Sometimes women have health conditions–like vaginismus, incontinence, or other pain–that a pelvic floor physiotherapist is uniquely qualified to help with.
This month I want to cover more about how the female body actually works when it comes to sex, and frequently I get questions from women whose bodies are distinctly NOT working.
Here, for example, are a few that I’ve received recently from women suffering from vaginismus and other pain:
I have struggled with painful sex for most of my marriage (it was better once I started sleeping more once kids were older and we had more sex, but then got more difficult again with early onset of menopause). We haven’t had intercourse for 3 years now because I finally said it burns and the gels etc don’t work. And although it was often painful, I miss it. Are we doomed to the rest of our marriage with no intercourse and just pleasuring each other in other ways?
When I first got married, sex was amazing. Fun, able to have orgasm, all of the above. Within a few months I began having pain and even during the times that it’s not painful, it’s only “meh”. I have stopped the pill (likely a contributor to health problems I was having). I have cut out all “irritating” food and drink after Dr diagnosed vestibulitis. Still not much improvement. And there doesn’t seem to be any rhyme or reason. It’s not a lack of lubrication (although that is an issue at times, we use a lubricant) What can I do!?
The simple truth is this:
Sex, while it is more than just physical, is DEFINITELY physical. And like any other parts of our bodies, our pelvic and genital regions can cause problems that make sex difficult.
The problem is that when we have problems sexually, we usually assume the problem is with us–something about our emotions or our relationship. We rarely seek out help, or at least we wait a long time to do it (I’m glad the second woman did see a doctor!). And so we often suffer in silence.
I shared my own story of vaginismus in The Good Girl’s Guide to Great Sex. I said:
The Good Girl's Guide to Great Sex:
When I walked down the aisle, I was carrying a huge amount of baggage related to trust. I had been left by my dad as a baby, abandoned by my step-father as a teen, and rejected just two months before my wedding by my fiancé. The latter man eventually changed his mind and came crawling back, and I welcomed him with open arms. Unfortunately, the rest of my body didn’t cooperate. As much as I loved my husband and wanted to make love, I was scared to get too vulnerable, and my body wouldn’t relax. And when you can’t relax, sex hurts.
…[A]fter confiding to a close family member about my problems, I was marched off to a gray-haired gynecologist, who explained to me that I just needed to get in touch with my vagina. He would conduct a full examination, with my husband present, inviting me to touch everything and name everything so I wouldn’t be scared of anything anymore. Apparently magically saying the word “vagina” is supposed to eradicate deep-seated trust issues. … I hyperventilated and beat a hasty retreat, never to darken the door of that particular doctor again.
I saw a doctor–a doctor who was supposed to be an expert in this. But even he didn’t realize what I really needed.
Thankfully, treatments have come so much further today, and the most trained medical practitioners for this are not actually physicians but instead physiotherapists with a specialty in pelvic floor issues.
Two years ago I gave my Girl Talk presentation about marriage & sex in a church in southern Ontario, and Sheela Zelmer, a pelvic floor physiotherapist, was in attendance.
I told her about my passion for getting women help in this area, and last week she sent me some information I’ll be sharing with you tomorrow about what to expect from an appointment with a pelvic floor physiotherapist. To start us off, though, I asked her to share with me some stories of people that she has helped, to show you that there often is treatment for some of these conditions.
Here’s Sheela: (It’s so hard to type that name with that spelling! 🙂 )
As a pelvic floor physiotherapist, I am so grateful to be able to work with women and men through issues that are often seen as very private, embarrassing and isolating.
Jessica’s Story: A Woman Suffering from Vaginismus
Jessica came to see me because she has been experiencing significant pain whenever she and her husband try to have intercourse. She told me that they have never had any penetration because of the pain, and now she can’t even bring herself to be intimate with her husband because she is always thinking ahead, worrying it will lead to penetration and more frustration and disappointment. Jessica and her husband waited until they were married to become sexually active and now that they want to start a family, she feels let down and that its somehow her fault. Her husband, who loves her very much, tries to understand and not pressure her, so he initiates intimacy very rarely. They both feel alone and worried.
When I asked a few more questions, I learned that this has been going on for almost 3 years.
Jessica told me she’s mentioned it to her family doctor who suggested she have a glass of wine to relax before sex, which didn’t work at all. She waited 8 months for a referral to a gynecologist who gave her the diagnosis of Vaginismus, but no treatment ideas. Frustrated, Jessica turned to Dr. Google and came across pelvic floor physiotherapy and that’s how she found me.
