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Pelvic Floor Physical Therapy

Physical therapy is an alternative therapy that treats injuries and certain conditions without the use of medicine or surgery. This means using physical methods of healing such as heat, massage, and exercise. Pelvic floor physical therapy (PFPT) focuses on stretching and/or strengthening a group of muscles, nerves, and ligaments that make up the pelvic floor. The pelvic floor is a small but mighty area that helps control the day-to-day functions of some very important organs such as the bladder, bowel, rectum, uterus, and vagina. These muscles help control your ability to pee, poop, insert a tampon, have sex, and for some to give birth.

view of pelvic bone and pelvic floor muscles

What is pelvic floor physical therapy (PFPT)?

Pelvic floor physical therapy (PFPT) is similar to other common physical therapies that focus on the muscles, ligaments, and nerves in other areas of the body. However, it is also very different because PFPT, is often done one-on-one in a private room and does not require the use of gym equipment. There are two important parts to PFPT; targeted therapy and independent stretching. Targeted therapy is done one on one with the physical therapist and focuses on the soft tissues (muscles, ligaments, etc.) both internally (inside the vagina either with fingers) and externally through massage of the hips, gluteal muscle (found in the buttocks), etc. Independent stretching is done both one on one and on your own, at home with a dilator. In most cases, the therapist will teach the patient how to use a vaginal dilator (that comes in various sizes) to help relax the vaginal muscles and stretch the vaginal tissue.

What are the benefits of pelvic floor physical therapy?

There are a lot of different reasons why both young and adult women may see a pelvic floor physical therapist. It can provide pain relief while also improving sexual function. For example, some women may experience pain when inserting a tampon or when having sex, which is a treatable condition called vaginismus. While other women may have a condition called Mayer Rokitansky Küster Hauser syndrome (MRKH). MRKH is a birth defect that causes the vaginal canal to be either underdeveloped or absent. Women with MRKH may benefit from PFPT to help stretch their vagina. This is called vaginal dilation. PFPT may also be helpful to treat constipation, chronic pelvic pain, and urinary incontinence (leaking urine). This guide focuses on PFPT as a treatment for vaginismus.

What should I wear to my first PFPT appointment?

Wear what you are most comfortable in. Anything loosely fitting is a great choice.

What should I expect during my first pelvic floor physical therapy (PFPT) appointment?

  1. A big part of pelvic floor physical therapy (PFPT) is learning about your anatomy; specifically, the muscles, nerves and ligaments that make up the pelvic floor. Your physical therapist (PT) will explain why you may need PFPT and help you feel comfortable during the first exam and with follow-up treatments. Your first appointment will begin by talking with your physical therapist (PT). The PT will likely ask you questions such as; do you have menstrual periods? If so, when was your last period? Do you have issues with your back/hips? Do you use tampons? If so, do you have pain? What does it feel like? Are you sexually active? If so, is sex painful? This is also a great time to ask any questions that you may have.
  2. Next, your PT will likely show you a model or picture of a pelvis and all the pelvic floor muscles. Your PT should review each of the pelvic muscles, explain how they work, and how they could be causing you discomfort.
  3. The last part is the pelvic exam. Since the therapy is individualized (designed to help your specific body) the exam is important so the therapist can assess what specific muscles, nerves and ligaments will require treatment. The exam takes about 5 to 10 minutes Your PT will ask you to contract (squeeze) and relax your pelvic floor muscles (similar to when you hold your pee). This exercise will help you “feel” where these muscles are located.
It’s common for both young and adult women with vaginismus to be anxious or worried about the exam but knowing what to expect and getting your questions answered will help a lot.  If you decide to have the exam, ask your therapist to slowly explain every step. If at any time during the exam you need a break, just ask the therapist to stop. The exam will help the therapist figure out what type of therapy is best for you.

What is vaginal dilation?

Vaginal dilation is often a major part of pelvic floor physical therapy. Dilators can be helpful for young and adult women with a variety of conditions such as pelvic floor dysfunctions (vaginismus) and MRKH. They work by stretching the skin in and around the vaginal area, slowly over time, in a controlled manner. The dilators are handheld and inserted into the vagina by the patient.

What do dilators look like?

The dilators are tube shaped and vary in size and material (some are plastic, while others are rubber). There are different kinds of dilators available, but the most widely prescribed dilators come in a set with different sizes ranging from XS-L. The smallest dilator is similar to the size of a slender tampon. The largest dilator is similar in size (both length and width) of a penis. However, most young women will begin with the smallest dilator.

Pelvic floor physical therapy (PFPT) is a wonderful alternative therapy that has the potential to bring welcomed relief for many women diagnosed with a variety of pelvic floor dysfunctions as well as those diagnosed with MRKH. If you think that you may benefit from PFPT, talk with your health care provider (HCP). They can be helpful in determining whether or not PFPT would be right for you!

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