Understanding Pelvic Physical Therapy

    The first time I told someone that sex was painful, I was immediately dismissed...by a medical professional no less. My doctor brushed my concerns away saying I just needed more lube or more foreplay. That wasn’t the problem, but I dropped the issue (and dropped the doctor). Fast forward a few months of increasing pain that left me unable to even have sex anymore, I found a gynecologist who worked with me to find a solution. It was something I never even heard of before: pelvic physical therapy.

    Who Pelvic Physical Therapy is For

    If people have even heard of pelvic physical therapy, they often think of it as treatment for women after giving birth. The reality is pelvic physical therapy solves a host of Problems (and can be sought out by men too).

    I went to PT for sex pain, but quickly discovered there was more relief waiting for me. My unidentified constant throbbing abdominal pain (that I had endured a successful surgery trying to treat) turned out to be irritated tissue. A few sessions of targeted massaging and the pain was gone!

    I also found relief for another issue compromising my quality of life: bladder issues. I found myself running to the bathroom almost every hour due to a sudden “I have to go - NOW” discomfort. Turns out, pelvic issues and bladder issues are pretty interrelated. As I worked on improving sex pain, my bladder issues also got much better.

    Pelvic issues can range from pregnancy-related to sex-related to bladder-related. The pelvic area is a complicated part of the body. When things go wrong, pelvic physical therapy can often be an attractive solution.

    What Pelvic Physical Therapy Is Like

    You meet with a specialist who spent years studying this arena and they build a multifaceted approach to get you lasting relief as soon as possible. Some patients even see an improvement of symptoms after one session!

    The First Appointment

    I walked into the clinic not knowing what to expect. I followed my assigned physical therapist into a room and we spent most of the session simply talking about my situation. Then she pulled out a model of a pelvis and walked me through how it works (turns out, it’s a lot more complicated than I realized).

    The next step was to establish a baseline and to target the problem areas. If patients are comfortable with it, the physical therapist will then conduct an internal exam (some patients feel more comfortable doing the internal exam a few sessions in). I was happy to discover it was nothing like a gynecological exam (no speculum here!) She gingerly touched outer and inner areas of my vagina, writing notes as I gave her feedback about the location and intensity of the pain.

    This step is also exciting for tracking progress. My first session even the lightest touch sent me trying to hold back tears of pain. A few months into my treatment, she repeated the exam. Many of the areas were almost entirely free of pain!

    A Typical Session

    These tend to last between 30 to 60 minutes. First, there’s external work. Depending on the reason for your visit, this can include stretching, massaging, pressing into the tissues, and so on. Then there’s internal work. This is always done with your permission each time. You don’t have to do internal work if it makes you uncomfortable, but it does rapidly speed up the healing process. Here the physical therapist will insert a finger inside your vagina and do various massaging, stretching, pushing, and other techniques.

    Your physical therapist should do everything in their power to make you feel comfortable. After all, they are interacting with a vulnerable part of your body that is made even more vulnerable due to the pain. My physical therapist and I chat the same way I do with my hairdresser, but her hands just happen to be in a different area.

    Your Homework

    Your treatment process includes more than the work done by the physical therapist. You’ll create a treatment plan that’s manageable with your lifestyle - and it may not include kegels at all. That’s another common misconception about pelvic issues. Kegels tighten things and some patients (such as myself) needed things released, not made tighter.

    Each treatment plan is different, but it can include a variety of approaches. Stretches help relax and strengthen. Breathing exercises and stress management help reduce stress and tension (which can be huge contributors to pelvic issues). Dilators are a tool that you insert inside you to help the vagina relax and open up more. You start off small and graduate to different sizes. I was skeptical it would do anything for my sex pain, but it ended up making the biggest impact in my recovery!

    What You Gain From Pelvic Physical Therapy

    The end goal, of course, is to fix whatever issue brought you to the clinic. It takes time, but you can conquer it!

    Beyond tackling my issues, I found pelvic physical therapy offered unexpected benefits. My homework of daily stretches forced me to engage in a self-care routine that I had been meaning to do (but never got around to). Now I spend 15 minutes a day stretching to relaxing music and lit candles, which helps combat the daily stress and anxiety of life.

    Pelvic physical therapy also gave me back a sense of control over my body. Before the experience, I felt helpless to do anything about the pain I was experiencing (or the way it was affecting my relationship to my body and to my partner). Starting pelvic physical therapy gave me answers about what was happening inside me and allowed me to take action with weekly sessions and daily home work. I no longer felt defeated by my painful situation - I felt empowered to do something about it. The emotional benefits, alongside the physical ones, made physical therapy a lifeboat during a hard time in my life. I encourage anyone who is experiencing pelvic issues to see what physical therapy can do to change their life as well.

    The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice.


    scrolling-text-image

    Without accessibility, there are no solutions, without accessibility, there are no solutions.

    Without accessibility, there are no solutions, without accessibility, there are no solutions.