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What to Know When Starting Pelvic Floor Physical Therapy

Jordan is a newlywed of nine and a half months, six of which have involved navigating secondary vaginismus and sex with her loving husband.

Photos taken at our wedding by Stevie Lowe and Heath Snyder

Photos taken at our wedding by Stevie Lowe and Heath Snyder

Pelvic Floor Physical Therapy

I started experiencing terrible, burning pain with sex three months after I got married in May of 2020--despite having little to no pain for those preceding three months. Now, six months since the onset of pain, I've finally gotten connected with a physical therapist who specializes in the pelvic floor. Most of our work in an appointment involves therapy for my entire core. When there is a problem in the pelvic floor (specifically the vagina, for me) you can often see side effects in the bladder and bowels. This looks like physically relaxing the muscles in my back, abdomen, and then my pelvic floor.

It's pretty much a lot of cupping on the back and stomach (but far less intense than you see with professional athletes), a lot of manual massaging, and slowly tensing and relaxing of the muscles inside my vagina.

You may be curious because you, too, are dealing with vaginal pain or simply because you've never heard of pelvic floor physical therapy (try saying that three times fast; I always get so tongue-tied just trying to say it once) and want to know more. Either way, I'm happy to share what I've learned so far.

Note: I will be using the word "likely" or "probably" throughout this post to avoid any unnecessary absolutes. I never want to inspire a feeling of doom in sharing the story of my pain, because it wouldn't be kind and I understand that every woman's journey is complex and unique.

8 Things to Know

  1. You don't have to know what's wrong before you get help.
  2. You probably don't know your anatomy very well. For example, do you use the word "vagina" when talking about anything remotely in that region? (Hint: The vagina is only one of those things.)
  3. The process is messy. Eventually, you'll schedule an appointment during your period. Yes, it's inevitable. Yes, your therapist knows it's going to happen--likely once a month. Yes, you're still going to feel a little awkward (or a lot) and want to apologize. While polite, your apologies are not necessary.
  4. The process is long. The first time I heard the word "progress" was three weeks into my therapy, and it wasn't because it was no longer painful to try and have sex anymore. "Progress" simply meant my pelvic muscles weren't trying to fight my therapist's fingers as much, that there was a hint of relaxation.
  5. Cherish the wins, no matter how small. If you can't find happiness in the little wins on this (potentially) very long journey, you'll get drowned in the overwhelming sense of failure with each painful attempt at intercourse and the snail's pace of recovery from something you never asked for. You can't rush yourself into proper vaginal health, no matter what it is that's going on. If it's a yeast infection or UTI, you wait on the antibiotics to do their job. If it's vaginismus, you wait on the physical therapy and prayers and process to restore your health. Believe me, if you "push through" painful sex, you'll likely cost yourself progress and time.
  6. By the time you seek professional help and treatment, you've likely imprinted mindsets you'll have to rewrite. If that's not you, ignore this next bit, because I don't want you to overthink it and talk yourself into having a false mindset. However, if you made the mistake (cough, me, cough) of pushing through to have the intercourse part of sex with your husband--for whatever reason--you likely formed a pattern. Your vagina, and now your subconscious mind, probably have learned to expect pain with intercourse. The first time it really sunk in for me, as to how much damage I'd caused myself, was SIX MONTHS after the problem started: I tried to visualize the first three months of our marriage, when intercourse was pleasurable, not painful, and I could physically feel the muscles inside my vagina clench and spasm at the mere thought of trying to insert a penis. It was devastating, realizing that in my own desperation and stubbornness, I had potentially prolonged my pain.
  7. And for everyone that cringed at my blatant use of the words "vagina" and "penis", learn to not apologize for talking about basic anatomy. Of course, there are situations where delicacy is polite (the moms around you would probably appreciate you not loudly talking about penises in front of their preteens). But, in order to understand for yourself what's going on, you're going to have to use some words you may not have ever brought into casual conversation before. It'll take some adjusting and maybe some blushing, but it'll be worth it, I promise. Part of knowing your anatomy, as I referenced in my second point, will be a lack of shame around the body parts God has given you--and I know for many, it's not that simple. I'll save that conversation for another day, but know this: your body was specifically, especially made and if that isn't enough, know that almost every other person in your life has one of these parts, too.
  8. Research can be your best friend and your worst enemy. Looking at other women's stories on Google and even blog posts like this will inevitably leave you angry that your specific issue wasn't addressed and upset because you feel like an oddball with no answers. I know that's how I felt, at least. Every time I read something dumb like, "Younger women have plenty of natural lubricant" (as if, because I'm not going through menopause, I don't have any issues with vaginal dryness) or that vaginismus can only happen after trauma or to someone who always had an issue with tampons (spoiler alert: tampons were fine for me and I did not give birth or suffer any other trauma to trigger my pain), I got so mad. I felt invalidated and unseen. But though you cannot look for an absolute answer online, some research can be beneficial, even just to help identify the type of pain or issue you're experiencing. It gave me words to what I was experiencing, especially as I felt like my gynecologist wasn't communicating well with me and as I started working with my physical therapist.

I'll do another update on what my physical therapy looks like later on. I don't expect to see results quickly (as much as I would like to), but I am so thankful to have gotten the ball rolling on my treatment. I'm in earnest prayer for myself and any of you who have gone or are going through anything similar—pain during sex is not normal and is worth having conversations about.

Much love to my fellow women and wives navigating these issues. I know how hard it can be.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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