Jessica’s story is unfortunately, quite common. Women’s pelvic pain costs the Canadian Health Care system over $25 million per year. Of that, painful intercourse accounts for approximately 10%. (1) The challenge is many family doctors and primary care practitioners aren’t familiar with vaginal pain and so they don’t ask the question or perform a thorough gynecological examination (2). Without the correct diagnosis, it is hard to get correct treatment. On the flip side, many women don’t realize there is help, so they don’t bring it up to their doctor. This under reporting leads to under treatment, which all serves to further delay recovery. It isn’t uncommon to hear it took 3-4 years for a diagnosis to be made.
When Jessica came in to see me she was understandably upset. After her assessment, we set up a treatment plan that would cover the next 3 months. The first thing we needed to address was her self talk.
It had taken several years and multiple doctor visits before she walked through my door. By now this issue was more than a physical problem. Her symptoms were affecting the way she saw herself: as a woman, as a wife, and as a future mom. And naturally, it was impacting the relationship with her husband. Our brain is our biggest sex organ, but one that is often neglected.
Throughout her program we kept circling back to her thoughts.
I encouraged her to speak positively about her body and to focus on her improvements rather than setbacks. We spent a lot of time talking about the connection that occurs with intimacy and we discussed other ways to build that intimacy that didn’t involve penetration.
Part of her treatment plan involved using vaginal dilators. Dilators are a set of smooth plastic or silicone wands that progressively get larger to gently stretch the vagina. She used them at home in conjunction with weekly visits, where I manually stretched her vagina gently and without pain.
Her treatment program also included guidelines about how much water to drink, how to maintain regular bowel habits, how to become more active and even how to care for her vagina.
Jessica’s program was modified over time and after 12 weeks we reduced her treatment frequency to every 3 weeks. Her recovery was not a straight road; there were times that life got busy and hectic and she noticed the effect stress and tension has on her pelvic floor, but she persevered and we celebrated every success.
Her whole treatment program took a year, and that is common in vaginismus. Jessica and her husband are intimate on a regular basis and penetration is part of that intimacy. She recently emailed me that they are now ready to start a family, and I’m so happy for them!
Bethany’s Story: A Woman Suffering from Post-Childbirth Incontinence
Bethany had her second child 4 months ago and feels that things aren’t the same “down there”. She notices that she will leak a few drops of urine when she coughs or sneezes and recently when she started working out she noticed her underwear was wet. She has started wearing a pantiliner everyday. She has shared this with her girlfriends but they all laugh it off and attribute it to having two kids.
Incontinence is the involuntary leakage of urine. It can be like Bethany’s experience: leaking with coughing, sneezing, laughing or even sex. Or it can be leakage that occurs with a sudden urge to void, maybe you can’t quite get to the bathroom in time. In either case, the urine in the bladder is squeezed out and the pelvic floor muscles can’t hold it in.
Bladder incontinence is common after childbirth, but just because something is common doesn’t mean it is normal.
Incontinence affects up to half of all women over the course of their lives (3). But only a third of women mention it to their primary care practitioner (4). It has huge implications: how can you be healthy and active when you are worried you will wet yourself? How can you be fully present and intimate with your husband if you are worried you smell like urine?
A lot of women try to manage incontinence on their own, which is a great idea. There are all sorts of pads, briefs and even devices that can be inserted into the vagina to prevent leakage. Many women try kegel exercises and there are even Bluetooth exercisers. But like anything, you should notice improvements if it is working. In Bethany’s case, she had been doing kegel exercises for a long time but was still leaking.
The truth is, not everyone needs to do kegels. In fact, in some cases, kegels make incontinence worse because the muscles aren’t activating properly-simply squeezing more isn’t helpful. Bethany needed to learn to relax her pelvic floor muscles in order to allow them to work more effectively. Her exercises were combined with information about staying hydrated, keeping regular bowel habits and how to workout without straining her pelvic floor. Her symptoms resolved quickly. Within 6 weeks she was no longer wearing a pad and was doing online exercise videos-all with dry underwear.
The moral of the story is that if you’re suffering with a condition that is hampering your sex life, seek help!
There ARE treatments available, and thank you, Sheela, for sharing those stories. Remember that you aren’t the only one going through this struggle, and that there are steps you can take to help get some relief!
Tomorrow we’re going to be talking about what to expect after you’ve booked that first appointment so you can be prepared. So make sure you don’t miss that!
Have you ever heard of pelvic floor therapy before? Have any of you used pelvic floor therapy and found it helped you? Let’s talk about it in the comments!
