TREATMENTS for Vaginismus:
Pros & Cons
4. PHYSICAL THERAPY (& BIOFEEDBACK)
If you want to go straight to reading a Success Story of a woman who cured her vaginismus with the help of a physical therapist, click here to go straight to Gina's success story .
In many western countries, when a woman is diagnosed with vaginismus, she is often referred by her doctor to a physical therapist (also known as a physiotherapist in some countries) who specializes in the pelvic floor muscles. Even if you are not referred by your doctor, you can find at least one or two of this type of physical therapist in any large town. They advertise as treating things like incontinence or post-pregnancy recovery. Or sometimes they advertise more euphemistically as treating "women's health issues".
All physical therapists are specialists in muscles. Since vaginismus is a muscle problem, a PT can be very helpful in treating it.
Most pelvic floor physical therapists are very familiar with vaginismus and very knowledgeable about it. However, it should be noted that vaginismus varies from mild to severe, and mild vaginismus is much more common. So most physical therapists have more experience treating mild vaginismus. If your vaginismus is more severe, you may have to help your therapist understand what it is like for you.
Depending on their training and the equipment they have available, physical therapists can offer several different treatments for vaginismus.
All physical therapists can offer a custom designed program of exercises and stretches that exactly fit the needs of their client. Many women with vag discover that they have tight and weak muscles in their entire pelvic region, such as the lower back, lower abdomen, inner thighs, and hamstrings.
Helping these muscles to relax and strengthen can improve the whole pelvic area, since all the muscles are connected.
Many women find out that their habitual sitting posture is unhealthy. For example, they may have been sitting in an unusually tense position, with their legs tightly crossed. A physical therapist can uncover these issues as she assesses a woman's whole body.
A physical therapist will usually educate her client on the structure of the pelvic floor muscles. A PT may have a diagram of the pelvic floor muscles, a 3-dimensional model of the muscles, or might even draw a picture of the muscles.
A physical therapist can do a hands-on assessment of a woman's pelvic floor muscles, by reaching into her vagina and feeling them. Most physical therapists know how to massage knots and tight spots in the muscles and many know how to use trigger point massage. A trigger point is a place that when pressed, can cause nearby muscles to relax.
Most physical therapists can offer some form of biofeedback. Biofeedback uses small sensors to pick up electrical conductivity in muscles, and so it measures how much they are contracting. The sensors can be external or internal. The external sensors are placed around the outside of the pelvic area, and the internal sensor is a small cylinder that is inserted in the vagina until it is inside the PC muscle ring.
The biofeedback sensors are connected to either a computer or a hand-held device that gives visual feedback. You may see a graph chart on a computer or a number readout on a handheld device. When a woman does Kegel exercises, which are squeezes and releases of the PC muscles, she can see how much her muscles are contracting.
By watching the readout, a woman can begin to make the connection between her mind and her muscles. She can learn how to do Kegels properly. She can see her muscles getting stronger from appointment to appointment. She can gain control over her PC muscles.
So it is a powerful treatment for educating and motivating a person to get better. In fact, some women with mild cases of vaginismus have recovered by using biofeedback alone.
Some physical therapists may be able to offer ultrasound treatments, which give deep warmth and relaxation to tense and sore muscles.
A physical therapist may provide a woman with vaginal dilators, sell her dilators, and or give her information on where to buy dilators. A PT can explain the dilating process and can give tips on dilating. For example, she may describe how to warm up the muscles beforehand and cool them down afterwards to prevent soreness.
A PT can help a woman use dilators in the office, or do the actual insertion of dilators for the woman. She can assign dilation "homework" to be done in the privacy of the woman's home.
When a woman is well on the way to recovering from vaginismus, a physical therapist may be able to help the woman select a device that exercises the PC muscles. And a physical therapist can help a woman learn how to use the device properly. This allows a woman to keep her PC muscles in good shape for life.
Keeping one's PC muscles in good shape prevents problems with incontinence later in life. It can prevent vaginismus from coming back. It also can improve the quality of a woman's orgasms. Many women who have never had a vaginal orgasm find that they can have them once their PC muscles are strong and healthy.
New treatments are developed from time to time, so there may be even more options than these in the future.
In addition to all these treatments, a physical therapist can be a great resource. She can give you understanding and moral support. She can keep you motivated. She may know of good gynecologists.
A physical therapist can give you a second opinion if you have questions about your hymen or other parts of your anatomy. Every once in a while, a physical therapist will spot a problem that a gynecologist may have missed, or discover that a problem was diagnosed incorrectly.
Communication between the client and the physical therapist is important. If a woman feels scared, nervous, or apprehensive about anything that is proposed in a physical therapists office, or has those feelings in general, she should say something. And also speak up if something hurts!
Remember that when you see a physical therapist, the therapist works for YOU. You are in control of what happens, unless you decide to turn over control to the therapist. So it is an individualized process. Each person who sees a physical therapist may have a slightly different experience.
Examples of how two different women approached their physical therapy:
Person A had a lot of fear as part of her vaginismus, and had also had bad experiences with doctors. It took a lot of courage for her to even set foot in a physical therapists office.
During her initial consultation, she told the PT that she was very scared, and preferred to just talk that day. She described her problem, and the PT described what she had to offer in the way of treatments. Person A said that she did not want the physical therapist to do a pelvic exam or other hands-on treatments.
So together they came up with a treatment plan that involved non-invasive things. They decided to do exercises, stretches, biofeedback with external sensors, and the PT would explain the dilating process so that person A could do it at home. This plan worked well for this person.
Person B did not have much fear as part of her vag, and she wasnt afraid of the physical therapist. During her initial consultation, she described her problem, and told the PT to go ahead with her usual treatment program. The PT said shed like to give her a pelvic exam to assess her muscles.
So during that first appointment, person B got undressed and the PT gently felt her pelvic muscles to see what they were doing. There were a lot of knots in her muscles, so the PT decided to begin treatment by massaging the tight spots.
After several appointments, when person Bs muscles were more relaxed, they proceeded to using biofeedback with an internal sensor. Eventually, they used dilators in the physical therapists office. And of course, person B was given homework assignments to dilate at home. This plan worked well for this person.
So whether you are like person A or person B, or somewhere in between, it will be okay with the physical therapist. A good physical therapist will be able to create a treatment plan that fits your needs.
PHYSICAL THERAPY: Pros
" A physical therapist can be a great source of external motivation for women who have trouble getting motivated. She can be a coach.
" A physical therapist can uncover underlying muscle problems that affect a womans entire lower body.
" Biofeedback is an extremely helpful treatment for many women with vaginismus.
" Most women who become pelvic floor physical therapists are kind and caring people.
" It can be really nice to talk to someone who understands your problem.
" It is possible that using the services of a physical therapist can help a woman to heal from vaginismus more quickly than if she works on her own.
PHYSICAL THERAPY: Cons
" Physical therapy can be expensive. Some insurance plans will cover it, and some wont. If you are paying for it privately, you may be able to get a discount on the price. (If the place is nice and really wants your business.)
" If you live in a small town or rural area, you may have to drive a long way to get to the nearest pelvic floor physical therapist.
" As with any type of medical professional, if you happen to get someone whose personality you dont like, you need to find someone else to work with. A good physical therapist will be very calm and trustworthy.
" PTs are human, and at times some of them may become over-enthusiastic/pushy. If that happens, you need to be firm with them. For example, if she wants you to do 100 Kegels a day, and you can only do 10, please say something. Or if she wants to try a treatment you find scary, please say something. Dont allow yourself to be injured or traumatized just to please the therapist.
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