Vaginismus and Physical Therapy

[Heather34]

I recently read the post in Vaginismus General (Congrats to Dr. P on #150) in which Erika, a physical therapist from Manchester, has just joined the forum. Welcome to you Erika and we all look forward to talking to you. Dr. P has proposed that we create a new topic devoted to questions that have to do with physical therapy as a treatment for vaginismus so that Erika can weigh in on this widely used type of treatment. For example, who might be a candidate for PT? Should PT be used as a first type of treatment? How does PT fit in with counseling? When should the Botox program be considered? How does PT work? How many sessions should be expected and when should a patient be referred for the Botox program? These are all important questions. Having Erika with us will broaden our knowledge. Thanks Erika again for joining us and we all look forward to reading your posts. Ladies, what specific questions do you have regarding PT?

I have one question and will start. Erika, I had the Botox procedure done in June and can now have successful intercourse. I still dilate regularly as I’m secretly terrified that “V” could somehow return. I anticipate dilating for a full year. Following this, if I were to ever experience a little pain and return to dilating but still experience pain, would PT be beneficial here to continue to work the muscles?

[evillemure]

Thank you for the nice welcome! PT may be beneficial b/c it would work on manually stretching the pelvic floor muscles. I always encourage my patients to bring in their partners to their PT sessions and I teach them how they can help their wives/girlfriends on a more regular basis. I also recommend after every shower/bath to just use a finger and manually stretch your vaginal opening. I find that most women are the tightest toward the bottom, so I suggest stretching downward for 10 seconds or so a couple of times can help. The hot water after a shower/bath will improve blood flow to the area, so the tissue will be more pliable rather than trying to randomly stretch throughout the day.

[Heather34]

Thanks for the tips Erika. I especially enjoyed reading the recommendation for finger stretching after a shower/bath. I have another question for both you and Dr. P. For those women reading this who are just beginning the dilating process post-procedure, would you also suggest that dilating after a warm shower/bath may be one of the most beneficial time??? Thanks again so much for your tips.

[Dr. Pacik]

I love the idea of water! Actually it is entirely safe to dilate in a warm bathtub. (Birthing is now done more and more in warm water.) Anything that creates relaxation is worthwhile. Dilating with fingers is also helpful. From one finger, you can progress to two. Stretch the opening and pull in opposite directions with two fingers. You can do this solo, or have your partner participate. All of this helps to become more comfortable with penetration.
New Question Erika: 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?

[evillemure]

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 she 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. As for answering your question, Heather, I agree with Dr. P that water is great for dilation – it causes vasodilation, so more blood flow can occur, making the tissue stretch easier. I know this sounds crazy, but I wonder after dilation how an ice pack to the area would do in order to maintain your gains? Ice after any workout is good and dilation is no different.

[Heather34]

Hi Erika. Thanks for your post and this is all so interesting to read. You wrote about Crisley’s ability to tolerate an intravaginal sensor post-botox where before you had to use the rectal sensor. This sounds so similar to my own personal story. I was so tense at all of the gynecological exams pre-procedure that they couldn’t even insert the smallest speculum. Post-botox, I was able to tolerate not only a speculum but also an internal ultrasound on a couple of different occasions (with the botox still in my system and after the botox had worn off). I think it’s exactly what you described as becoming relaxed and comfortable with your body in addition to being in compliance with the dilation schedule.

I love the discussion concerning WATER and think the ice pack idea could possibly work really well. I also have a couple of more questions about water. Both Erika and Dr. P wrote that it is ok to dilate in a warm bathtub. I never tried doing this in the beginning because I always assumed that I needed to use a lot of lubricant (i.e. KY Jelly, Pre-Seed, etc.). We’ve also never had sex in the hot tub, again, b/c I assumed I needed to use a lot of lubricant. For any ladies reading this, what have been your experiences with either dilating or having intercourse in WATER (i.e. bath, shower, hot tub)? For someone who has been having intercourse for a considerable amount of time, what have been your experiences with sex in the water? Does it feel much different?

[Dr. Pacik]

Water Sports

Dilating or having intercourse in water simply requires a different type of lube. Water based lubes won’t go very far. The vaginal dryness noted for about four months, related to the Botox injections, interferes with natural let down. It is for this reason I recommend using cocoa butter, both on the outside as well as on the inside, and on your dilator or partner’s penis.
I especially recommend this to women using a hot tub whether or not they have vaginismus. The bromine in a hot tub can be very drying, and pre-treatment before hot tubbing can be protective. For those who stay a longer duration simply re-apply every hour or so. Other lubes to consider are silicone based and olive oil or any of the other natural oils.