American Physical
Therapy Association

Section on Women's Health
American Physical
Therapy Association


Commonly Treated Conditions- Pelvic Pain Syndromes

Pelvic Pain
Pelvic pain is described as pain in the lower abdomen, pelvis, or perineum and is considered to be chronic when symptoms have been present for more than six months. The pain may be described as aching or burning in the area of the perineum or abdomen.

What causes pelvic pain?
Pelvic pain can be caused by problems such as pelvic joint dysfunction, muscle imbalance within the muscles of the pelvic floor, trunk, and/or pelvis, incoordination in the muscles related to bowel and bladder function, tender points in the muscles of the pelvic floor, pressure on one or more nerves in the pelvis, and weakness in the muscles of the pelvis and pelvic floor. Pelvic pain can also be related to the presence of scar tissue after abdominal or pelvic surgery. There can be organic disease processes related to pelvic pain as well therefore it is important to consult your physician to fully determine the cause of your pain,

What are the symptoms of pelvic pain?
Symptoms of pelvic pain, in addition to pain in the lower abdomen and pelvis, may include: pain in the hip or buttock, pain in the tailbone, limited sitting tolerance, pain in the joints of the pelvis, pain with sexual intercourse, tender points in the muscles of the abdomen, reduced range of motion in the hips and lumbar spine, urinary frequency, urgency, or incontinence, painful bowel movements, constipation and/or straining with bowel movements,

How can physical therapy help?
Physical therapists are trained to evaluate and treat joint dysfunction, muscle tightness, weakness or imbalance in muscle groups, and nerve entrapment- all potential signs of pelvic pain. Physical therapists trained specifically in the area of pelvic health can identify the possible generators of pelvic pain and develop a treatment plan specific to the patient suffering from pelvic pain. A physical therapist trained in this area may utilize hands on techniques to address muscle tightness or targeted exercises to improve muscle strength and reduce faulty patterns of muscle recruitment. Other treatment strategies may include biofeedback, retraining of uncoordinated muscles, postural training, and strengthening of the abdominal core muscles.

Sexual Pain: Tips to Reclaim Your Sex Life
There are many reasons men and women have sexual pain. Sexual pain in this discussion refers to any discomfort that occurs in the genital area during sexual intercourse or foreplay. Sexual pain can occur at any age. Vaginal pain conditions can include skin irritations and tight muscles near the external female genitalia or vulva and in the pelvic floor, which is a bowl of muscles spanning from the pubic bone anteriorly to the coccyx bone posteriorly. Physical trauma to the genital area including a history of sexual abuse can also be a factor in sexual pain. In men, the prostate gland, a walnut-sized organ located just below the bladder, could be inflamed and cause pain before or during ejaculation. It is important to get the right medical diagnosis for your pain, as well as the right treatment for your symptoms. Seek the help of doctors and other allied healthcare professionals who are trained in this field. Tight muscles and joints near the back, buttocks, legs, stomach or genital area can trigger tenderness or pain in the vaginal or rectal areas. Physical Therapists can help alleviate this pain by stretching and relaxing tissues that are close to and around the pelvis.

7 ways to eliminate sources of sexual pain:

1. Eliminate sugar from your diet. Check the foods and drinks you eat for sugar content, including natural and organic sugar. Sugar and other chemicals can contribute to skin irritation and pain. Eliminating one or two things at a time from your diet will allow you to decide if it could be contributing to your pain. Sweets, desserts, certain juices, breads, pastas, sauces and salad dressings can contain sugar, so read the ingredients and eliminate them for a few days or eat them in moderation to see how your body feels. Some medications and drugs may also cause pain or discomfort, so talk to your doctors about your particular situation.

2. Take a blood test to see if your hormone levels are within normal range. A decrease or imbalance of certain hormones in your blood can cause tissues to feel irritated. You could be put into menopause temporarily if you are under the age of 50 and have a decline of the hormones estrogen, progesterone and testosterone. For men, having a PSA or prostate specific antigen blood test can help detect if there is a prostate-related problem .

