- How I Recovered from Postpartum Painful Sex, Part 1
- How I Recovered from Postpartum Painful Sex, Part 2
- What It’s REALLY Like to Get Physical Therapy for Painful Sex & Pelvic Floor Disorder
- Real Hope: Pelvic Floor Rehab at Home
- Mind-Body Rehab for Painful Sex & Pelvic Floor Disorders — The Ultimate DIY Guide
I’ve written two articles now on how I recovered fully from debilitating postpartum sexual pain (read Part 1 here and Part 2 here). Pelvic floor physical therapy was the backbone of my recovery. It’s not just for painful sex, though. A hypertonic (too-tight), dysfunctional pelvic floor can cause everything from intercourse pain to incontinence to chronic UTIs to organ prolapse.
If you have any kind of pain or dysfunction in your pelvic region, pelvic physical therapy might be able to help. For me, they were downright miraculous.
(FYI, your “pelvic floor” is the many layers of muscle that form the “bottom” of your body, stretching across your pelvic opening, holding up your organs, and controlling your orifices.)
Today, I’m sharing what pelvic floor physical therapy is like. It can sound mysterious and vaguely horrifying. Let me take away some of that mystery and horror!
I received two kinds of pelvic floor PT–pelvic floor biofeedback by a skilled technician and internal pelvic floor physical therapy from a well-trained physical therapist. (If you read my last post, you saw that the all-important second piece to my recovery puzzle was the daily physical-therapy-at-home work I did, but I’ll have to discuss all of that another day.)
What Is Biofeedback?
Biofeedback may sound “out there,” but it’s very straightforward. It typically means using an instrument to give your conscious mind real-time information about unconscious processes happening in your body. That’s it.
When your conscious mind gets this information, you have the opportunity to connect certain sensations or feelings in the body with the live readings you see. Then you can learn to alter those readings and the physiological processes that produce them.
For example, a heart rate monitor can be used as a biofeedback device. It’s giving you real-time information (feedback) about what’s happening in your body (bio). In the case of your heart rate, you are already consciously aware of it on some level (you generally know your heart’s pounding or beating slowly), but you do not perceive slight variations or consciously control it. Your nervous system does that without your conscious mind’s interference, thankyouverymuch.
Yet, you can learn to influence your heart rate. Really! Practice watching your heart rate monitor and trying to alter your pulse. You’ll notice, perhaps, that your pulse tends to slow on the exhale and that certain feelings in the body coincide with the slower heart rate. In time you’ll learn how to re-create those feelings in your body and reduce your heart rate at will. Try it. (This comes in very handy when you’re nervous and the doctor wants to take your pulse. He may then be impressed and say, “You must be a runner!” And you just smile serenely.)
What Pelvic Floor Biofeedback Is Like
There may be other kinds of pelvic floor biofeedback. I can only share from my own experience.
First, a technician helps insert a probe into the vagina, or if that’s impossible, attaches sensors to the perineum (the latter produces less accurate readings). I’ll be honest, even though my technician was wonderfully patient and gentle, this was extremely stressful the first few sessions, and it took me time to recover before the session could continue. However, it was without a doubt worth it, and I’m so thankful I didn’t run away like I wanted to.
The technician then connects the probe to a computer or other device, and you see real-time readings on the screen from your pelvic floor (PF) muscles.
(My first time, I was told to relax, and I thought I was relaxed everywhere. I was quite experienced with relaxation, in fact. Yet I was completely out of touch with my pelvic floor! While I consciously felt relaxed, the computer screen showed that my PF muscles were constantly contracted—a spasm. When asked to perform a kegel, I could. I consciously contracted my PF muscles and watched the reading go much higher. Then I stopped the conscious contraction. The reading dropped . . . but not to zero, only to my previous over-tense baseline. Yikes.)