(1)Chen, I et al, Hospital-associated Costs of Chronic Pelvic Pain in Canada: A population based Descriptive Study, JOGC, March 2017, Vol. 39, Issue 3, 174-180
(2) Dr. Lev-Sagie (Israel), 1st World Congress 2013
(3)The Canadian Continence Foundation: Promoting a Collaborative Consumer-Focused Approach to Continence Care in Canada, Westmount, Quebec, July 2001.
(4) Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306:14; discussion 1314-5. Epub 2006 Oct 2.
A few months after I got married I saw obgyn #1. She told me I had a “small hymenal ring,” prescribed Xanax and told me to “relax.” I didn’t feel taken seriously; I knew something had to be wrong. Few months later I confided in a nurse friend who recommended a NP. Despite googling like crazy, it wasn’t until a few days before my appointment that I discovered Vaginismus and thought I had it (that’s how I found your blog!). The NP confirmed it and I cried. She recommended a sex therapist. Sex therapist referred me to gynecologist #2 who referred me to PT. I started using dilators and went to PT for 10 months. It’s been 4 years and I still use a dilator before intercourse but sex is great!
Your blogs about right thinking helped my mental and the PT helped my physical.
Thanks for sharing your story — as someone still really struggling it gives me hope!!
Even though i’m a single woman who’s never had intercourse, i fear i might actually have vaginismus. Because i have never been successful inserted the smallest tampon or my pinkie finger in my vagina with freaking out!!! Just thinking about it sends chills down my spine. I have never been to an OBGYN and have no plans to go anytime soon, only when i get married. I hope i’m wrong about my vaginismus. If not, i have pinned this article for future references. I sympathize with these women because having anything come near my hole sends me running for the hills.
I know it’s terribly scary, but I would encourage you to see a gynecologist and tell her your concerns. I was much like you- I could never successfully use tampons, they always leaked because I couldn’t fully insert them, and I never went to a gynecologist until I was 31 and engaged, because I figured I had never done anything sexually so there was no need before that. Then I discovered my vaginismus on my wedding night, and now my main memories of that are how excruciating it was to attempt intercourse, and crying alone in the bathroom in the middle of the night because I felt like a failure. No one should have to start their marriage that way.
Hey Kate, just out of curiosity, if you have a concern about your body why do you want to wait until you’re married to address it rather than now? What if you don’t get married for a long time? You might want to use a tampon at some point (it makes swimming and other sports easier). It’s ok to want to have a healthy body for you, not just for a future spouse. Also, even if you only want to think about this in terms of sex within marriage: if treatment for vaginismus takes a year–wouldn’t you want to do that before you’re married than during the first year of marriage which already comes with enough stress and transition? I don’t want to sound bossy, but I do think you should consider seeing a doctor if you believe something in your body isn’t functioning properly.
All good points, Sarah. You gave me things to chew on. I’m going to think and pray about it. I have a history of physical abuse by my psycho mother who has violated me in that area, so perhaps that abuse has something to do with it. However in the mean time i’ll ponder your comment. Thank you! 🙂
Totally agree with Sarah, here! It’s absolutely okay to go see a doctor now. And it does make a difference!
I agree with the others, Kate. I think you should go see a gyno now just for a check-up and to discuss your issue with tampons. You don’t have to be sexually active to see a gynecologist. In fact, it’d be the wise and healthy thing to just go for a check-up. Your vagina should receive check-ups like any other part of your body does, especially if you’re having an issue with your vagina (& I’d consider pain during the insertion of a tampon to be an issue).
I was never able to wear tampons either as a teen due to them being too painful to insert. I would put the applicator to the opening of my vagina so that my labia were touching my fingers and try to give it a little push in, but that was literally as far as I could get without pain ensuing. Had to quit swim team too once my period started, which seriously bummed me out. My mom thought I was just being a wuss about the pain (even though I’ve always had extremely painful periods since my first at age 11, but that’s a different story), and she wouldn’t come in the bathroom and show me how to insert it properly or even try inserting it for me like I asked her to do. I remember saying “c’mon mom, you grew me in your womb, have seen & cleaned my genitals thousands of times, and heck, even inspected me for intestinal worms after all your children and their friends got pinworms during kindergarten. Surely you can help me with this!” But my mom was too squeamish about vaginas that she wouldn’t help me, and gave me a hand-held mirror and said to figure it out on my own.
