Pelvic Pain Dysfunctions: What You Need to Know

Pelvic pain dysfunctions are a silent disease. Many young women (as well as older women) suffer from pain in the pelvic region causing pain with intercourse, tampon insertion and sometimes light touch. 

Most of the women that come to see me about their pelvic pain have seen at least five doctors prior to physical therapy. The majority of them have been told somewhere within their search for treatment that they should just relax and have a glass of wine.

This is very upsetting to a physical therapist, knowing that this type of pain and dysfunction is musculoskeletal and can be treated with traditional PT techniques. It just happens to be in a very delicate area of the body. This area has muscles that are similar to other areas of our body. They can become very tight, and this tightness can be treated with appropriate techniques.

The reasons patients have pelvic pain can include:

• A gynecological problem
• Painful periods
• Muscle spasms
• Injury to the area

No matter what the cause is, the muscles will reactively tighten and spasm to protect the pelvic floor region. This tightening and spasming can cause difficulty with penetration including intercourse and tampon use.

Dyspareunia is the medical terminology for pain with intercourse. Dyspareunia can be caused by muscle spasming. The muscle spasm of the pelvic floor around the vaginal opening which causes dyspareunia is called vaginismus.

Vaginismus, which is one of the common diagnoses of pelvic pain, is a muscle spasm of the muscle that surrounds the vagina. This muscle can clamp down and cause difficulty with penetration and pain with intercourse. Throughout my 30+ years as a physical therapist in treating pelvic dysfunction, the most common comment from women who have vaginismus is that they have pain with intercourse.

There is help for patients with muscle tightness in the pelvic region. Treatment options include physical therapy and on some occasions, surgical intervention.

Treatment options in physical therapy include:

• Myofascial release and trigger point release can be performed by a physical therapist to the tight muscles of the pelvic floor. These techniques help with relaxation of tight muscles.
• Ultrasound is a modality that can be used in tight muscles to help increase circulation and decrease tightness throughout the muscles in the vaginal area.
• Retraining the muscles of the pelvic floor and teaching them to relax can also be a treatment option.
• Internal vaginal biofeedback can be used to teach the muscles of the pelvic floor to “let go” and relax so muscles can restore their flexibility and pain with intercourse can decrease.
• Electrical stimulation can also be used with internal or external electrodes. This is used to decrease overall pain and muscle tension and increase circulation of the pelvic floor, which in turn also will decrease the tightness of the muscle and decrease pain with intercourse.
• Stretching the pelvic muscle with a dilator. A dilator is a 6” long cylinder piece of plastic which is inserted into the vagina to stretch both the outside muscle of the pelvic floor and the inside muscle in the vagina. Dilators come in many sizes, starting with extra small all the way to large. Stretching the muscles will help decrease the tightness so intercourse is less painful. Using a dilator will also decrease the hypersensitivity of the vaginal opening. The vaginal opening can become very hypersensitive to light touch, causing pain. This in turn will cause more muscle spasming, which causes more tightness, which causes more frustration. 
• Other treatment options in physical therapy include postural reeducation and visceral mobilization. 

If you have pelvic pain and are living with it, please consider your treatment options. You do not have to suffer in silence—there are many ways we can help you.

Connie Strey is a Physical Therapist at PT Center for Women, 3232 N Ballard Rd, Appleton, WI 54911. To make an appointment with Connie call or text 920.729.2982.

PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.