial exercises or hands-on treatment based on the assessment findings. Treatment may include:

• Breathing techniques or general relaxation exercises to help relax the pelvic floor muscles
• Exercises and hands-on guidance to improve pelvic floor muscle control, particularly the ability to relax fully
• Manual release, stretching, exercises or dilator therapy to reduce pelvic floor muscle tension and improve flexibility
• Vestibular desensitization exercises
• Recommendations to improve hydration and mobility of the perineal skin.

If this condition is affecting your sex life and you would like to learn more about pelvic floor exercises and treatments, contact us! Our qualified physiotherapists are here to help!

Call us for a physiotherapy appointment or book online!