It wasn’t until I was in college and talking to my boyfriend/now husband that he said, based on his experience with his sister, female friends and past girlfriends, what I was explaining didn’t sound normal and that I should go see a gyno. So I told my mom I needed to schedule a check-up. She was apprehensive and got angry at me because she thought I wanted to go because I was already sexually active or planning to become sexually active soon with my new boyfriend. (Note to moms: NEVER shame your daughter for wanting to schedule a gyno appt!!!! Seriously!) Anyway, at age 20, I went to the gyno’s for the first time, and sure enough, I had some vaginal issues. It wasn’t vaginismus, but instead, my hymen covered the whole opening of my vagina with only several holes to let the menstrual blood out monthly. No wonder tampons hurt!! I’d been trying to break my already oversized hymen with one! Right then and there in the office, they stuck a syringe of numbing solution into my hymen, removed my hymen with a scalpel, gave me some stitches, and sent me on my way. The most painful part was the needle going into the hymen (felt like a piece of glass being shoved into my vagina, but only lasted about 30 seconds). After that surgery, I was able to use tampons, graduating from the smallest, thinnest ones I could find to super sized ones as I became less scared of things going into my vagina & my vagina was a little more stretched out.
Anyway, moral of my story: just because you can’t use tampons doesn’t mean you have vaginismus. It could be related to your hymen too or another gynecologist or psychological issue (& often, if you have a physical gynecological issue, psychological issues or fear of being inserted by things often follow due to the pain you’ve experienced in trying previously). The only way to know is to go to a gynecologist and get a check-up. Tell the dr your concerns and see what they say. And if they dismiss you, get a second opinion. I like female gynecologists for that reason: I find they dismiss your issues and your pain far less in my experience. I’d do this sooner rather than later, personally. Hope you get your answer soon!
Natalie, thank you so much for sharing that comment! That’s amazing, and I’m sure there are others who will read it with the same issue and will get help.
I’ve been to pelvic floor PT twice, though both times, it was therapy for my vaginismus in conjunction with childbirth complications that I’m sure my condition contributed to. (A nasty tear that didn’t heal properly the first time, and a hip that got thrown out of alignment the second time- I went to a new and better PT for that, and she theorized that my muscle spasms were a factor in that.) The second time did help me more physically, and I can get through intercourse without pain most of the time now. I’m honestly a little jealous that the patient in this article got some help with the mental side of things, because that’s my biggest struggle with it now. Fighting through it for my entire marriage has left me with a lot of baggage, and it takes me so much effort to make myself relax that there hasn’t really been anything left over to focus on pleasure. So it’s still hard to honestly say that I can enjoy sex now. I hope that someday, it can be different, especially after all the posts on here lately about how sex is supposed to be mutually good. But I haven’t had any success in finding local professional help from a Christian perspective (I’m honestly afraid a secular sex therapist would just tell me to watch some porn and I’m not paying for that advice), so I think I’m just going to have to somehow work through all the mental stuff on my own.
I really do want to make a course on vaginismus where I talk about how to get over some of that trauma (because I truly think it was trauma that I went through, too. ) It is on my bucket list, Becky. I just need to find more time. I know it’s so important!
Please do write that series on the trauma of vaginismus. After a torturous year of lousy dr care (I have some horror stories) after discovering that sex is horribly painful I’m barely even willing to think about doing the next step (which is physical therapy). I hate sex more in my mind than my body does at this point, and I don’t trust doctors an more.
I had a horrible experience with doctors. They just didn’t get it! But pelvic floor physiotherapists honestly are trained in this, and they see it all the time. It really can help! Don’t let your life be stolen from you. If it were your eyes, you’d get help. Just think of this as a physical problem, rather than a failing of some sort, or even a reflection on what sex is. I know that’s hard; I’ve been there. But you can get through it!
So excited to see this post and that more are going to follow! I’ve been married 2 and a half years, and pain during sex has always been a problem for me. I talked to my gyno about it in the beginning, and her response, like so many, was to “drink some wine and keep trying”. (Which is useless, and if you’re struggling with pain during sex, this only reinforces negative thinking about yourself and your body). Luckily, my husband is in grad school to be a physical therapist, and they had a pelvic floor PT come lecture. He told me about her and how everything she was talking about lined up with everything we had been going through for two years.
Long story short, I went to see her for about 3 months, where she did manual stretching for about an hour. At home, I used different dilators and yoga stretched that she assigned. I’ve since been able to have sex without pain, but not every time. Unfortunately, I wasn’t able to see my PT for the full treatment period because of how expensive each appointment was, but I still use the dilator every so often.
I wouldn’t say PT fixed everything – there are still times when sex is painful for me. Usually stress plays a big roll because I know I’m not relaxing. I’m in the process of coming off of the pill to be sure that it isn’t factoring into my discomfort and lack of libido. My husband still really struggles with trauma from the past two years – he is terrified of hurting me again, so mentally we’re not in a good place.
