Physical Therapy

Content Written By: Pamela Morrison, PC and Talli Yehuda Rosenbaum, BS, PT

Professionals involved in sexual health have traditionally included educators, counselors, therapists, and physicians, particularly in specialties such as psychiatry, gynecology, and urology. The inclusion of physical therapists in the team of professionals involved in promoting sexual health and in treating sexual dysfunction is a relatively recent advancement. Physical therapists are trained to provide treatment to restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. As community health professionals, physical therapists are involved in health and fitness education and promoting wellness. As sexual health is an integral component to overall wellness, and sexual activity a valued human activity, physical therapists in various settings have an important role in promoting sexual health and treating dysfunction.

Physical therapists provide treatment to restore function, improve mobility and relieve pain, prevent or limit permanent physical disabilities of patients suffering from injuries or disease and promote wellness. As sexual health is an integral component to overall wellness, and sexual activity a valued human activity, physical therapists in various settings have an important role in promoting sexual health and treating dysfunction.

Within physical therapy is a specialty known as urogynecological rehabilitation. Physical therapists involved in this specialty are trained in the treatment of disorders related to the pelvic floor. Pelvic floor disorders include urinary dysfunction such as incontinence (unwanted loss of urine) urgency, and frequency, as well as organ prolapse, which refers to a situation where the bladder, uterus, and/or rectum “fall” downwards into the vaginal canal. Pelvic floor disorders due to muscle weakness contribute to these conditions and sexual dysfunction has been found to be closely associated with them. Low libido, vaginal dryness, painful intercourse, decreased orgasm rates and intensity, and decreased overall sexual satisfaction have been reported in women with urinary incontinence. The relationship between urological and sexual problems has prompted the suggestion that women with urinary problems be questioned about their sexual function. The literature does support the use of pelvic floor strengthening exercises with physical therapy to improve quality of life and sexual function in women with urinary stress incontinence.
The physical therapist is an important member of the team of professionals treating sexual pain disorders. Pelvic floor hypertonus (high muscle tone) dysfunction is a component of sexual pain, and an important part of physical therapy is teaching the patient how to normalize muscle tone. The physical therapy intervention generally consists of evaluation and treatment with education and cognitive behavioral therapy, exercises, manual therapy techniques, and modalities including pelvic floor biofeedback and electrical stimulation.

The physical therapy approach to the treatment of women with complaints of inability to have intercourse, or painful intercourse, includes taking a detailed history, performing a physical exam, and providing a treatment plan together with the patient. Physical therapists provide education, anatomical and physiological information, and give specific exercises with the goals of decreasing pain with intercourse and allowing vaginal penetration mobility. Physical therapists provide exercises to decrease the sensitivity of the painful tissues. Manual techniques, including massage, stretching, soft tissue and bony mobilizations, are important components of treatment. Patients are often taught how to use gradual vaginal dilators to overcome the anxiety involved in penetration as well as to help stretch the vaginal tissue. Pelvic floor sEMG (surface electromyography) biofeedback is one of the many tools available and commonly used by physical therapists in the treatment of vulvar pain syndromes. In EMG biofeedback, a sensor is placed in the vagina and the muscle activity of the pelvic floor is recorded and displayed on a computer monitor. With this visual feedback, the woman is able to see how tense or weak her muscles are, and this allows her to learn the proper methods to relax and strengthen her muscles.

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