Physiotherapy

A women's health physiotherapist can be helpful for pelvic floor muscle rehabilitation (e.g. biofeedback, pelvic floor exercises, trigger point therapy). There is a professional group of physiotherapists interested in women's health and vulval pain called Pelvic, Obstetric and Gynaecological Physiotherapy, or POGP - see their website to find a professional local to you.

In terms of self-help, some women find that strengthening their pelvic floor muscles using pelvic floor or Kegel exercises can help reduce their symptoms. Some websites that explain how to do pelvic floor exercises are:

Also take a look at our workshops as the VPS sometimes sponsors seminars on how to exercise your pelvic floor.

Pelvic floor muscles desensitisation

The protective guarding response that can occur in women with vulval pain needs to be unlearned, so that the body begins to remember that inserting something into the vagina does not need to be painful. This can be achieved by gradually and progressively inserting bigger items into the vagina (such as one finger, then your partner's finger, then a small vaginal dilator) to desensitise the area and gently stretch any contracted vaginal tissues. Desensitising these muscles is a crucial part of the management of conditions such as vulvodynia and vaginismus when sex is painful. This procedure should be used in conjunction with the medical treatments if necessary.

You can try the dilators, the vibrator and the exercises all together if necessary. Results can take time, so be patient!

 

Vaginal dilators (also known as vaginal trainers)

Dilators are smooth cylinders made of plastic or silicone which are inserted one at a time into the vagina to help develop confidence with penetration. Designed to help desensitise the area and make you less phobic about touch, dilators are used to relax the muscles around the entrance to the vagina and to gently stretch the area. They come in a set of different sizes, or sometimes can be bought individually. The dilator sizes are graded for use at different stages of treatment, with the smallest size being used first, then gradually moving up in size until the largest can be easily and comforably inserted.

Many women find the traditional plastic dilators hard and clinical and prefer to use a simple vibrator or even self-massage of the vulval area. However, dilators now also come in silicone, and some have a vibration option as well, so you can use whatever type works best for you.

 

How to use dilators

Starting with the smallest dilator, lightly coat it with a vaginal lubricant, then insert it in and out for a few minutes. When ready, you should move on to using the next largest dilator in the set, then increase by one size every week until you are either using the size of dilator which matches your partner's body or you feel comfortable to resume intercourse (whichever happens first). The time that the vaginal dilator should spend in the vagina is the same on each occasion, i.e. around 10 minutes. Some women feel more conscious of the pelvic floor muscles if they contract and then relax them around the dilator. If you can manage it, use the dilators regularly. If using the larger ones is painful, then get used to using the smaller ones each day.

After use, the dilators can be rinsed under the tap between applications and dried off, but no other specific treatment is necessary to cleanse them.

When using the dilators, make sure that you use a good lubricant that suits you and doesn't aggravate your condition.

For a diagram of the muscles of the pelvic floor, go to www.pilates-pro.com/pilates-pro/2007/1/22/the-anatomy-of-core-stability.html?currentPage=2 and scroll down the page.

 


 

How to exercise the pelvic floor muscles

Go to a quiet room where you will be neither distracted nor disturbed.

Sit comfortably on a firm chair which is of the correct height for you, sitting so that your feet are planted firmly and slightly apart on the floor.

Lean forward a little, resting your hands on mid-thighs.

Concentrate on the area around your back passage or anus and imagine you are trying to stop passing wind.

Think about the area around the front passage (urethra) and vagina and pull these muscles in.

Now try pulling in the muscles around the anus (back), vagina (middle) and urethra (front) together.

It should feel as if you are drawing the muscles forwards and upwards, as if moving your sitting bones together, but also lifting up inside.

There should be no outward sign that you are doing anything.

Practise contracting and relaxing until you have got the idea.

Try not to pull in the buttock, thigh and abdominal muscles at the same time.

Attempt to isolate the pelvic muscles for this exercise.

Do not hold your breath; counting the seconds aloud during the hold phase will help you to keep breathing.

Once you are sure that you have identified the pelvic floor muscles, start exercising:

  1. Pull in the pelvic muscles.
  2. Hold for up to 10 seconds (count aloud).
  3. Release slowly and with as much control as you can manage.
  4. Once you are sure that you have relaxed fully (rest for as long as you held), pull the muscles up again and repeat this up to 10 times if you are able.
  5. Repeat 3 to 4 times daily.
  6. Also try to be aware of your pelvic floor muscles througout the day. If you notice you are holding tension in them, try to relax them fully. This becomes easier with practice.

 If you manage to obtain an appointment with a specialist women's health physiotherapist, they will give you a personalised programme of pelvic floor exercises, which will be tailored to your individual needs and capabilities.

Some general points about pelvic floor muscle exercises:

  • Choose a convenient time and place where you can exercise regularly.
  • Put a reminder about pelvic muscle exercises somewhere obvious to you (or set an alarm on your watch or mobile phone).
  • Avoid quick pelvic floor muscle exercises where you don't hold the contraction, as these tend to cause an increase in pelvic floor muscle resting tone.
  • Be aware that it will take 6 to 8 weeks of regular exercise before you can expect to see a possible improvement, and approximately 3 months for the pelvic muscles to strengthen (or indeed for you to feel more confident that you are releasing them effectively) to a remarkable degree.
  • You could try inserting one finger into the vagina to check the strength of your squeeze as you pull in the pelvic muscles. Alternatively, if this is daunting, you may be able to feel a pelvic floor contraction if you place the tip of your index finger on the perineal body (on the outside, between the vagina and back passage).
  • If you are overweight, try reducing your weight.
  • Try not to become constipated, as a full bowel will put pressure on the bladder, and straining to empty your bowel will weaken the pelvic muscles.
  • If your job involves lifting, think of your pelvic muscles as well as your back - pull up your pelvic muscles when lifting a heavy weight.
  • If you smoke, consider giving up, since constant coughing puts a strain on the pelvic muscles.

Research

Editor's note: for discussion of one particular study examining the use of vaginal dilators, please see our Published research page. Alternatively, for further or more recent research on physiotherapy for vulval pain, you can visit the PubMed database, which allows you to search for studies online.