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Physiotherapy for Painful Sex

Physiotherapy for Painful Sex

Introduction

Tearing and pain during sex were some of my earliest Lichen Sclerosus symptoms, which I have blogged about (here). After getting my Lichen Sclerosus diagnosis, I told myself I was not going to let this disease take away my sex life. However, I knew I couldn’t do this alone. I decided I was going to create a Lichen Sclerosus team to help me with painful sex. This team would be there to help me navigate the ups and downs of living with LS. This is critical because I believe it takes a team to address all the different aspects of LS (e.g., physical, sexual, mental, spiritual, etc). First on the list was to find a physiotherapist, specifically, a pelvic floor physiotherapist. In this post, I discuss my first appointment with a pelvic floor physiotherapist. If you are interested in potentially exploring pelvic floor physiotherapy, this may help give you insight into what to expect. 

Don't forget to read until the end for this post's #TuesdayTipbyLLC!

How to Find a Pelvic Floor Physiotherapist?

I have degenerative disc disease and because of this, I have spent a lot of time in physiotherapy and rehabilitation centers over the years. Thus, I knew most of these institutions had physiotherapists specializing in pelvic floor issues, such as painful sex. I researched some clinics in my area and found Jane Bai’s profile. I loved her use of a biopsychosocial approach to treating pain and her emphasis on patient education.

Shortly after, I booked online and had my appointment a couple days later.

Image of a person at their desk, on the computer concentrating with paper and pens surrounding the desk. This picture represents the research I did in trying to find a pelvic floor physiotherapist.

The Initial Pelvic Floor Physiotherapist Appointment

My first appointment with Jane was in the summer of 2019. For the initial session, Jane began by asking general health questions and then proceeded to more specific pelvic health-related questions. For instance, she asked about urinary issues, bowel movements, and low back pain. Afterward, she asked me what I was hoping to get out of physiotherapy.

“I have Lichen Sclerosus and this causes painful sex. Ideally, I want to be able to have pain free sex”, I responded.

When Jane responded, I knew I was in the hands of an amazing health practitioner.

“I do not know a lot about Lichen Sclerosus. I have never treated anyone with it before, but I will absolutely research this” she said.

Honesty.

And humility.

These are rare traits in the healthcare industry. I felt comfortable working with her and trusted her because of her honesty. People who are willing to admit their knowledge gaps and who are willing to research to fill in these gaps, are, in my opinion, way more trustworthy than practitioners who treat patients despite not having the appropriate background.

An Unexpected Question

After discussing my goals and going over my relevant health information, we moved on to a physical examination. Much like a gynecological examination, this involves removing your pants and underwear, covering yourself with a blanket, and having the health care worker assess your vulva and vagina. However, something critical happened before we proceeded with the examination; something I had never experienced with any doctor or health care practitioner's office before.

Do you have a history of sexual trauma? I ask because this will dictate how I move through the physical examination.”

“Yes, I do”, I responded.

I may not ever have the words to express how this made me feel. I was shocked because I had never been asked this question before and I was profoundly grateful. Having a trauma-informed physiotherapist made me feel incredibly safe–I always entered any vulvovaginal exam with my guard up but her question instantly put me at ease.

Before she left the room for me to change, she very calmly explained every step of the examination to me. She noted I could ask her to stop at any point if I felt uncomfortable or uneasy.

The Physical Examination

Part of the examination involves the physiotherapist inserting their finger(s) into the vagina to feel the vaginal/pelvic muscles. From this, they gain information such as whether the muscles are tight, whether there are trigger points, etc. I was rather nervous about this because at this stage even inserting one finger caused me pain. In fact, two weeks before my appointment with her I had a very traumatic experience with a gynecologist which caused me tremendous pain during and post examination — and that was just from him inserting one finger. Consequently, I was nervous that Jane may not be able to insert a finger.

However, Jane was incredibly gentle and moved very slowly. She explained every step and, moreover, why she did it and what she was looking for. This really helped put me at ease. Surprisingly, when she inserted her finger it did not hurt! I attribute this largely to her being trauma-informed, which included asking about past trauma, her calm demeanor, explaining each step of the examination, and being slow, careful, and gentle every step of the way. She was able to identify some tight areas and trigger points without causing me any physical distress.

Image of a silhouette of a human head with the word 'Trauma' in caps in the brain region, representing my history with sexual assault and how grateful I was to have a physiotherapist who was trauma informed.

A Key Learning Moment

One interesting thing I learned from the examination was I am prone to tensing and bracing my muscles and have trouble relaxing them. For instance, when she asked me to do a Kegel, she said I had great strength. On the other hand, when she asked me to release, I couldn’t instantaneously release. It took a good 30 seconds for my muscles to unclench. 

I will blog more on the topic of tensing, trauma, and pain in future posts. 

Suffice it to say, it was clear my vaginal muscles were in defense mode and had a hard time relaxing.

Post Physiotherapy Examination

After the examination, Jane went over homework for me to doand laid out our plan of attack. My treatment plan would involve some stretches and yoga poses, relaxation methods, and dilators. I’ll dive into the detail of what each component involved in future posts, but I left the clinic feeling optimistic. This was a nice contrast to the hopelessness that dominated my mind most days before my Lichen Sclerosus diagnosis.

Image of person next to a stability ball as I had some exercises to do as part of my treatment plan in physiotherapy.

Conclusion

In sum, my first experience with pelvic floor physiotherapy was overwhelmingly positive. It consisted of my physiotherapist taking a detailed medical history, listening to my concerns and aspirations, a physical examination, a debriefing, a treatment plan, and homework. The fact that Jane was so thorough, compassionate, and knowledgeable helped make what could have been a stressful appointment very pleasant. In my next blog, I’ll discuss some of the practices we did to help alleviate pain during sex.

If any of my readers are in the Toronto area/live in Ontario and experience pelvic pain issues, Jane is available for virtual pelvic floor physiotherapy. Her details are:

Website: https://www.pelvicpro.ca/bio

IG page: @PelvicPro

Pelvic Floor Meditation Series: https://www.youtube.com/channel/UCfpkNg5XNUKXfFdsItslFqA 

Get in Touch with Me!

Do you or have you worked with a pelvic floor physiotherapist? What was your experience like? Are you debating working with one? Let me know in the comments below or feel free to contact me via social media. I would love to hear from you!

Instagram: @thelostlabiachronicles

Facebook: @TheLostLabiaChronicles

#TuesdayTipbyLLC: Find a physiotherapist that you fit well with. Don't settle for the first one in your area. Research their background and make sure you feel comfortable and safe with them when you see them.

By Jaclyn

I am the author of The Lost Labia Chronicles, a blog about Lichen Sclerosus, Sex, and Mental Health. I was diagnosed with Lichen Sclerosus in 2019 but had been symptomatic for over a decade. My mission is to provide support and hope to others with Lichen Sclerosus.

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