Pelvic Floor PT 101: What Is Pelvic Floor Physical Therapy Like?

I’ve mentioned in the past (here and here) that several years ago I was diagnosed with vulvodynia and vaginismus – two disorders that often go hand-in-hand. Vulvodynia makes the vagina extremely sensitive to even the slightest touch, and can cause vaginismus, which is when the pelvic floor muscles clench uncontrollably in an attempt to guard against the pain. Together, these disorders can make any kind of touch or insertion, from doctor exams to sex, very painful or impossible.

A PSA for those who need to hear it: Pain during sex is not normal. Please don’t let anyone, not even your doctor, convince you otherwise. Keep talking until you find someone who will listen (and feel free to reach out to me via my contact form if you have questions – I will always try to respond!).

Once diagnosed, my specialist told me that part of my treatment would include visiting a pelvic floor physical therapist, twice weekly, until my pelvic floor muscles learned how to relax again. A physical therapist who would be putting her fingers inside my vagina in order to manipulate and release the muscles there.

Friends… believe me when I tell you, I found this information jarring, to say the least.

I’d had some very painful doctor exams by that point and was frankly terrified at the idea of putting anything inside my vagina, let alone subjecting myself to the torture of someone else poking around in there twice a week. Truly, I was not thrilled at the prospect.

On the other hand, I wanted to have sex, badly. My boyfriend and I had a great sex life even without penetrative sex, but it was something I wanted to experience – pain-free – so, so much. Enough that it outweighed my fear of going to the physical therapist, and so I made the appointment.

The First Appointment

The waiting room was bright and vaguely homey; it didn’t feel as clinical as a doctor’s office, more like a yoga studio or somewhere that might have “wellness” in its title. My specialist had referred me to this office, though my insurance didn’t cover the doctor. (As it turned out, my insurance didn’t cover any pelvic floor physical therapist; it seemed to cover physical therapy for every body part except vaginas. Ah, the joys of the U.S. health care system.) I checked in and sat down, crossing my sweatpants-clad legs (per the receptionist’s instructions when I made the appointment) anxiously.

Before long, my new PT, Jackie, stuck her head in and cheerily called me back to a small room with a desk, a couple of chairs, and an exam table. We sat in the chairs as Jackie introduced herself and told me her qualifications; she was warm and down to earth, and she instantly put me at ease. I was also glad that she didn’t immediately have me strip down or put on a gown – I felt so much more comfortable talking about such sensitive (and yeah, embarrassing) topics while still wearing all my clothes. She then asked me a bunch of questions about my sexual and health history, in order to understand exactly what led me to seek her help.

Next, Jackie left the room so I could undress from the waist down, like a gyno exam, and gave me a sheet to cover my lower half while lying on the exam table. When she came back, she assured me that if I was uncomfortable or wanted her to stop touching me for any reason, all I had to do was let her know and everything would stop. She put on gloves and then used a lubricated finger to check the muscles around the entrance of my vagina. If she found a tight muscle, she would press down on it, applying pressure until the muscle released.

It was less awkward than I expected, but painful, too. There’s no getting around it: releasing years of pain from the body is no easy feat, and my first few sessions were particularly uncomfortable. I’d developed a high pain tolerance from years of dealing with these issues on my own, but I was still sweating at the end of each appointment.

Having a good PT made all the difference in the world, though. Jackie checked in regarding my comfort and pain levels throughout the entire appointment, always taking care to make sure I wasn’t more uncomfortable than I could handle. We also chatted like two ladies at the hair salon, about our jobs, our dogs, and our partners.

At the end of the appointment Jackie proclaimed, “You’re going to get better fast, I can tell,” and I believed her.

Next Appointments

Jackie estimated that it would take about six weeks, or twelve appointments, to get my pelvic floor calmed down and in working order (for lack of a better term?). Not every appointment was exactly the same – sometimes Jackie also showed me stretches or yoga moves that she thought would help with my healing – but mostly I just laid on the table, trying to relax while Jackie worked.

After a few appointments, maybe three or four and certainly fewer than I expected, she told me she thought I could try having sex again.

“Really?”

But she was right. After years and years of pain and frustration, it only took three or four appointments with Jackie to make it stop. It was shocking and wonderful and at the same time, bittersweet. I felt so regretful that I hadn’t gotten help sooner, or known how to get help sooner.

The rest of the appointments were more of the same. Jackie also had me dilate at home between appointments, and over the next few weeks I learned breathing techniques and other ways to relax my pelvic floor on my own.

A Word About Cost

As I mentioned, my health insurance didn’t cover any of this, which meant I had to pay for all of it out of pocket – $90 per appointment (at twelve appointments… I’ll let you do the math). I’m extremely lucky that I was in a position where my partner and I could afford to do so, but it wasn’t easy, and it shouldn’t be that way. Treatment should be affordable and accessible to everyone, but it’s just not, and I can only hope that changes as awareness grows. Of course, this was my experience several years ago, and every person’s doctor and insurance situation is different, so it’s kind of impossible to guess what someone might have to pay. But unfortunately, I imagine cost will be restrictive to many. That being said, make sure to check with your insurance company, and see if they have an appeals process if you are turned down for coverage.

All things considered, the cost of the treatment, and all the discomfort, was well worth what I got at the end of six weeks: a completely pain-free sex life, for the first time ever. And it wasn’t nearly as awkward or scary as I thought it would be; if anything, I wish I’d found a way to get treatment earlier than I did.

If you think you might need a pelvic floor physical therapist, consult with your GP or gynecologist.

(Note: I am not a doctor and this is not medical advice; I’m presenting my own experiences for informational purposes, but you should consult with your doctor before making any changes that may affect your health.)

Header image via Unsplash.