First – Diagnosis
Dyspareunia, vaginismus, and vulvo/vestibulodynia are terms frequently used in the diagnosis of painful intercourse. Dyspareunia refers to pain during intercourse. Vaginismus is characterized by excessive tension in the pelvic floor muscles (primarily the pubococcygeus muscle), which consequently prevents intercourse. Vulvo- and vestibulodynia are associated with a burning, stinging pain and a feeling of discomfort that occurs in various situations, such as during attempts at intercourse, or persists constantly. During the diagnostic process, an examination by a specialist is necessary to assess the causes of the symptoms and determine the appropriate course of treatment.
In what cases should you see a physical therapist?
If the symptoms are caused by pelvic floor muscle dysfunction (e.g., excessive muscle tension resulting from increased physical activity). If the cause is different (e.g., trauma or conditions such as endometriosis), but muscle dysfunction (e.g., excessive tension) is also present, working with a physical therapist will be an excellent complement to the therapeutic process.
What does the therapy involve?
Manual therapy techniques are an integral part of a physical therapist’s work. Soft tissue techniques involve the therapist using their hands to treat excessively tense, painful myofascial structures, primarily in the pelvic region. Elements of visceral therapy involve gentle techniques performed primarily on the abdominal wall, aimed at relaxing, improving mobility, and enhancing blood flow to internal organs, thereby providing relaxation and relief.
In chronic conditions, this offers the possibility of breaking the vicious cycle of pain that exacerbates existing symptoms.
The physical therapist will also select appropriate exercises and activities that you can perform on your own to enhance the therapeutic effects. Working with the diaphragm and breathing is also a fundamental part of the therapy.
The educational component is very important. Awareness of the body structures responsible for the ailments and the ability to locate them enable you to control them. By engaging with the affected structures, you can influence them—for example, through conscious relaxation of overly tense muscles. A physical therapist will support the entire process, explaining how to gain control over your own body, particularly the pelvic floor muscles, which are difficult to locate on your own.
Author: Małgorzata Starzec, M.A.
