You’ve probably never heard of pelvic floor physical therapy before, and that’s a shame: It’s an extremely helpful treatment option for a variety of difficult medical conditions. Your pelvic floor drapes across your pelvic area like a hammock, and supports the pelvic organs (the uterus, bladder, and rectum). It also assists with urinary and anal continence, and serves a role in core strength and orgasm. People of all genders have a pelvic floor.
To help me learn more about pelvic floor physical therapy, I spoke with Heather Jeffcoat, a physical therapist and the owner of Femina Physical Therapy in Los Angeles, and author of Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve. Here’s what you need to know about pelvic therapy and how it can help you.
How pelvic floor physical therapy works
A lot of things can weaken the pelvic floor, including pregnancy, childbirth, and aging, resulting in pelvic pain as well as bladder, bowel, and sexual dysfunctions.
The first step of pelvic floor physical therapy is gathering the client’s history, ascertaining their goals, and providing education about how the pelvic floor works. This is followed by a manual examination. From there, physical therapists use a combination of manual therapy, pelvic floor exercises, biofeedback, and/or vaginal dilators. Patients are seen for regular appointments, and are given exercises to complete at home.
You can find therapists by searching American Physical Therapy Association and the International Pelvic Pain Society. Many PTs, including Dr. Jeffcoat, also offer telemedicine appointments if you’d prefer to get started that way or you can’t find a PT in your area.
What pelvic floor physical therapy can treat
Pelvic floor PT can be effective at treating a wide array of conditions, including:
- Painful sex
- Pain with tampon insertion or OB/GYN examinations
- Vulvar pain
- Vulvar itching
- Urinary urgency and frequency
- Recurrent UTIs
- Urinary incontinence
- Bowel incontinence
- Pelvic and/or lower abdominal pain
Dr. Jeffcoat says, “I like to tell physicians that if they have been searching for a cause of someone’s pain between their ribs and their hips/pelvis and they have been medically cleared, they should be referred to a skilled PFPT.”
Pelvic floor PT can also be used to prepare transgender patients for gender confirmation surgery, and to facilitate healing post-surgery.
Pelvic floor physical therapy and sexual pain
Recently, researchers at the Center for Sexual Health Promotion at Indiana University found that 30% of women experienced pain during their last sexual encounter. Even though sexual pain is widespread, it often takes a very long time for a woman to get diagnosed with a sexual pain condition. I have heard horror stories from clients who were told by their doctors that their pain was “all in their head” or that they needed to “just have a glass of wine.” I’ve heard of doctors recommending a shot of alcohol or an anti-anxiety medication right before sex. Dr. Jeffcoat has heard the same stories, and says most traditional physicians are ill-equipped to deal with sexual pain even though the reality is that there’s almost always a physical cause.
If you try to talk to your doctor about your sexual pain and get met with an infuriating response like “just relax,” finding a pelvic floor physical therapist in your area could be a much better bet. A good PT will work with you to uncover the root of your pain and discomfort, and develop a targeted game plan for relief. I’ve worked with a lot of clients with sexual pain, and they’ve all sung the praises of pelvic floor PT.
Keeping your pelvic floor in shape
Even if you’ve never heard of pelvic floor physical therapy before, you’ve probably heard about the field’s most popular exercise: kegels. There has been an explosion of articles about kegels (also known as PC exercises) in the last few years, and there are also a ton kegel trainers on the market purporting to help you get your kegel muscles into tip-top shape. Kegel exercises can have great benefits, including stronger orgasms and greater urinary control. But Dr. Jeffcoat advises a bit of caution. She shared that about half of all women are doing kegels incorrectly, and around 25% are doing them in a way that could make their other symptoms worse. She’s not a fan of vaginal weights or trainers because, she says, they can worsen incorrect form.
Dr. Jeffcoat says that if you’re currently experiencing sexual pain, urinary urgency or frequency, bladder pain, urge incontinence, constipation, rectal pain or any pelvic pain, avoid kegels and check in with a PT first.
If you don’t have bowel or bladder symptoms, Dr. Jeffcoat recommends doing a mix of longer holds and shorter pulses. To find your PC muscles, cut off your flow of urine before your bladder is empty. The muscles that you have to use to do so are the ones you want to target. For the longer holds, gently squeeze your PC muscles for 3-5 seconds, then gradually release. For the shorter pulses, squeeze your PC muscles, then immediately release. If you want to ensure you’re doing kegels correctly, or want a customized game plan, definitely check in with a PT.
If you feel embarrassed about what’s involved in pelvic floor PT
Yes, your PT will be directly manipulating your muscles through the walls of your vagina or anus. But Dr. Jeffcoat assured me that a good pelvic floor physical therapist is passionate about their work, and about helping their clients feel comfortable. Pelvic floor issues are very common, and PTs want to help remove the stigma around getting help. Dr. Jeffcoat’s standard initial visit is 90 minutes, a good chunk of which is spent talking and helping you feel more comfortable. You also have the option to postpone the physical examination until a later session.
It may also help to think about the positive effects of pelvic floor physical therapy. I asked Dr. Jeffcoat about some of her favorite patient success stories, and she told me about seeing patients consummate their marriages for the first time ever. One case was after 19 years of marriage. She also wrote, “I’ve had so many women that are able to get pregnant without fertility treatments because they can have pain-free sex. I’ve seen women gain a new sense of empowerment by reaching a goal they truly never thought would never happen.” There can also be something incredibly validating about knowing that the pain isn’t “in your head.” The bottom line: pelvic floor physical therapy can be life-changing.
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