I say all this to say – THERAPY WORKS! But it’s a long process that only addressed the physical problems for us. Mentally, there’s still so much to work through. But this blog helps me tremendously, and my husband too. It’s because of your series on birth control that we decided as a couple to get off the pill. Thank you for doing this series – it’s so important for women going through this to know that it’s common, and that they’re not alone.
Thank you so much for sharing your story, Rebecca! And I am sorry that you’re going through this. I really am. I’ve been there. And some people have found that when they get rid of the hormones that things do improve. Not all, but some!
Thanks for sharing this information. My wife had pelvic pain for like two months. I took her to a doctor and the doctor found a solution to her problem. Here is question I have can a women cycle make her tired if it is longer than normal. That can affect sex. Thanks for the information.
“Can a woman’s [menstrual] cycle make her tired if [her cycle] is longer than normal” was your question. And though I’m not a doctor, I’d say that yes, having your period often makes you very tired. If her period is longer than normal (most women’s periods are 2-7 days if they’ve been menstruating for more than a year), my concern would be 1) anemia / iron deficiency which often causes to fatigue, and 2) hormonal disorders which also are almost always accompanied with some sort of fatigue or sluggishness due to the woman’s hormones being out of balance. Best to go to a doctor to have them check out all the possibilities, run tests, see what she’s low in, etc.
I went to pelvic PT specialist after a terrible first delivery and cannot recommend them highly enough. I couldn’t walk long distances without pelvic pain. I was nervous about my first visit but she was so kind and after about six months of exercises the pain was gone. I haven’t had any issues since, even after several more children. I’m so glad we’re talking about this more. I’ve heard that in Europe seeing a pelvic floor specialist after birth is standard.
Thanks for sharing your story, Tini!
I had to see a pelvic floor specialist for bladder issues. I was fortunate she asked about my sex life too. It’s been painful for four years. After treatment we are doing great. I recommend anyone having issues to try it out. It’s weird to first but the results are Ahhmazing
Oh, that’s great, Brenda! Thank you so much for sharing your story!
My doctor has ordered pelvic floor PT for me. The first visit is on April 3 and I am kind of worried about what is going to happen.
Hi Gaye, I know new things are scary and I don’t want to diminish your sense of fear, but this therapy might also be a great opportunity for you. There’s obviously a reason your dr prescribed PT. I don’t know if it’s pain, sexual dysfunction, bladder leakage or some other thing, but imagine living FREE of whatever it is you’re dealing with. Also, be honest with your physical therapist. I have friends who are pelvic floor PTs and they are all extremely conscientious about their patients emotional/mental needs as well as their physical needs. I’m sure your therapist will be too, and if not, try to find a different one.
So happy to see this post! I have had pain during sex since I got married and became sexually active over 3 years ago. I was absolutely devastated, after remaining a virgin until my wedding only to discover sex was painful and awful. It was this blog where I heard about vaginismus, and somewhere along the way I saw pelvic floor therapy was recommended.
I booked an appt with a PF therapist, and have been so blessed by her. I could never use even the smallest tampon before starting my appointments, and within weeks I could use the largest tampon size!
While I still have pain with intercourse and sex is an area of my marriage that still needs some healing, my therapist gave me the encouragement I needed to keep trying. It was a deep fear of mine that the pain would prevent my husband and I from ever starting a family but God is faithful and I am currently 20 weeks pregnant with my first baby. 🙂 I am still seeing my therapist as those appointments are also helping me prepare for labor!
That’s awesome, Robyn! I’m so glad. And thank you for taking the time to write this and give me some encouragement, too!
I am so glad you are pointing women to pelvic health physical therapy! I’ve had PT for dyspareunia when I was postpartum with my firstborn and I’m currently seeing a PT for working through how my abuse history and messages I’ve received about sex and my role as a wife are currently impacting my intimacy with my husband. I want to recommend a podcast that was incredibly informative and helpful for me in my journey towards healthy sexual intimacy. The Faith & Feminism podcast with Megan Tschanz had a guest pelvic health PT, Amy Moses, on to discuss sex and pelvic floor health. Check out episodes 29 and 30 for that discussion.
Does anyone have tips on how to find a pelvic floor physiotherapist? I did a google search, and the ones that have come up have been ones who specialize in helping those who are dealing with sex change stuff (switching genders), which I don’t want to go to. What do I look for to find a good one?
I went to see a pelvic floor specialist for my fractured tailbone. She was able to adjust it vaginally so it didn’t bother me any more.