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  • Karah Charette, PT, DPT, RYT

How Can Pelvic Floor Physical Therapy Help Sexual Dysfunction?

Many people still do not know what pelvic floor physical therapy is, let alone that it can help with sexual dysfunction! If you feel you have hit a wall with pain with sex or decreased sexual appreciation, you may want to consider what pelvic floor physical therapy can do for you.

The first question you may ask is “what is the pelvic floor?”. The pelvic floor is essentially a sling of muscles at the base of your pelvis that plays a vital role in bowel, bladder, and sexual health. Whether you are penis-bodied or vulva-bodied, all bodies have this important group of muscles and all bodies can benefit from treatment of these muscles when symptoms present.

“Pelvic Floor Dysfunction” simply refers to the idea that the pelvic floor muscles may not be working to the best of their ability. For some folks, the issue may be that the muscles are being held too tensely, or that there may be a lack of coordination in both contracting and relaxing these muscles. It is important to work with a skilled pelvic floor physical therapist to have an individualized assessment in order to determine what specifically may be going on with your pelvic floor muscles.

It is important to acknowledge that the pelvic floor muscles play a key role in sexual arousal and orgasm, as well as penile rigidity. Issues in any of these aspects of sexual appreciation can be due to lack of coordination, lack of blood flow, and lack of elasticity or suppleness in the structures that support these functions. Healthy muscles are ones that can fully contract and relax, and this motor control can be improved with pelvic floor physical therapy.

For people with penises, overactive pelvic floor muscles can often present as:

  • Erectile dysfunction

  • Premature ejaculation

  • Pain after ejaculation

  • Penile and/or testicular pain

  • Rectal pain/spasm

For people with vulvas, overactive pelvic floor muscles can often present as:

  • Itching or burning at the vulva

  • Pain in the clitoris

  • Superficial pain with insertion

  • Muscular resistance to penetration

  • Pain with deep penetration

  • Inability to orgasm

  • Painful orgasm

  • Rectal pain/spasm

It is important to know what an evaluation with a pelvic floor physical therapist would be like. Often times there can be fear or anxiety because you do not know what to expect. An initial consultation should be at least 60-90 minutes in order to allow for there to be enough time to take a comprehensive history and to allow for your story to be fully heard as an individual. Spaciousness in this first visit is vital to allow for an environment of safety to be established with such an intensely personal type of care being provided.

After your story is heard, an exam can take place. This often includes an assessment of posture, functional movement, and breathing strategies as pelvic floor dysfunctions do not happen in isolation at the pelvis. Pelvic floor physical therapists are trained in special techniques to complete an internal assessment if indicated and with consent. This internal assessment can be done intra-vaginally or intra-rectally and is performed with one gloved finger with appropriate lubricant (no equipment is used). This assessment allows for the therapist to assess the individual muscles of the pelvic floor to be more diagnostic, as well as to assess the motor control and function of these muscles.

If you are someone who feels intimidated by the idea of an internal assessment, the great news is you do not have to participate in that type of assessment the first visit or ever if you do not want to. Pelvic floor dysfunction is often driven by many other factors above and below the pelvic floor. One area that is deeply connected to the pelvic floor through nerves and fascia is the abdomen. Many pelvic floor physical therapists who are trained in visceral fascial mobilization techniques have great success with treating pelvic floor dysfunction without ever having to do internal work. The physical therapists at Bodyful Physical Therapy and Wellness are trained in these techniques and have seen many clients benefit greatly from this specific work.

Once a thorough examination has been completed, a unique and individualized treatment plan can be established collaboratively with you to meet your specific needs and goals. The treatment may include education on pelvic anatomy, exercises designed to promote improved motor coordination, breathing exercises to regulate the nervous system, manual therapy to facilitate changes at the tissue level, and potential use of dilators for folks wanting to achieve pain free penetration. Dilators can also be an important tool after gender affirming surgeries such as a vaginoplasty and pelvic floor physical therapy can help immensely in the recovery from that procedure.

It is important that whoever you choose to work with for treatment is trauma informed and nervous system informed. The body and how it expresses cannot be separated from emotions and experiences. Therefore, it is also important to consider working with a psychotherapist who is informed in sex therapy treatment practices while working with a pelvic physical therapist. Clients who work with this type of team see better results faster and with longer lasting relief.

Whatever team you choose to work with, if you are taking a step to reach out and ask for help, you are taking a courageous and important first step. Sexual dysfunction is incredibly intimate and vulnerable, and it is your right to experience not only pain free sex but also pleasurable and joyful sex. No matter your gender identity, sexual identity, or sexual preferences, you deserve care that is inclusive, accessible, and effective.

If you’d like to learn more about receiving pelvic floor physical therapy services, you can reach out to Bodyful Physical Therapy and Wellness where you will see options for online consults and education as well as in person therapy visits at our office in Oakland, CA.

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