By: Faraley Vander Schilden
1. WHAT EVEN IS THE PELVIC FLOOR? WHAT DOES IT DO?
Located on the inside of the bones of your pelvis, the pelvic floor is made up of muscles, ligaments, blood vessels, nerves, and connective tissue that hang like a hammock between your pubic bone and tailbone. Its main functions are to help support your internal organs, provide stability to your pelvic girdle, low back, and hips, act as a “sump pump” for fluid exchange between blood and lymph, provide bowel/bladder continence, and allow for penetration and orgasm. Having a healthy pelvic floor allows all of these aspects of function to manifest.
2. HOW DO I KNOW IF I AM USING MY PELVIC FLOOR MUSCLES PROPERLY?
When you activate or lift your pelvic floor muscles, you should feel your perineum drawing upward without the use of your abs, inner thighs, or butt muscles. It can feel like you are holding in the passing of gas, or holding in a tampon. This is not a painful muscle contraction.
3. ISN’T PELVIC FLOOR PHYSIOTHERAPY ONLY FOR PREGNANT PEOPLE AND PEOPLE WITH VULVAS?
Nope! Every body has a pelvic floor, so every body could benefit!
4. CAN PELVIC FLOOR PHYSIO HELP ACHIEVE ORGASM OR AT LEAST IMPROVE MY SEXUAL SATISFACTION?
Encouraging the full range of motion of the pelvic floor, as well reducing overall tone of pelvic floor muscles can help. This alongside with education about arousal, positions, lubrications, toys, etc. assists in empowering a person with greater knowledge of their body’s sexual capability.
5. CAN PELVIC FLOOR PHYSIO HELP ME WITH PAINFUL SEX?
Absolutely – pelvic floor physiotherapy can help with the mechanical and muscular aspects of painful sex (such as tight pelvic floor muscles, hypersensitivity, scar tissue, pelvis/SI joint, lumbar spine issues, etc.). There can also be psycho-emotional aspects to painful sex, and so having mental health support to deal with those facets of the pain can help the whole self move forward.
6. HOW COMMON IS IT TO “LEAK”, EVEN IF YOU HAVEN’T HAD A BABY?
It is actually quite common – approximately 20% of vagina owners who have not had children will leak. This is more likely with sports such as running, gymnastics, and heavy weight lifting. This type of presentation is more often due to discoordination of muscles causing excessive pressure on the pelvic floor muscles, which then fatigue and allow for leakage.
7. I HAVE HEARD THIS TYPE OF PHYSIOTHERAPY INVOLVES AN INTERNAL EXAM – IS THIS TRUE?
Typically there is some sort of internal assessment, but this may not be necessary. There is a huge amount of information and education that is included in assessing and treating someone’s pelvic floor so depending on your presentation, an internal assessment may not be required. This is your body and you can decide what feels right for you – nothing needs to be decided right then.
8. I HAVE ANXIETY RELATED TO AN INTERNAL VAGINAL ASSESSMENT – WHAT ARE MY OPTIONS?
Again, an internal assessment may not be required, but if it is and this doesn’t work for you, an assessment of your pelvic floor muscles can be performed anally.
9. DO PEOPLE EVER BECOME AROUSED DURING ASSESSMENT/TREATMENT?
While pelvic floor physiotherapists generally assess the muscles by digital insertion in the vagina or the anus, it is very medically-minded and anatomical in the approach – more relaxed than the doctor’s office but not the intimacy of your bedroom.
10. IS THERE ANYTHING MY PARTNER CAN DO TO HELP WITH PELVIC FLOOR TREATMENT?
I love to include a partner in treatment whenever I can. They are more than welcome to join a session where I can show them some treatment options that may be helpful. This is not always feasible depending on your specific issue, but it may also be appropriate to state here that you are welcome to bring another person to your appointment if that creates a safe space for you.
11. CAN I BE ASSESSED EVEN IF I AM HAVING MY PERIOD?
Yes you can, but it comes down to patient comfort. I guarantee your pelvic floor physiotherapist doesn’t mind if this is the case, but generally I find patients reschedule if they are experiencing heavy flow.
12. WHAT TYPES OF CONDITIONS CAN BE TREATED BY A PELVIC FLOOR PHYSIOTHERAPIST?
Urinary or fecal incontinence, pain with sex, constipation, vulvodynia, vaginismus, tailbone pain, erectile dysfunction, prolapse, pregnancy, postpartum, post-surgical conditions (prostatectomy, rectal cancer, hysterectomy, etc.)…the list goes on!
13. CAN I SEE A PELVIC FLOOR PHYSIO FOR EDUCATION ON FUNCTION AND EXERCISE WITHOUT EXPERIENCING ANY DYSFUNCTION?
Totally – some people just want to learn what their pelvic floor is and how to connect to those muscles from a proactive standpoint.
14. WILL HAVING ANAL SEX DAMAGE MY SPHINCTER?
As with any type of sex, if you desire it, are prepared for it, and are using the right approaches (lube, toys, etc.), the risk is low. Progressing very quickly with anal dilation may have some adjustment periods but unless there is actual tearing to the sphincter, it should be fine.
15. IS MASTURBATING GOOD FOR THE PELVIC FLOOR?
Absolutely. Arousal increases blood flow to the genitals, and this allows for heightened sensation. Orgasm causes a rhythmic contracting and relaxing of the pelvic floor muscles and the overall event leaves one feeling euphoric and relaxed. Anything that you can do that encourages pleasure, safety, and relaxation in your body is good for you!
16. ARE THERE SEXUAL POSITIONS THAT ARE BETTER FOR THOSE WHO EXPERIENCE PAINFUL SEX?
Positions that allow the person on the receiving end to control depth of thrust and speed. Positions on top or side lying give the most control over these aspects, but overall ensuring proper arousal, lubrication, and communication also assist.
17. WHAT ARE SOME PRODUCTS THAT WILL MAKE PENETRATIVE SEX FEEL MORE PLEASURABLE?
-the Link Up Ultra Soft Cock Ring Sets are fantastic for customizing penetration depth
-these dilators are a soft and gentle tool for folks with vaginismus, pain during penetration, and/or tight muscles, and offer you the chance to work your way from painful sex to a pleasurable penetration situation!
18. I HAVE AN STI – CAN I STILL SEE A PELVIC FLOOR PHYSIOTHERAPIST?
Yes you can as treatment involves a lot of history and education, and STI history is part of that. If your STI is currently active/flaring up (herpes, genital warts, etc.) it may not be indicated to perform an internal treatment at that time.
19. I HAD A BABY AND WANT TO GET BACK TO BEING INTIMATE WITH MY PARTNER – ANY SUGGESTIONS?
COMMUNICATION. Take your time. Ensure you are aroused, use LOTS of lube, and don’t try to rush. You may feel more comfortable keeping things external instead of having penetration as you or your partner’s goal. It really is an opportunity to peruse your “sex menu” rather than skipping to the “main course”.
20. DO I NEED TO SEE MY DOCTOR FIRST FOR A REFERRAL? WHO PAYS FOR THIS?
You do not need to see your doctor first unless your private insurance requires it. If you have insurance, then they usually cover up to a yearly maximum so check what your plan states in regards to physiotherapy. If you don’t have insurance, the fee will be out of pocket unless you have coverage under Medical Services Plan.
FARALEY VANDER SCHILDEN is an Orthopaedic and Certified Pelvic Floor Physiotherapist. She works at RISE Health in Fernwood located at 1275 Bay Street – (250) 381-7473.