Shelby (patient’s name changed for confidentiality), is a recently married, busy student in her mid-twenties. Shelby was experiencing “extreme pain” (8/10) at the vaginal opening during initial penetration, causing her to no longer value or find interest in sex.
Shelby noticed a strain on her marriage due to her fear of intimacy, and was worried that without proper care, this can cause irreversible damage to her relationship. She visited her MD who found no medical cause for her symptoms, and was referred to pelvic physical therapy. Shelby is aware that she is a highly anxious person, and has a supportive partner who tries, but is unsure of exactly how to help.
At EMH Physical Therapy, she received 7 treatments in total, seen twice a week. In less than a month, she was able to return to pain-free intercourse. Her Pelvic Pain Questionnaire results improved from being 50% impaired, to 2% impairment.
Shelby experienced very quick progress! How is this possible?
Below are the pelvic PT treatments that aided in her success:
- We taught Shelby some mind exercises to quiet her hyper-vigilant nervous system and brain. The nervous system needs to be retrained to accept an experience that’s typically normal and painless but has become painful. The brain’s role is to protect the body and with a sensitive nervous system sending danger signals, brain sent pain each time she attempted intimacy. We calmed down Shelby’s nervous system by educating her on pain science, implemented sleep hygiene, stress management techniques and incorporating physical activity into her weekly routine.
- Our thoughts and emotions can contribute to your pain experience. For those with chronic pain, fear spreads, or in other words- “generalizes”. Fear of doing an activity that now hurts, can activate your body’s stress response - which increases more pain signals to body. What once may have been a small area of discomfort now spreads to an entire area of the body. However, positive emotion can slow down spread of fear. Shelby was educated on positive self- talk, and how her expectations regarding sexual intercourse can influence how she experiences pain.
- Desensitizing pelvic floor muscles via manual techniques. Shelby’s pelvic floor muscles were gently stretched and mobilized in clinic. Her body learned that stretching tissues was not dangerous, rather safe. Shelby was taught to maintain her progress with the use of personal dilators at home.
- Including her husband in her journey. Although the body never forgets a past memory, the nervous system is “plastic” or teachable to unlearn faulty patterns. The nervous system and brain have the ability to inhibit a bad memory by creating new neural pathways to respond to intimacy as positive, safe. With this in mind, Shelby taught her husband how to stretch her pelvic floor muscles with her personal dilators. This allowed Shelby’s nervous system to rediscover her husband’s touch as non-threatening and safe.
- Movement! Exercise can help desensitize one’s pain system. Shelby was diligent about performing her home exercise program. Her program was composed of exercises designed specifically for her body, targeting global muscles that were holding tension.
Shelby was able to progress through her journey very quickly as a result of her diligence with her home exercise routine, high level of focus during her sessions, and her personal decision to make her recovery a priority. It is important to remember for those with chronic pain, recovery can take several months; however, regardless of the length of your journey EMH Physical Therapy is here to help. If these symptoms sound familiar, please reach out to us at EMH Physical Therapy to begin your journey to recovery.
- Richards, Erica. “Mental Health Among African American Women”. Johns Hopkins Medicine, 2020 https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-among-african-american-women
- Brand, Morag. “Journey- Arrow”. DerivSource, October 2017 https://derivsource.com/2017/10/18/switching-sonia-drivers-challenges-libor-winds/journey-arrow/