In Part 1 of my story, I explained how I came to discover that my many years of vaginismus and painful sex were connected to my decades-long experience with endometriosis. I also shared how a casual statement by a pelvic floor physical therapist rocked my world, i.e., that “Sex should never be painful,” and how it finally prompted me to pursue treatment for this frustrating condition. Treatment for painful sex is out there–there’s hope and help! Below, I outline the steps of my healing journey, and tips that I hope will help you, if you have also been unable to enjoy sex due to physical pain.
Step 1. Take a break from sex
The first step in my treatment plan, and most importantly for me, was to take a break from sex. With the new knowledge of what had been going on for nine long years and learning that it wasn’t normal, I needed time to process what I had unintentionally been putting myself through each time my husband and I were intimate. In order to get to a place where I could enjoy sex again, I needed to allow myself time to heal mentally and emotionally, just as much as physically. So, I connected with a good counselor to work with in tandem with physical therapy. Importantly, my husband has been incredibly supportive, loving me well during this whole process, which was another major component of my healing from painful sex.
Step 2: Learn to physically relax and loosen up
Many women are all-too familiar with hearing the phrase “just relax!” when they open up about their fears or experiences of painful sex. While folks who say that often mean “just chill out about it!” (which can be pretty frustrating–if not downright annoying–to hear), there is a nugget of truth in there: for women like me with vaginismus, we do need to train our pelvic floors to “just relax!” Of course, it’s not something that can be done by unwinding with a glass of wine or a hot bath. It can be difficult (but important) work, requiring guidance from a trained professional.
Step 2a. The anti-Kegel: Learn how to relax the pelvic floor
That’s why the second step in my journey toward healing from vaginismus and painful sex was for my pelvic floor physicial therapist, Dr. Jenny,* to teach me what it felt like to relax my pelvic floor, and how to mentally “check in” with it more frequently.
I would soon learn that I was unknowingly tightening up my pelvic floor throughout each day, so I began to work on telling my pelvic floor to relax. She taught me that diaphragmatic breathing helps to naturally reduce tension in the pelvic floor. This meant ten minutes lying down daily, expanding my rib cage with each breath and relaxing with each exhale. This was tough.
Step 2b. Adding a vaginal dilator
After a few weeks, I advanced to using a vaginal dilator, a smooth, hard, cylindrical piece of medical-grade plastic. This was tougher. I practiced inserting that into the vagina while diaphragmatic breathing and working on maintaining a relaxed pelvic floor. Because I was diligent with this, Dr. Jenny said she noticed small improvements pretty quickly with my case. With practice, I made progress in retraining my brain to tell my pelvic floor to settle down–that it’s okay when something harmless is being inserted, and that it’s okay to go with it and not resist by tightening up unnecessarily.
Step 3. Passive stretching and de-escalating daily homework frequency
About two months or so later, it was time to progress. I had learned to tell my pelvic floor to relax, but the superficial tissues had become tight as well. This would require a passive stretch, which I would achieve with the dilator during step three of this personalized process. Thankfully, I could back down from daily “homework” of diaphragmatic breathing and stretching, but it would be important to remain consistent at least every other day. This was not easy.
Step 4. Progress update and reassessment
About six months later–that’s right, six long months of hard physical, mental, and emotional work (which was absolutely worth it)–I was able to notice a difference with intercourse, but still needed to maintain my stretches 1-2 times a week.
Unfortunately, some pain with intercourse still came and went, so Dr. Jenny recommended another evaluation, during which she identified:
- Increased dryness due to a loss of estrogen from early menopause
- Some effects of scar tissue throughout my abdomen from many surgeries over the years
My primary care doctor gave me a bioidentical vaginal estrogen cream to use consistently, and Dr. Jenny continued to manually break up the scar tissue during our pelvic floor physical therapy sessions. I would also add abdominal and scar massage to my homework exercises. These additional treatments made for a dramatic improvement. I only saw Dr. Jenny in her office about seven times over the course of eight months, which is indicative of the fact that, as with most forms of physical therapy, most of the hard work is done by the individual at home (which takes commitment and diligence).
