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Specialized Women's Health Physical Therapy: What ELSE to Expect on your First Visit Follow up video blog answering some questions from our first video post about what to expect at your very first pelvic floor physical therapy session. Individual experiences will vary. But listening to internationally recognized women's health physical therapist Karen Liberi, MS, MPT, WCS may help relieve some fears and anxiety, especially surrounding the pelvic floor muscle evaluation.
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EXERCISE ROUTINE TIPS FOR THOSE WITH PELVIC PAIN
"Toning up" may actually be a "sexual downer" on body parts that need to be the most relaxed and comfortable for those intimate moments. 2. Seats and ClothingFind the softest, most pliable seat possible and wear loose-fitting clothes when riding a bicycle, motorcycle, or scooter. Better yet, consider giving up these activities. The pressure against your already sensitive genital area can cause symptoms to flare up. 3. Give Up the Attitude of "Playing Through the Pain"While coaches often urge athletes young and old to "play through the pain", it's vital to abandon this attitude when it comes to enduring painful sex as an adult. Please don't believe that you must have sex to please your partner despite the pain and if you don't something is fundamentally wrong with you. Nothing could be further from the truth. A loving partner would never want to cause such suffering. 4. See a Pelvic Floor Physical TherapistMore and more physical therapists (PTs) are incorporating pelvic pain treatment into their practice as the urgency of effectively treating sexual pain increases. A growing number of doctors consider pelvic floor physical therapy a vital component of a complete treatment plan for sexual pain. Specialized pelvic floor PTs utilize various methods to release trigger points in the body. Trigger points develop through contraction or spasms in the muscle groups surrounding the vagina, bladder, and lower bowel. Using manual pressure, biofeedback, and other techniques these health care providers can often aid sufferers. Patients are eventually given techniques to maintain wellness at home.
 Vaginismus is a condition that affects the muscles of the pelvic floor and involves involuntary spasming or clenching of the pelvic musculature. Typically this reactive tightening of the muscles is in response to insertion or the attempt of insertion of an object into the vagina, making vaginal intercourse painful and sometimes impossible. Thankfully, this condition is becoming more and more recognized by the mainstream media. But coming along with it are some misconceptions about vaginismus that we'd like to clear up. Myth #1: Kegels Cure VaginismusKegels, done correctly, are a great strengthening technique for the muscles of the pelvic floor for many women and men. However, someone who is struggling with vaginismus is not a good candidate to begin practicing kegels. While kegels may be introduced later on to help the overall pelvic and core musculature function together during certain body movements, they should be avoided at first. The focus of treatment should instead be on the ability to consciously recognize and relax the pelvic floor muscles. It is best to receive this treatment under the direction of a specialized women's health physical therapist who can guide you through imagery and biofeedback techniques. Also, consider our physical therapy digital download chapter packages to assist you at home. Myth #2: Vaginal Dilators are Used to 'Stretch' the MusclesDilators are an incredibly helpful tool for those with vaginismus. Their function in the treatment process, however, isn't so much to "stretch" the tight muscles of the pelvic floor. The pelvic floor muscles are already quite capable of stretching far beyond what is needed for sexual intercourse (think, delivering a baby). The problem with vaginismus is that the central nervous system (the brain and all its related systems including the spinal cord and nerves) is sending signals to the pelvic musculature to brace itself for what it considers or 'remembers' to be painful: vaginal penetration. So dilators work by desensitizing the central nervous system (see Myth #3 for more on this) and by providing trigger point release (intentional pressure to points of muscular tension for the relief of pain, much like in your neck or shoulders). To learn more about the science of chronic pelvic pain and the use of dilators in the treatment of vaginismus, purchase the DVD Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain. We recommend dilators from Syracuse Medical Devices as they are made of medical grade material and have a consistent length. It is important to have a long enough dilator to be able to reach the second layer of the pelvic floor musculature even with the smallest dilator in diameter. Myth #3: You Just Have to Try to Relax and Keep Practicing SexIf you continue doing as you have been doing - having sex that is painful, then setting yourself up in that same environment with your partner will actually perpetuate or re-enforce the pain - because your mind is already anticipating the pain - it is a known response and you cannot just "force" a relaxation response instead. But if we remove the “red flags” from the brain and place YOU IN CONTROL using the dilators, we can re-train the brain to realize that there doesn’t need to be a “fight or flight response”, we can begin to “unwind” the nervous system. When you start with an extra small dilator and can insert and move it and do self stretches with low to no pain - then the brain starts to realize that - OK - that wasn’t so bad and the secondary responses of muscular tensions ease also allowing for less pain and your overall confidence level with repeated successful sessions with the dilator allows you to become ready for return to intercourse with low to no pain. It is important that you abstain from intercourse (not intimacy) during dilator sessions until you can progress to the proper size. So essentially what happens is you change the perception in your brain about the health of your vagina, decreasing the sensitivity of your nervous system to keep the muscle tension in check to help achieve a good end result. Content Providers of this Article, paindownthere.com, and video guide series for Healing the Pain 'Down There':
Robert Echenberg, MD Karen Liberi, MS, MPT, WCS Alexandra Milspaw, PhD, LPC
"doing mode", you're operating almost exclusively in the sympathetic branch of your autonomic nervous system. This system is associated with the "fight or flight" response, shallow breathing patterns, muscle tension, and increased heart rate and blood pressure. These stress responses of the body not only negatively influence the pelvic floor muscles but also the overall pelvic region including bladder and bowel function, both common triggers of genital, sexual, and pelvic pain. 2. Pelvic Traumas, Injuries, or SurgeriesInjuries to the pelvic floor region caused by childbirth, previous pelvic surgeries, falls on the coccyx bone, and other accidental traumas to the region such as straddle injuries can all contribute to the development of chronic pain in the pelvis and genital area. Take for instance, the condition once known as "bikers syndrome" that affects long distance bike riders. Cumulative targeted pressure on the pudenal nerve overtime can cause damage to the nerve. This particular nerve branches out into the entire vulvar region and can therefore emit painful stimuli anywhere in the pelvic region, not just at the "sits bones". 3. Present or Past Physical, Emotional, or Sexual AbuseMemories from past (or current) abuses are stored in pathways along the central nervous system, and even in particular muscles, especially the psoas muscle. The psoas muscle has a direct and neurological connection to the pelvic floor muscles. These bad memories that are stored by the nervous system awaken when it is feeling threatened or when trying to protect itself. Even when attempting consented, pleasurable sex, the nervous system can interpret this environment as threatening. Protective measures include muscles tension and clenching (which leads to pain, which leads to the fear of pain, which leads to further clenching), and the over-sensitization of the pelvic nerves. 4. Participation in Competitive SportsMany popular sporting activities require tight, clenched body positions and breathing from the chest in order to perform. If we are taught by these sports (or cultural influences) to suck in our stomach and breathe from the chest and clench our buttocks at all times as a matter of "good posture" this can, over time, be detrimental to the health and function of the pelvic floor. In addition, young women who participate in sports are more likely to experience sports-related injuries such as injuries to knees, ankles, legs, and hips. If a knee, for instance, is favored for a long enough period of time the opposite pelvic area takes on more stress and can contribute to pain due to compensatory patterns. 5. Genetic, Hormonal, & Dietary InfluencesStructurally the body is not symmetrical and consequently curvatures of the spine, leg length difference, being left or right footed, all have a bearing on the long-term cumulative stress on one side of the pelvis or the other. Genetic and hormonal influences can also put us at risk for other triggers commonly associated with pelvic, genital, and sexual pain. For instance, endometriosis, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome or "IC"). The dietary decisions we make also influence how and when these triggers manifest in the body. Foods can promote the inflammatory responses contributing directly to pain, but also inhibit the immune system from functioning properly.
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AuthorStephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur. Archives
February 2019
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