Do you feel pressure or heaviness between your legs? Have you ever had the strange sensation that something is falling out of your vagina? Does your vagina look or feel different since having a baby? Have you changed the way you urinate or have bowel movements to complete one? Read
What’s worse than dealing with a pain in the ass? Dealing with pelvic pain!
You’re not alone. Chronic pelvic pain, also known as vaginal pain, perineal pain, ‘pain down there’, or pelvic floor muscle pain, is a common problem. It affects approximately one in seven women. In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. Of all referrals to gynecologists, 10% are for pelvic pain.
While it may seem different, the pelvic anatomy is similar to that of an arm, leg, or back. Our body is held together by ligaments, muscles, nerves, fascia, joints, and lots of connective tissue. All of these structures can be strained, torn, weakened, or injured. Just as you would rehabilitate your torn rotator cuff muscle or Achilles tendonitis, you may have to treat your painful pelvic floor structures.
Pelvic pain can be a physical and emotional nightmare, particularly when you’re trying to share an intimate moment. It can feel very isolating. One may feel unable to address this issue with her friends, family members, partner or doctor. As physical therapists specializing in women’s health issues, we too often hear the story of the desperate patient discussing her pelvic pain with her gynecologist/urologist/obstetrician and being told that “it is normal” or “it will pass after a while.” She is often told that she needs to seek the services of a therapist to talk about her intimacy issues and learn how to manage her stress.
There are many types of pelvic pain.
Where is the pain? Is it constant? Do you suffer from burning, swelling, itching, or inflammation?
These symptoms may be mistreated for a yeast or bacterial infection, when in fact it could be vulvodynia, if it has been going on for more than three months. Vulvodynia is a chronic pain condition that can affect the labia majora/minora, vestibule, vagina, and urethral openings. Muscle tension and spasm is commonly found in women with vulvodynia and physical therapy may reduce pain levels by 40-60%.
Do you have pain with initial penetration when attempting to have sex? Or is there a deep pain in certain positions?
You may have muscle spasms and trigger points in your pelvic floor muscles. This can lead to an overactive pelvic floor muscle dysfunction, meaning your muscles don’t want to relax. They will be tight and painful, until you understand how to make them relax.
Did you tear badly during delivery?
Whether through gradual tearing or an intentional episiotomy, there has been trauma to your pelvic floor and vagina. While this injury will heal in time, and the stitches will eventually fade, sometimes they don’t heal well. You may suffer from painful scar tissue, which may be exacerbated by pressure, touching, washing, or intercourse.
A woman’s health physical therapist can help to do the following:
Assess where your pain is coming from. Depending on what is the problem, there are different manual therapy techniques can be performed to release the scar tissue, reduce the muscle spasms, or treat the injured tissues. A therapist may also employ modalities to decrease pelvic pain, such as cold laser therapy.
Assess if you are having nerve pain that is contributing to your discomfort (such as pudendal neuralgia)
Show you gentle exercises and treatments as part of a home exercise program to decrease pain, such as muscle stretching or core strengthening
Treat over-active pelvic floor muscles with computerized biofeedback and clinician cueing.
Perform skin rolling and myofascial soft tissue work to break down restrictions in the surrounding pelvic, hip, and abdominal areas.
Show your partner how to help with your home exercise program if needed
There are also some things that you may be instructed to do on your own.
Stretch your pelvic floor and hip musculature
Self-massage with a dilator or other tool to treat the painful areas
Use a foam roller to release the tension in your hip and low back musculature
Practice diaphragmatic breathing and stress management techniques
Try modalities such as heat, ice, sitz baths, or vaginal steams
Eliminate inflammatory foods and incorporate more low oxalate foods
Follow these suggestions for good pelvic hygiene:
Clean the labia majora with a very mild non scented cleanser (such as Neutrogena bar soap) and leave the other internal structures alone. These structures are actually self cleaning, and do not need extra friction/washing which may exacerbate symptoms
Avoid getting shampoo on the vulvar area
Use 100% cotton menstrual pads and tampons
Eliminate other feminine products such as sprays, powders, and douches
Follow these clothing guidelines to decrease pelvic irritation:
Wear cotton underwear and loose fitting pants and skirts to create less friction on the vulva
Remove wet swimwear or underwear immediately after use
Avoid fabric softener on underwear
Use a dermatologically approved detergent
Sit on a donut pillow to decrease pressure on the vulva
Avoid hot tubs
Follow these recommendations to avoid flare-ups while exercising:
Avoid bicycling or other exercises that put direct pressure on the vulva
Avoid exercises that create a lot of friction on the vulva, such as power walking or running?
Follow these suggestions to minimize pain during and after intercourse:
Use water soluble lubricant
Urinate and rinse vulva with cool water after intercourse
Use ice packs on vulva after intercourse
Experiencing pelvic pain can be a demoralizing and lonely experience. We understand this and the effect it can have on a couple in the bedroom. Sex Again by Jill Blakeway is an impressive and insightful resource for women to get reacquainted with the passion and romance they once knew (or never experienced). But, this under-treated population of women with pelvic pain can’t rekindle their bedroom romance until their pain is addressed. Since they often don’t know where to turn, we sincerely hope this blog will help give them some answers. We are always available to help at Body Align Physical Therapy.