So she asks you to relax, then to contract your PF (do a kegel). She may ask you to just lie there and breathe for a while. She watches the readings. You might be lying there, and suddenly she says, “There! What did you just do? Your muscles relaxed.” You will have no. darn. clue. what you just did. You were lying there. Just like you were 2 minutes ago.
You’ll go through cycles of contracting and relaxing, and she’ll say “Oh! That was a good release after the kegel. Do it like that again.” And you’ll have no. darn. clue. what you did differently that time.
You watch the monitor too and see changes the changes yourself and have no. darn. clue. why the readings fluctuate.
It can feel really frustrating!
Then there is the electrical stimulation. If she thinks it will be productive, she sets the probe to conduct just enough of a current to contract and release your muscles at intervals. This can help break a spasm.
After a while, with all this work—how long it takes varies for each person, maybe 1 session, maybe 8 sessions—it starts to click. You begin to replicate the relaxation at will sometimes.
You practice at home too, trying to recapture that feeling, using imagery to guide you. Eventually, you really get it. You might waltz in, and your PF is at zero or as good as zero. You contract for a kegel, the readings go up, then you release, and they drop all the way back to zero. It is SO exciting.
You gain confidence and begin to notice what your PF is doing in daily life. You’ll find that it’s often tense, and you practice releasing it. Over time, your PF can learn a new normal, a relaxed normal.
I already mentioned that the first portion of my journey progressed rapidly. In my second session I was able to achieve some zero readings. Many factors contributed to that, not least of which my prior practices of mindfulness, meditation, body awareness, and relaxation. Even so, I had “bad days,” when I suddenly felt hopeless all over again because I couldn’t make the connection that day.
It is normal to have ups and downs! I used emotional acupressure and healing techniques (like the TAT) on the down days to help me cope with the intense emotions.
You may have noticed that this kind of PT is an emotional process. I wish I had been able to allow that to just be, instead of constantly blaming myself for being an emotional basket case.
What Internal Pelvic Floor Physical Therapy Is Like
So then there’s the part where a skilled physical therapist works on your pelvic floor muscles from the outside and the inside (via the vagina) with her fingers. She, too, provides “biofeedback” by telling you, This area is tense, and can you feel that? Okay, now it’s released, can you feel that?
It’s actually very important to have this kind of hands-on biofeedback because a machine can only pick up certain kinds of information. A live person can feel infinite subtleties throughout many layers of muscles. She seeks out places where the muscles are knotted, where fascia is twisted, where nerves are caught in dense tissue, where there are restrictions.
She oh-so-gently massages them and uses all kinds of techniques to guide the body to release tension patterns . . . frankly, I don’t know what all she was doing. Most of the time my eyes were closed, tuning in to the sensations, searching for a connection to what she was describing about my body, and breathing deeply, inviting my body to open and relax.
My PT was absolutely amazing. I thought that never in a million years could I let someone work on me like that. I won’t say that it ever became completely comfortable, and yet she made it as non-weird as it could possibly be. I am so grateful.
She even asked me to bring my husband in with me one time. She showed him some techniques for helping my PF relax. That was nerve-wracking to be sure (these are fairly invasive techniques), but she was as professional as could be. And it turned out that practicing those PF releases at home with my husband was essential. For a while, it was necessary before intercourse. The first time we tried that, I was ready to give her a black eye for suggesting that it could be part of foreplay. It was the most awkward, mood-killing thing ever. Ever. With just a little practice, however, it became quick, easy, and was a huge gift to our renewed sex life.
It goes without saying that trust is essential with internal work. You must feel comfortable with your therapist.
Soon, I’ll detail what my physical therapy homework involved. I’m excited about sharing that information because anyone can use the tools and techniques to help even a totally normal postpartum recovery (including tears and episiotomies).
Where I got my physical therapy: the Pelvic Health & Physical Therapy Center in Houston, Texas
Excellent interview with a physical therapist who does this kind of internal work: A Too-Tight Pelvic Floor