Healing pain with intimacy
Often women who have problems with painful intercourse have already tried other treatment options without success. They may be scared, frustrated, angry, or just depressed. Painful intercourse can cause problems with relationships, and there are emotional issues tied to multiple physical and psycological problems.? Fortunately, Dr. Salazar at CORE Pelvic PT is skilled in assessment and treatment of neuromuscular problems that cause sexual pain.
The physical therapist attempts to determine through the musculoskeletal assessment the source or contributing factor of the pain and/or reason for the dysfunction. She will look at muscle imbalance or incoordination, find any surgical adhesions, lower back irritation, muscle weakness and/or other factors that are contributing to the pain.
Treatment plans are highly personalized. Often treatments include addressing any problems noted in the evaluation, pelvic floor exercises such as Kegel exercises, visualization techniques, postural change plans, and manual therapy such as ultrasound, biofeedback, electrodes or myofacial release therapy. Often psychotherapy is also a part of the healing process by collaborating with a sex therapist.
Biofeedback may also be used as a treatment tool. For example, a patient who has increased pelvic floor muscle tone that contributes to pelvic pain, painful intercourse, or vaginismus (increased tone of the pelvic floor muscles) may measure a high resting tone of greater than 3 microvolts. The patient is able to observe a bar and/or number graph (or hear a tone) which shows this measurement and is instructed in pelvic diaphragmatic breathing exercises or other relaxation techniques as she focuses on relaxing her pelvic floor muscles to achieve a resting measure below 3 microvolts. For someone who may have weak pelvic floor muscles, the goal would be to contract so that she can observe a higher reading on the screen. For example, someone with less than a measure of 6 microvolts upon pelvic floor contraction may observe the screen and attempt to contract her pelvic floor muscles so that a number higher than 8 occurs.
Surface electrodes or internal vaginal or rectal electrodes may be used. Surface electrodes are placed at the perineum as closely as possible to the vagina with a ground electrode at the ischial tuberosity (“sitting bone”). It is also helpful to have surface electrodes at the transverse abdominus (lower abdominals) to observe potential substitution patterns of muscle recruitment. Resting tone, strength, and endurance measurements are recorded as a baseline.
Musculoskeletal Structures of the Pelvic Floor
The pelvis contains a complex system of nerves, arteries, veins, ligaments, muscles, organs, bones, and fascia, al! of which must be functioning normally to enable optimal-normal pelvic floor muscle function. (1)
- Treating Female Pelvic Pain Disorders Using a Combination of Pelvic Floor Physical Therapy and Sex Therapy
Ginger Manley, APRN, CST and K. Lynne Odom, PT, MOMT; Contemporary Sexuality Vol.40, No. 3, March 2006
- Pelvic Pain Every Woman Experiences
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Core Pelvic Physical Therapy
Clinic is located at:
1510 N. Argonne Rd., Suite F
Spokane Valley, WA 99212
Tel: (509) 279-2867
Fax: (509) 279-2419