Treatments
WHAT IS IT?
Pelvis floor physical therapy (PT) is used for both vaginal pain and for urinary incontinence.
With pelvic floor PT a physical therapist assesses the function and strength of the lower pelvis muscles. The PT uses various techniques to make vaginal penetration easier and ease vaginal pain. Biofeedback sensors may be used in the vagina to measure how much you can contract the vaginal muscles. The therapist may teach you breathing exercises to help relax tense pelvic floor muscles. You may be given pelvic muscle exercises to do such as Kegels (also called pelvic floor muscle training or PFMT) . The therapist may use massage, which may include massage of muscles through the vagina. This massage will stretch and release tissue within the pelvis. The therapist may also show you how to use vaginal dilators. The intent is to improve vaginal or pelvic pain.
PT is also used to help with urinary incontinence. In this case the focus is on strengthening the pelvic floor muscles.
OUR BOTTOM LINE: DOES IT HELP?
YES. Working with a physical therapist trained in pelvic floor PT may help with vaginal pain with sex, and with urinary incontinence.
A common and normal response to pain is to tense up. For many women with vaginal pain or pain with sex, pelvic floor muscle tension becomes a part of the problem – even if it was not the root cause of the problem. Decreasing that pelvic floor tension may be highly effective and is exceptionally low risk.
Pelvic floor muscle training (PFMT), also known as Kegels, helps many women with incontinence. While some women can do these on their own, a trained physical therapist can help ensure you are doing them correctly and measure your progress.
PAIN DURING SEX
The small number of current studies suggest that physical therapy for pain with sex decreases pain scores. But most of these studies were done in women where pain was not related to menopause.
BLADDER CONTROL PROBLEMS
Pelvic floor muscle training exercises (also known as Kegels) helps decrease the number of incontinent episodes. For some women incontinence goes away completely. But, they must be done correctly in order to work.
POTENTIAL RISKS & SIDE EFFECTS
The prospect of pelvic floor physical therapy often makes people feel uncomfortable, shy or nervous. Physical therapy can sometimes be uncomfortable, in any area of the body, but a good physical therapist will listen to you and will do their best to put you at ease and avoid causing pain.
QUALITY OF LIFE EXPECTATIONS
NONE
IF I WANT TO TRY THIS TREATMENT WHAT ARE MY NEXT STEPS?
Find a physical therapist who focuses on pelvic floor physical therapy.
The National Vulvodynia Association website is a good resource to find a therapist with experience treating vaginal pain and pain with sex
For urinary incontinence look for a therapist that specializes in women’s health, pelvic-floor dysfunction, and urinary incontinence. Here’s a tool that can help you find the right type of physical therapist near you, from the American Physical Therapy Association. https://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx
What is pelvic floor physical therapy? International Society for Sexual Medicine. https://www.issm.info/sexual-health-qa/what-is-pelvic-floor-physical-therapy/
National Vulvodynia Association www.nva.org
We were unable to find trials of vaginal physical therapy for either vaginal pain or urinary incontinence.
Authors: Dr. Katherine Newton, & Dr. Leslie Snyder. Last reviewed February 15, 2021
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