Pelvic Floor Physical Therapy and Sexual Health
What is Pelvic Floor Physical Therapy?
Pelvic physical therapy is a subspecialty of physical therapy that focuses on all aspects of pelvic health. While many people associate it primarily with pregnancy and postpartum care, we help individuals of all genders across the lifespan. Common conditions we treat include urinary incontinence or frequency, pelvic, hip, or low back pain, pain with intimacy, constipation, and erectile dysfunction, to name a few.
What to Expect in Your First Session
During your initial pelvic physical therapy assessment, we conduct a detailed history review, gathering all relevant medical information that may impact your pelvic health. We take a holistic approach, evaluating your walking pattern, hip and back mobility, and ability to perform functional movements such as squatting, bending, and lifting. As part of this comprehensive evaluation, we also offer a pelvic assessment to better determine your specific needs and guide your plan of care. This assessment is entirely optional and may include an external and/or internal evaluation. We always discuss your readiness beforehand, ensuring that you feel comfortable and informed throughout the process.
Treatment Options
Addressing the Nervous System
Our primary goal for patients with sexual health dysfunction is to establish psychological safety. We often recommend seeing a sex therapist alongside pelvic physical therapy, as our treatment may bring up past or current experiences requiring mental health support. We have found a collaborative approach alongside a mental health professional improves patient experience and outcome.
We help support the balance between your body's two main nervous system responses—your "fight or flight" system (sympathetic) and your "rest and relax" system (parasympathetic). Many people are familiar with the fight-or-flight response, but the body also needs to activate its relaxation system to feel safe and at ease.
If you're working with a sex therapist, we can complement that work by using physical techniques to help your body regulate the relaxation response. This may include hands-on treatments to calm the nervous system, as well as exercises like breath work to promote a sense of safety and relaxation.
Holistic Approach to Pelvic Floor Health
We take a whole-body approach to pelvic floor treatment, recognizing the interconnectedness of muscles, nerves, and fascia. This means:
The pelvic floor muscles are linked to the back, hips, and legs through fascial connections. Fascia is a connective tissue that weaves throughout the body, creating an interconnected system where tension or dysfunction in one area can affect another. Tightness or restrictions in the lower back, hips, or thighs can pull on the fascia surrounding the pelvic floor, contributing to discomfort, weakness, or pain. By addressing these connections, we help restore balance and improve function throughout the body.
The pelvic floor shares nerve pathways with the abdomen, back, and lower body. This means that issues like abdominal tension, lower back pain, or nerve irritation can contribute to pelvic floor dysfunction. Likewise, pelvic floor dysfunction may cause discomfort or symptoms in these other areas. By addressing the nervous system’s role in pain, movement, and muscle activation, we can help improve function and reduce symptoms holistically.
Limited mobility and strength in surrounding areas can lead to pelvic floor tension. When muscles in the hips, core, or lower back are weak or restricted, the pelvic floor may compensate by tightening, which can contribute to pain or dysfunction. Improving mobility and strength in these areas helps the pelvic floor work more efficiently and reduces unnecessary tension.
Improving mobility and strength enhances movement options for sexual activity, increasing confidence in finding comfortable and enjoyable positions. When your body moves more freely and feels strong, you have greater options for positioning during intimacy, reducing discomfort and improving overall confidence.
Additionally, increasing physical activity can boost mood, helping to reduce stress, anxiety, and depression—all of which play a role in sexual health.
Direct Pelvic Floor Treatment
Pelvic floor physical therapists are trained in specialized techniques to improve muscle function, including lengthening and strengthening exercises. An internal assessment (optional) helps determine the best approach for your needs.
To improve pelvic floor muscle mobility, we use:
Guided breathing exercises with tactile and verbal cues to support muscle relaxation.
Soft tissue mobilization to release tension in the pelvic floor.
Pelvic opening exercises to promote relaxation and mobility, improving overall function and reducing discomfort.
Education on dilators and pelvic wands to aid in muscle relaxation and mobility.
Once optimal muscle length is achieved, we focus on strength and control, which is essential for:
Enhancing orgasm and reducing pain.
Addressing erectile dysfunction and/or premature ejaculation.
Improving blood flow to decrease discomfort and promote healthy function.
This integrated approach ensures a comprehensive path to better pelvic health and overall well-being.
Pelvic Floor Physical Therapy Plays a Role in Sexual and Mental Health
Pelvic floor physical therapy plays an essential role in addressing sexual health concerns, and when combined with other therapeutic approaches, it offers comprehensive support for both physical and mental well-being. By working with a pelvic floor physical therapist alongside a sex therapist, we create a collaborative team approach to support your goals for improved mental, sexual, and overall health. Together, we ensure a holistic plan that addresses both the physical and emotional aspects of intimacy, helping you feel empowered and supported on your healing journey.
Want to learn more about how to work with us? Contact us via our website. We look forward to supporting your journey toward better health.
Written by Dr. Erika Darbro PT, DPT, PRPC and Dr. Alison Saum PT, DPT, OCS
Envision Pelvic Health & Wellness