Living With Painful Intercourse: Physical Therapy

Up until just a while ago, I had no idea that this condition had treatments other than topical medication or surgery available. Then, my doctor introduced me to the concept of physical therapy. Immediately, some pretty gnarly images of what physical therapy for painful intercourse would constitute came to mind.

Googling the subject did not really enlighten me, either. I knew there would be internal work, which makes just about anyone with this condition shudder, but I also heard some stray discussion of “dilators.” Dilators, for the uninitiated, are essentially dildos. I’m not exactly a prude, but I’m certainly the sort of shy person who would die if anyone stumbled into her bedroom and found a dildo – this fear, more than any moral sensibility to be sure, is what has kept my bedroom relatively (relatively!) free of the sex toys and gadgets that I might still enjoy with vulvar vestibulitis. So, knowing that physical therapy would encompass these two realms that I generally avoid, let’s just say I wasn’t exactly thrilled to walk into my first session this week.

I expected to find an extremely clinical setting. Instead, I found an office very much like you imagine any office in the world. The only difference was the sterile, white bed in the corner with hospital pillows and the bunch of degrees and charts on the walls. The woman who met me didn’t wear a white coat; she was dressed business casual. What followed out handshake was an extensive question and answer session about every possible type of pain I could remember, including back, leg, and abdominal pain. Then, she very compassionately reached out a hand and said, “This is the worst part, but it’s probably best we start with an internal exam to gauge the level and location of the pain. We can do that next time, if you need to prepare, or we can do that now. We can also avoid it completely if the pain is too much right now, but it may mean it takes longer to pin down the information we need to start helping you. This isn’t going to be like a gynecological exam, and we will move at your pace.”

Folks, it is just so rare that anyone takes you seriously about the pain that I was speechless. Doctors always use the word “discomfort,” as in, “Are you experiencing discomfort when I jam this instrument up there because I’ve decided you still must get this exam for birth control despite all your complaints about the painfulness of exams?” Yes, former OB/GYN I frequented for the first two years of my marriage, as I said two seconds ago and on all previous occasions, I am experiencing agony, not discomfort. Thanks for not using the smallest speculum and treating me like a cow you need to get in and out of your office as quickly as possible, regardless of how I will be aching for days as a result of your cavalier attitude toward my well being.

Anyway, I had come to this physical therapy session prepared, so I said, “Let’s go for it.”

There is such a difference when someone believes and trusts you. It took 45 minutes to complete the exam, and she moved slowly, meticulously, to avoid extraneous discomfort. Rather than have me strapped and straddled on one of those gynecology tables, which she rightly assumed had some intense psychological associations for me, she had me lay on the bed in the corner. She sat at the end of the bed, very informally. She used only her fingers – no speculum or other tools. She was speaking calmly to me the whole time, asking about the degree of pain. Any time I expressed that the pain was intense, she backed off.

Throughout the entire exam, as well, she was pressing certain muscle points on my body. First on my legs, then around my pelvic bone, and then up along my abdomen and toward my belly button. I was amazed to discover that several of these points she pressed were painful, as if they were bruised. I’d never felt pain from those areas before, not until she pressed them. She said that the muscles she pressed feed into the vaginal area and thus, if they are too tight or screwed up, they can lead to some of the pain associated with this condition. While they aren’t the total answer in my case, they are a part of the problem. Then, while one hand was still engaged in the exam, she began helping me to stretch my legs and back while pressing down with her other hand on these muscle points. We held these positions for several minutes. Finally, when we finished and she removed her fingers, I felt no pain. No pain, only discomfort! That was a win in my book.

After the appointment, and still today, I feel sore, as if I ran a couple miles without stretching before and after. But I’m hopeful. For the first time in a very, very long time, I’m hopeful that maybe I can have sex with discomfort rather than pain. Or, and I hardly dare speak it, maybe sex without discomfort?

I’m curious to see where this physical therapy leads. She gave me an entire list of exercises to try at home and a routine to start following nightly. No dilators yet! My only problem has been finding those same muscle spots she pressed and remembering how she had me stretch my legs and back. Also, I feel a little silly doing these stretches, but you know what? I don’t even care. The prospect of painless sex is overwhelming motivation. Heaven willing, I haven’t gotten my hopes up for nothing. Heaven willing, this physical therapy may mean that surgery isn’t inevitable, that painless sex is possible (or, at least, that slightly uncomfortable sex is possible). Heaven willing, it means that I’m not bound to feel that children are a distinct maybe, just because the thought of trying every night to get pregnant makes me want to hide under the bed (alone!).

Have any of you heard about or received physical therapy for this condition? What are/were your expectations? Have any of you used dilators for this condition before?