Jill Hoefs is a physical therapist with Body Align Physical Therapy in New York City. She is a regular contributor to the YinOva blog.
The following article was written by Gail O’Neill, PT, a specialist in pelvic floor physical therapy at ShiftPT in New York City. ShiftPT and Gail are friends of the YinOva Center, and offer valuable information and care to our community.Finally, your bundle of joy has arrived! Those first several weeks just seem to fly by, don’t they? Adjusting to feeding schedules and sleeping routines (or lack thereof) can be overwhelming at best. Sadly, many women also live with pain, especially during intercourse, and even embarrassing urine leakage (incontinence). While medication, and in some situations even surgery are recommended, these are certainly not the only treatment options.
There is a solution that could be right for you.Women’s Health Physical Therapy (PT), also know as Pelvic Floor PT, is a specialized type of therapy that can alleviate and in most cases eliminate some of these problems following your delivery. There have been numerous published studies to support the effectiveness of Women’s Health PT.
Most women don’t talk about it.Many women are a bit reticent to discuss these very important issues usually due to embarrassment, and also because they don’t believe there is a solution. Usually following childbirth, the tissues should heal by your 6-week check up. If you are still having pain, you must tell your Dr. If he or she is not aware of this type of PT, you may want to suggest this as a plausible avenue for treatment.
What you need to know.It is normal to feel vaginal discomfort the first few times you have intercourse following a vaginal delivery. But, it is important that you do not push past the discomfort to avoid pain. This discomfort may be due to vaginal tears, episiotomy scars, forceps or vacuum delivery, the baby’s pressure on your pelvis during the birthing process, and/or low estrogen levels during breastfeeding.
Some women may experience urinary leakage when they lift, cough, sneeze or laugh which is termed stress incontinence. This occurs when the abdominal pressure increases. Normally, one’s pelvic floor muscle strength can counteract this, but following the birthing process, these muscles may be weakened and in some cases torn. Your PT will help with retraining your pelvic floor musculature.
Some women may also experience joint pain. This may be caused by physical strain while carrying the fetus, the secretion of the pregnancy hormone relaxin, which relaxes the ligaments, and the rigors of labor. There are many traditional types of PT treatments available to help with this. They may include: stretching and strengthening exercises, hands on techniques, modalities and posture retraining. These exercises will be specifically tailored to a body recovering from childbirth, as traditional exercise may not be appropriate. She will also teach you breastfeeding, burping positions and proper lifting techniques to reduce the stress on your joints.
What treatment involves.Your PT will use a variety of hands on treatment techniques to stretch, release, balance and desensitize some of the tissues involved. She may use biofeedback, electric stimulation, as well as manual techniques to help jump-start these muscles in order for them to contract normally.
PT visits are generally weekly. Typically, postpartum pain patients require 10-12 visits for vaginal pain, 4-6 for incontinence, and 6-8 visits for joint pain (unless there is a pre-existing condition). At the end of the course of treatment, most women feel significantly or completely better. In the state of New York, you can see a PT without a script from a physician for as many as 10 visits spanning a four week period of time. The costs range per visit depending on treatment and many insurances will provide coverage for the visits.
Gail O’Neill is a Licensed Physical Therapist and Pelvic Floor Specialist in Greenwich Village, New York City with over 30 years of Orthopedic experience in Physical Therapy. As a mother of three she is passionate about helping women who are affected by these common discomforts.
- Ask the RE
- Better Living
- Book Recommendations
- Cancer Care
- Chinese Herbs
- Chinese Medicine
- Chinese Medicine
- Early Start
- Emotional Issues
- First Aid
- Five Elements
- Front Desk Staff
- Giving Back
- Green Living
- Healthy Eating
- Healthy products we love
- Infertility Support Group
- Infertility TV
- Living Strong
- Love & Libido
- MB – Jill's book
- Naturopathic Healing
- Naturopathic Medicine
- News Feature
- Nutritional Counseling
- Nutritional Supplements
- Online Articles
- Pelvic pain
- Post Feature
- Prime Time
- Self Care
- Setting Out
- Sex Again
- Skin care
- Stress Reduction
- Support Groups
- The Environment
- Top Blog
- Weight Loss
- Well Woman
- Wellness Interviews
- Western Medicine
- What does your acupuncturist eat?
- Women's Health
- Yinova Cleanse
- YinOva Kids
- YinOva News
- acupuncture back pain body cancer children chinese herbs chinese medicine cleanse cooking depression diet digestion Emotions environment exercise fertility food health healthy healthy eating healthy recipes herbs infertility INT IVF libido Massage medicine meditation miscarriage nutrition pain pilates pregnancy recipes seasons sex Sex Again sleep stress support V-Steam weight loss wellness yoga