If you experience sexual pain, menstrual pain or lack of control with your bladder or bowels, a specialised type of physiotherapy may be able to help cure your ails. Yep, you can get physiotherapy for your genitals. And the results can be life-changing.
Illustration by Sam Wooley.
Let’s cover the basics first. Your pelvic floor is comprised of a group of muscles that rest at the base of your pelvis, forming a sort of hammock-like shape. It serves a variety of functions, including keeping many of your organs in the right place, helping contain your pee and poop until you’re safely on the toilet, and aiding in childbirth. These muscles contract involuntarily during orgasm, and can play a role in orgasm strength and timing. Like any other muscle, your pelvic floor muscles can range in tone from weak to strong, and can hold tension or inflammation.
I spoke with Liz Miracle, a San Francisco-based physiotherapist, to get the details on what this type of physiotherapy is, what it can treat, and what to expect.
How to Know if Pelvic Floor Physiotherapy is Right for You
There are a lot of different things that can go wrong in and around your pelvic floor, so pelvic floor physiotherapy can address a surprisingly large range of issues, including:
- Sexual pain conditions, including vulvodynia (pain in the vulva) and vaginismus (pain in the vaginal canal).
- Pain related to menstruation or endometriosis.
- Sexual performance issues, including difficulty achieving or maintaining an erection and orgasmic timing.
- Frequent urination.
- Urinary pain, including interstitial cystitis.
- Leakage of urine, stool or gas.
- Painful bowel movements.
- Preparing for or recovering from childbirth.
Miracle says, “… basically if it is happening below the belt, the pelvic floor may be involved.” Even though your initial instinct might be to see your OB/GYN or a urologist, many MDs don’t have enough training to deal with the complexities of the pelvic floor. This is particularly true when it comes to sexual pain and performance issues. I’ve worked with a number of clients who were told by their doctors to “try to relax”, “have a glass of wine” or “take an Advil”. Since pelvic physiotherapists focus specifically on these muscles, many of them have much more training, experience and sensitivity.
How to Find a Physiotherapist
Your best resource is the Australian Physiotherapy Association. They have a therapist locator tool that can help find someone in your area. Miracle advises choosing a therapist who has a certification in pelvic physiotherapy. Since they’re obviously dealing with a sensitive area of the body, you may want to ask around for recommendations or read online reviews.
What to Expect from Your First Appointment
Before meeting with your physiotherapist for the first time, gather as much information about your concerns. Write them down, so you don’t forget. What are your symptoms? When did they begin? Is there anything that makes them worse or better? What questions do you want your therapist to address? Your therapist will also have plenty of questions to ask about your history.
Physiotherapy is, as the name implies, physical. Your pelvic physiotherapist is going to want to conduct a vaginal and/or rectal physical examination to feel what’s going on with your pelvic floor. This will involve inserting one or two gloved, lubed-up fingers into your vagina and/or rectum for a few minutes, and feeling your muscles. Ladies, you’ll be overjoyed to know that physiotherapists don’t use speculums or stirrups, so the exam isn’t nearly as bad as a typical OB/GYN appointment. A good physiotherapist will ask about your level of comfort with the examination, and will allow you to bring a friend or family member into the room if you want some extra support. If you don’t feel comfortable with the physical exam, are on your period or are in too much pain, you can talk about your history, get more details about physiotherapy and ask questions. Your therapist may also be able to suggest behavioural changes you can work on until you feel comfortable giving the physical examination a go.
From there, your therapist will fill you in on their recommendations and game plan for tackling your concerns, which might include exercises for you to do on your own, ongoing physiotherapy, or appointments with other specialists. Expect this first appointment to last between 45 minutes and an hour.
What to Expect from Physiotherapy Sessions
The treatment plan depends on your specific condition, but you can expect to see your therapist weekly or bi-weekly for anywhere from 30 minutes to an hour and a half. Your physiotherapist may do massage or trigger point work (focused massaging of any knots in your muscles). Or they may lead you through pelvic strengthening or relaxing exercises that you do on your own, like Kegels.
Of course the idea of someone massaging your private parts is going to bring up discomfort for some, but physiotherapy can be an amazingly effective treatment. If you’re unable to enjoy being intimate with your partner, or wracked with anxiety about your lack of bladder control, the potential gains of physiotherapy are well worth a bit of initial embarrassment.
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