Questions about Physical Therapy

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    Erika, a physical therapist in Manchester, NH, is a member of our Forum and has written excellent posts regarding physical therapy as a treatment for vaginismus. Erika and Dr. Pacik worked together in the treatment of a patient with vaginismus, Crisley.

    Dr. Pacik asked Erika the following question:

    When you continued working with Crisley after her Botox, what did you observe were the differences pre and post treatment, and what type of therapy did you do and for how long?

    Erika replied:

    The major difference I saw with Crisley was her ability to tolerate intravaginal treatment post Botox. Prior to her Botox she was very guarded and couldn’t relax, but post treatment she presented so differently. She was relaxed and more comfortable with her body – it was obvious she had been compliant with her dilators. She was also able to tolerate an intravaginal sensor for EMG, which was impossible pre-Botox. Prior to Botox, I had to use a retal sensor (intravaginally) b/c it was so much smaller in diameter than a vaginal one.

    This is an interesting post. Prior to being treated with Dr. Pacik’s Botox procedure, I tried pelvic floor physical therapy but was never able to progress because of my inability to relax and the hitting a wall feeling that was there with any attempts at insertion. I tried very hard to do this, but just like intercourse, was unable to move beyond the resistance feeling to insert a thing. Have you also tried physical therapy in the past? If so, what was your experience like? Some additional general questions include:

    1. How does PT work?
    2. How does PT fit in with counseling?
    3. How many sessions should be expected and when should a patient be referred for the Botox program?

    I look forward to reading your posts.

    Dr. Pacik

    More severe vaginismus patients have considerable difficulty with PT because of their underlying fear and anxiety with any form of penetration. It is for this reason that many fail to progress with dilators or can only advance so far, but not enough for intercourse. More severe vaginismus is characterized by spasm at the entry to the vagina which is the “wall” women complain about.
    Crisley, the patient mentioned above failed two separate physical therapy programs, one year apart, by an excellent therapist who specializes in pelvic floor problems. She was able to achieve pain free intercourse six days after treatment. For those who would like to hear her story, I interviewed her for YouTube. She had the courage to go public and even translated the interview into Portuguese. Her interview generated more than 10,000 hits and has empowered many other women. Here is the link for Part 1
    Part 2 can be viewed

    Additional YouTubes about vaginismus can be viewed by linking to:

    Crisley is still dear to my heart and continues to do well now more than four years post treatment.


    I fairly recently started physical therapy, and I think it’s excellent. I believe it’s what’s going to make my journey to painless sex a least a little bit faster.

    I learned very specific things about my vaginismus from my physical therapist. One of the most important ones I learned was that I should absolutely not be doing kegels, but reverse kegels! My sex therapist had told me to do kegels, but my physical therapist told me that was very wrong, and to do reverse kegels. And man am I glad she told me to do that! They help so much! Doing a reverse kegel during dilator insertion makes it painless, and doing reverse kegels while holding in the dilator also helps take away any pain!

    She also taught me which specific areas of my pelvic floor muscles were more sensitive than others (my taking her finger and doing some tests). I now specifically aim my dilators to stretch out the areas that need to be stretched out the most.

    I also learned from my physical therapist that my body is apparently chronically in fight-or-flight mode, as if always ready to receive physical pain. She taught me breathing exercises to do every single day.

    Overall, 10/10 would recommend. Vaginismus is both a psychological and physical problem, and the physical part really should be addressed.


    Hi Kitten. Thank you for your post. I think you are doing awesome in PT. I tried seeing a pelvic floor physical therapist and was unsuccessful with this as I could not overcome my fear/pain automatic response to any insertion. For me, I was only able to overcome after I was put to sleep and woke up from my Botox procedure with the dilator already inserted inside of me. This somehow helped to flip a switch in my mind and allow me to see that I was not broken and I could have something inside of me and it didn’t cause pain. Thereafter, I was able to progress with the dilators and have successful intercourse. For anyone reading this right now who does not know, could you help by explaining what a reverse kegel is? Also, the breathing exercises sound excellent and helpful as well. Is this diaphragmatic breathing? I have tried this type of breathing in the past with hypnosis and for relaxation and have found it very useful. Please know we are all here to support you in your journey of overcoming. Sending hugs!

    Quote from Heather34 on January 6, 2014, 13:49
    For anyone reading this right now who does not know, could you help by explaining what a reverse kegel is? Also, the breathing exercises sound excellent and helpful as well. Is this diaphragmatic breathing?

    Sure! A reverse kegel is essentially what it sounds like – the reverse of clenching up those pelvic muscles. A reverse kegel is loosening those pelvic muscles. You know how most people will explain how to do a kegel for you by telling you it’s the muscle movement of stopping yourself from peeing, while you’re in the middle of peeing? My physical therapist told me that to do a reverse kegel, you make the muscle movement you would do as if you were about to make a bowel movement. The first time she had me try it, she made me hold up a hand mirror so that I could observe my genitals while I did it. When I did the reverse kegel (moved my muscles as if to make a bowel movement), I could see the area expand outward a little (loosening up).
    She told me to do reverse kegels instead of regular kegels because, as she explained it, “Your pelvic muscles are already chronically tightened up; the last thing you want to do is practice making them even tighter. Instead, you want to practice loosening them up.”

    As for the breathing exercises I do, yup, it’s diaphragmatic breathing. While I do them, I keep a hand on my stomach so that I can feel it go outwards and inwards as I take deep breaths and then slowly let them out.

    Thanks for the support! :3


    This is a wonderful explanation Kitten. Thank you so much. :):):)

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