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?

By Michelle Miller

Michelle Miller is a twenty-something blogger, cook, freelance writer and editor living in Seattle, Washington. She’s a feminist trying ever-so-hard to embrace her spaces, conventional or not. She looks forward to numerous bad hair days, burnt cremes, a soapbox or two, and maybe (just maybe) a yellow polka-dot bikini in the years ahead.

12 replies on “Living With Painful Intercourse: Physical Therapy”

This is really interesting. I’m a virgin for various life circumstance reasons (as opposed to religious/moral/etc). I have had awful, awful experiences with the gynecologist, too. My first one, I felt like I was one of many uteruses on an assembly line and not an actual person yelping in pain while having instruments jammed and shoved into my tenders. I didn’t know that I should not hurt for days after a pelvic and a pap smear. I told me current doctor about that, and she looked at me and said “You know, I’m not a fan of causing pain. That’s why I’m a doctor.” And she talked me through everything and discovered that my cervix is very tender in one area and does not appreciate being poked. And behold, I was not in pain for days.

I have no idea how my lady parts will respond to sex when the time comes.

I can’t really speak to why I’ve had this experience with gynos, or why my experiences are so common for women with pain, but I have to think it’s because some gynos seen enough examples of exaggerated discomfort that they just assume discomfort is always faked?

Or, you know, those gynos were just asshats. Could be. :)

This sounds like an amazing experience with a PT! Also, the way you describe her reminds me of my rhuematologist. :)

I know that sex toys can be scary. Have you considered getting a chest with a latch on it for “personal care” items like the potential dilators, lubricant or other topical gels, or even eventually- goodness gracious!- actual sex toys that might work for you? Even looking for a trunk or even something that looks like a hope chest can be a good choice. I have a mid century side table that has a little drawer that I use for this purpose at the foot of my bed for now, though I’m personally looking for a chest to use instead some day.

A good friend was prescribed dilators and was fairly open about it several years ago. The graduating scale, size wise, goes very very slowly for a lot of people, so it’s not some scary tear-yourself-open-on-a-regular-basis thing. It’s more comparable to gradually building up in weight lifting. You start itty bitty (like the 5lb or even 2 lb weights are for building up your arms) and very slowly work yourself up to whatever your doctor deems as standard, just like a good personal trainer should at the gym. (That is, if they are a good, health based rather than image based PT.)  To carry the metaphor, the steps you are working on are the stretching and movement exercises that you need to do to prepare yourself. Some people don’t even need to go up to the Dilators, which could be either fantastic or scary.

I hope that whatever your outcomes in your PT that they are super satisfying.

This is such great advice. I’m looking at eBay, Amazon, AND Etsy as we speak for a nice lockable chest!

I really appreciate your description of the process with dilators. They scare me a little less now. There’s no reason I have to start with something that will cause me pain; I can start slow and work with it.

This is a revelation to me.

This is so interesting, and I’m so, so glad you’ve found a professional who is thoughtful, considerate, knowledgeable, and listening to you. Long may it continue. And I have to say it makes a lot more sense than the slap-on-this-anaesthetic-cream approach of some doctors.

I’ve found yoga really good for teaching that kind of calm body-awareness you mention – is this muscle working? Is it tense? Why is it tense; what is it doing? What about that one? Can I relax it?  If I move slightly this way, does that change pain into discomfort or discomfort into relaxation? Not that I’m suggesting at all that yoga is a replacement for specialist physical therapy – it isn’t at all – just that our bodies and how they work can be very opaque to us without outside help and knowledge.

The very best of luck with this treatment, Michelle.

Now this fascinates me. I have often appreciated yoga for the same reasons you mention, but until now, I hadn’t put it together that the techniques are essentially the same. Focus, find the muscle(s) in your body, find the source of the tension, and BREATHE.

Hmm… This sounds like a really good excuse to go get that yoga class membership I’ve been wanting all year…

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