Sex Matters: Pelvic Floor Physical Therapy

By on October 1st, 2014 Categories: Sex Matters

In our previous columns, we’ve discussed several issues related to the vaginal and vulvar changes that can occur as a result of cancer treatment, including vaginal dryness and irritation. Some simple solutions include using vaginal moisturizers and lubricants. In addition, some women may need vaginal dilators to help stretch the tissues that have become less elastic and hardened over time as a result of treatment or reduced hormone levels.

Some women may find it helpful to get specialized therapy for their tightened pelvic muscles. Pelvic floor physical therapy can help a variety of conditions including interstitial cystitis (sometimes called painful bladder syndrome), overactive bladder, painful intercourse, and unexplained pain in your lower back, rectum, or pelvis.

For some women who experience pelvic floor tightening or vaginal muscle spasms, pelvic floor physical therapy may be the answer. A pelvic floor specialist can help you retrain your pelvic muscles.

At your appointment, the physical therapist may conduct a variety of different assessments, such as talking with you about your condition and medical history. The therapist may also want to watch you walk, sit, and stand so that he or she can examine your pelvis and back muscles as well as pelvic joints.

Pelvic floor physical therapy is a hands-on approach involving both external and internal manipulation. Some techniques include tissue massage, myofascial release (applying gentle pressure to tight connective tissue), and working on joint movement.

If you’re comfortable with it, the therapist may also do an internal exam. Typically, the therapist places a gloved finger inside of your vagina and helps assess the pelvic floor muscles that may be in spasm, overly tight, or showing weakness. The therapist may also feel knots of tightened muscular areas that can trigger pain — also known as trigger points. Sometimes, pressing on this point will allow the tightness to be released. Some health care professionals may also consider injecting the trigger point with medications, including topical anesthetics, or possibly prescribe intravaginal Valium to help ease the muscle spasms.

The pelvic floor physical therapist is specifically trained to help address these muscular problems within the vagina. Repeated treatments can help ease the pain and help address the underlying medical problem.

Physical therapists also use a variety of devices to help you learn to relax your pelvic floor or to treat your pelvic pain. One of these devices is a probe inserted into the vagina that delivers electrical stimulation to your muscles, helping to soothe the nerves and decrease pain. Some physical therapists also offer a home device for personal use.

Biofeedback can be helpful in discovering how tense your muscles are and may help you learn how to relax those muscles. Probes and electrodes may be used in this case. A physical therapist can also use an ultrasound machine to direct high frequency sound waves to help treat painful muscles in the pelvic area.

To find a qualified pelvic floor physical therapist, ask your gynecologist or medical oncologist for recommendations.

Pelvic floor physical therapy is often covered by insurance. Check with your insurance company to make sure, and get a referral if your insurance requires it.

Next month, we’ll tackle the issues of minimally absorbed topical vaginal hormones as a possible treatment option for women experiencing severe dryness. This is often a controversial discussion; women diagnosed with breast cancer, oncology teams, and gynecologists might not always agree on whether to use these treatments.

If you’ve tried pelvic floor physical therapy, use the comments area below to let us know if it helped you. And if you have questions about topical vaginal hormones, please post them here as well!

Michael L. Krychman, M.D.C.M., is the executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, California. He is the former co-director of the Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer. Dr. Krychman is also an American Association of Sexuality Educators, Counselors and Therapists (AASECT) certified sexual counselor. He is an associate clinical professor at the University of California, Irvine, Division of Gynecological Oncology, and the medical director of Ann’s Clinic, a high-risk program for breast and ovarian cancer survivors. His special interests include menopausal health, hormone therapy, sexual pain disorders, loss of libido, and chronic medical illness and its impact on female sexual function as well as breast cancer sexuality. Dr. Krychman is also a member of the Breastcancer.org Professional Advisory Board.

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