Steps to Health
Seek the Help of a Pelvic Floor Physiotherapist
Imagine if a woman had a headache everyday, one would expect that over time her shoulder and neck muscles would become very tense. The same thing happens to the muscles that surround the vagina. Women who experience vulvar pain develop problems with their pelvic floor muscles. These problems include increased pelvic floor tone/tension, instability of the pelvic floor muscles, and poor control over the pelvic floor muscles.
Some women with vulvodynia may also experience an involuntary spasm of the pelvic floor muscles – vaginismus. Women often feel like the vagina is too tight and or too small. It may feel like the vagina is going to tear. Sometimes the spasm is so intense the vagina cannot be penetrated. Sometimes just thinking about sex can cause this spasm!
Physical therapy interventions include techniques that help women learn to control both the contraction and relaxation of the pelvic floor, education on the changes that occur in the pain signaling system in vulvar pain and pain management techniques, and instruction in the use of graduated vaginal inserts. Women find using the inserts helpful for learning how to keep their pelvic floor muscle relaxed during vaginal penetration. A sexual counselor and or a pelvic floor physiotherapist often work together to guide this treatment. Helpful tools physiotherapists commonly use are biofeedback, TENS (transcutaneous electrical nerve stimulation) and acupuncture. Many women notice that when their ability to voluntarily relax their pelvic floor muscle improves, the pain associated with sexual activity decreases significantly.
Thorough physical therapy assessment and treatment addresses all aspects of interdependent pelvic floor function including bladder, bowel, lumbar and pelvic back support, as well as vulvar pain and spasm. It is important to consider all aspects of pelvic floor function as unaddressed pelvic floor dysfunction in one of these areas may limit improvement in another area.
How to find a physiotherapist in your area:
Look at “Find a physio” at the Physiotherapy Association of BC. Enter “vaginal pain” under area of expertise.