If we address painful periods in teens, they may not have to experience painful sex later
What a journey it has been, considering how long it took for me to figure out what was going on and how much I thought I knew about endometriosis and pelvic pain. The pain with sex I experienced for so long was not normal–and was preventable. Had I been aware of the link between painful cramps and painful intercourse, I could’ve gotten help right away–long before I was ready to have sex–and avoided many years of pain. This got me thinking about women who struggle with cramps, even teenage girls. What difference might it make in their overall quality of life to understand this link, and be more aware of the benefits of pelvic floor physical therapy earlier on?
Here is what Dr. Jenny has to say about painful cramps, even in young women, and how tightness can effect quality of life:
“Chronic pain is never normal, and it will cause secondary and tertiary dysfunctions over time. Treatment starts with our language: painful periods are common but not normal. With that understanding, we may be more proactive in seeking care sooner. Pediatric pelvic floor physical therapy is a sub-sub-specialty, and these treatments are vastly different from treatments for adults, but the therapeutic principles and goals are still the same: improve the body’s response to pain, decrease abnormal compensations acquired because of the chronic pain, and restore muscle and connective tissue function through its full range of motion during functional activities–from full contraction to full relaxation. If left untreated, conditions can progress. The good news is that muscle and scar tissue can usually improve with proper guidance from a skilled pelvic floor physical therapist.”
A few quick takeaways from my healing journey
My journey towards healing from painful sex and vaginismus was a huge learning experience for me. After many in-depth conversations with Dr. Jenny, I’d like to share some nuggets of information that I have found to be very helpful during my own healing journey, that I believe more people ought to know.
Endometriosis and painful sex
If you have endometriosis, it is unlikely that the endometriosis lesions themselves are causing painful intercourse, pain with tampon use, or pain with pelvic exams. The pain is likely the result of recurring painful cramps over time, which have caused the pelvic floor to tighten up and remain tight. This is why even a good excision surgery won’t directly relieve painful intercourse. (Importantly, not every woman with endometriosis has painful cramps or painful intercourse, but if you do, now you know there is something that can be done about it!)
A note about finding a good pelvic floor PT
Women of any age, including teens, with moderate to severe cramps might greatly benefit from at least having a pelvic floor PT evaluation. That said, pelvic floor PTs have different experience levels (and as Dr. Jenny mentioned, pediatric pelvic floor PT is even more of a niche expertise). To make sure you’re connecting with a pelvic floor PT who is qualified for painful sex treatment, call ahead of time and ask if they do internal examinations–not that you’ll necessarily need one, but it indicates that they have completed advanced training for true pelvic floor dysfunction.
Getting the specific type of help you personally need
Vaginismus, like I experienced, can be mild, moderate, or severe. The same goes for many reproductive or pelvic floor issues. No two diagnoses or treatment plans are exactly the same, because every woman and situation is unique. Personalized treatment from a qualified professional is important. No matter what your issue, treatment and healing times will vary from person to person, and can take weeks or many months.
The success of your painful sex treatment program is largely up to you and how committed you are to keeping up with the personalized homework programs given by the PT. On the flip side, if treatment hasn’t improved painful sex (or period pain, or another pelvic issue) for you despite your cooperation and consistent efforts, be sure to continue conversations with your PT and primary care doctor. Consider a second opinion. Lastly, keep in mind that there is a definite mental and emotional component to consider as well. Connecting with an experienced counselor may be as invaluable for your healing journey as it was for mine.
*Dr. Jenny Porter is a physical therapist at Pivotal PT & Wellness in Mandeville, Louisiana, specializing in pelvic floor therapy for men, women, and children with bladder, bowel, sexual, and pain dysfunctions.
Additional Reading:
Why are so many women experiencing painful sex?
Three facts about endometriosis that prove it’s more than just a painful period disease
Painful sex before your period? How tracking your cycle could help stop sex from hurting
What to do when fertility awareness isn’t a magic pill for a great sex life