3. Reconsider your contraceptive choice. If you use condoms, try non-latex condoms to rule out skin irritation since some people are allergic to latex and don't know it. If you already use oral contraceptives and develop sexual pain, talk to your doctor to see if he or she recommends getting off of birth control pills. Five years or longer on the pill is considered long-term use and can affect certain hormone levels. Even if you haven't been on the pill for a long time, some doctors will recommend going off of it if you have vaginal pain. Some women who have endometriosis have been put on oral contraceptives for painful menstrual periods. Endometriosis is a condition that occurs when the tissues that line the uterus and are shed monthly during menstruation grow outside of the uterus and appear in other places like the bladder, bowel, vagina and other areas of the pelvis where these tissues normally do not grow. Scar tissue buildup from endometriosis can cause pelvic pain. If you have been using oral contraceptives for more than three months to help your symptoms of endometriosis and are not feeling relief, it may be time to discuss other treatment options with your doctor. Weighing the pros and cons of oral contraception should be made after you have been educated with the help of your doctors and healthcare providers.

4. Drink water to stay hydrated. Approximately 60 ounces or the equivalent of eight 8 ounce glasses of water a day is needed for the average person, but body size and activity level will factor in to each person's specific needs. If you exercise you may need to drink more water, and if you do not play sports or work out your body may not require as much water. Muscles and bones need good nutrition to work properly and feel normal, and adequate water consumption is part of this. Check with your doctor or a nutritionist for more information about your specific needs.

5. Exercise at least 2 to 3 times a week. In general, exercise improves blood flow in the body and helps muscles and bones stay in better shape and out of pain. The American Heart Association recommends daily exercise of 30 minutes for good heart health. Doing cardiovascular exercise helps other muscles stay in shape including many that connect to the pelvis and pelvic floor muscles. Consult with a physical therapist to determine the right type of exercise for your body. Stretching leg muscles such as the hamstrings, calves, and buttocks muscles can ease tension or pain in the pelvic area and relax vaginal and rectal muscles. A physical therapist can also teach you specific exercises and movements to help you feel more comfortable during sex. These might include stretches for the pelvic floor muscles, sometimes referred to as the Kegel muscles, that are located inside the vagina and rectum.

6. Breathe and breathe more during sexual activity. Many people do not breathe well during sex or hold their breathe during sexual activity; this is one time where taking some deep breaths with your mouth open can be helpful before, during, and after sexual intercourse. Breathing well will intensify orgasms and help to increase blood flow and oxygenation to the tissues, as well as to relax the body. A tense body may add to the pain.

7. Seek support from a psychotherapist. In addition to physical pain, there may be tension and conflict that arises between sexual partners due to a decrease in sexual activity or a lack of interest in sex due to pain. The body affects the mind, and the mind affects the body. The two are interconnected and not separate. Getting help to deal with certain issues can help the healing process.

Consult with a physical therapist that specializes in pelvic pain about your specific needs. There are many physical therapists that do manual soft tissue massage and use other modalities to help heal tissues and decrease pain in the vaginal and rectal areas. Your physical therapist might teach you how to work on the internal or external vaginal and rectal tissues or how to use a cylindrical tool called a dilator to stretch these muscles and lessen sexual pain. Other medical professionals who specialize in treating men and women with sexual pain include urogynecologists, urologists, gynecologists, sex therapists, psychotherapists, colorectal and pelvic pain doctors. Once an accurate diagnosis is made for your symptoms, there are very effective treatments. If one treatment approach does not work, try another approach. Certain conditions may take months to relieve. Keep searching for help until you find someone or some combination of treatments that works for you!

From the Women's Health Section of the APTA Written by : Deena Poll Goodman

There are techniques and positions that can reduce back pain during sex. The best back-saving sexual positions you should use depends on your specific back problem. For women who have a disk condition, you should keep your back in a neutral to very slightly arched position.

Your best options:

  • lying face down, pillow under your hips, and your partner on top
  • kneeling on the floor, elbows on a chair and your partner behind you
  • sitting on his lap, facing him, with his hand giving back support

If your pain is caused by arthritis or other degenerative changes, try keeping your lower back slightly flexed so that it is flattened, not arched. This takes the pressure off the pain areas.

Your best options:

  • the missionary position with both knees bent as much as is comfortable
  • being on top
  • lying on your side with your partner behind you

If your pain is caused by sacroiliac joint pain, which is usually one-sided caused by trauma, overuse or pregnancy.

Your best options:

  • the missionary position with your leg on the side that hurts, up over your partner
  • lying on the side that does not hurt with a pillow supporting the bent leg
  • lying on your back with your partner on their side with one of your legs over their

From the Women's Health Section of the APTA


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