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Sex and Sexuality

Besting Bacterial Vaginosis, Part II

By Riva Preil

The diagnostic features of VBD include extreme pain upon attempted vaginal penetration, vestibular pain when touched with a cotton swab, and erythema (redness) in the vestibule. These are called Freidrich’s criteria. Treatment includes tricyclic medications (ex. amitriptyline) to alleviate pain, especially in cases of secondary VBD. Also, antiseizure medications (ex. carbamazepine) and anticonvulsant drugs (ex. gabapentin) have been used to help women with VBD. One should speak with their physician regarding medications and the possible side effects if they think they may benefit from this form of treatment.

Furthermore, physical therapy is a crucial component in treating VBD. The pain which results from VBD can be viewed as a stressor or assault to the pelvic floor muscles. In response to pain, the muscles in the pelvic floor can tighten and may even spasm as a protective mechanism to prevent further injury. However, the tightening of the muscles themselves can cause a cascade of problems including formation of trigger points, decreased muscle flexibility, skeletal misalignments, and additional nerve compression. Therefore, women with VBD should participate in physical therapy to help treat the secondary musculoskeletal dysfunctions.

Vestibulectomy, a surgical procedure performed to remove the irritated and vestibular tissue along with the inflamed nerve endings, should be used as a last resort and only if all the treatments have failed. The hesitancy surrounding this surgery is due to the fact that nerves tend to have better memories than we want them to have- the brain may still continue to perceive pain even from a severed nerve! (This is similar to the concept of phantom limb pain, and this is the reason why individuals may continue to feel the presence of a limb even after it has been amputated.) Therefore, since the initial success rate of vestibulectomy is only 60% (approximately), it should be reserved for individuals who are completely unable to participate in intercourse due to pain (if medication and physical therapy were unsuccessful). Fortunately, this procedure should not impair areas associated with sexual pleasure, and it has not been shown to interfere with fertility, pregnancy, and delivery.

—FAQ

Frequently Asked Questions

Pelvic Floor Disorders and Treatment

What is pelvic floor dysfunction and why does it happen?

Pelvic floor dysfunction is extremely common and occurs when the muscles, tissues, or nerves of the pelvic floor are weakened, tightened, or injured by trauma, chronic strain, or overuse. Pelvic floor disorders can result from traumatic injury such as a fall, from sporting activity, surgery, or childbirth. They can also happen from more chronic issues, such as infection or chronic inflammation such as endometriosis. Pelvic floor disorders can be a consequence of poor alignment or posture, overuse, or improper movement. The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel, or sexual dysfunction in people of all ages.

Who should I see to get a proper diagnosis?

Many healthcare providers don’t assess – or don’t know how to assess – the pelvic floor muscles and nerves, so it’s important to get a proper diagnosis from a practitioner who specializes in pelvic floor dysfunction and pelvic pain. Too often patients tell us that they’ve been to 10 different doctors and healthcare providers and their symptoms have not improved, or have worsened. Find a specialist right away and get on the path to healing as quickly as possible.

Why do healthcare providers miss (or misdiagnose) pelvic floor dysfunction?

Long story short, the medical practice is divided into areas of the body: Urology. Orthopedics. Gynecology. But the body itself doesn’t have walls; every system interacts with everything else. Sometimes providers are so laser-focused on what they treat that they miss the whole picture. 

As more and more research emphasizes the importance of physical therapy as part of a complete treatment regimen, more and more physicians are learning how to recognize and treat pelvic floor disorder. In the meantime, if you’re not getting relief from your current treatment, make an appointment with a pelvic floor specialist to learn more.

How does pelvic floor dysfunction affect sex?

Pelvic floor muscles have a huge impact on sex. Muscles that are shortened or tight and are unable to elongate will not allow for good blood flow into the genitals. This can result in pain, weaker erections, diminished sensation, inability to orgasm, and even decreased lubrication. Pelvic floor PT can help with these issues by enhancing blood flow and improving muscle function. 

How can pelvic floor dysfunction cause bloating?

Pelvic floor dysfunction, a condition characterized by the inability to correctly relax and coordinate pelvic floor muscles, can significantly contribute to bloating due to its impact on gastrointestinal functions. When these muscles are not functioning properly, it can impact the ease of emptying and make it difficult for your body to pass stool and gas through the intestines. This obstruction leads to an accumulation of waste and gas in the gastrointestinal tract, causing bloating and abdominal discomfort.

Is it true there’s internal massage?

There can be. We do perform internal soft tissue mobilization of the pelvic muscles that are inside your pelvis and are accessible only through the vagina or rectum. We never do internal treatment without your consent and understanding.

What makes someone a pelvic floor PT vs a regular PT?

All pelvic PTs get additional training in pelvic floor internal treatment through continuing education and at our clinic. 

We pride ourselves on the level of training we provide, not just at the beginning but throughout the time our therapists spend at Beyond Basics. We know that learning is a life-long process.  We also provide additional training in physiology of the GI system and urinary system as well as sexual health and function and nutritional training. Most PT programs and schools do not provide the depth and breadth of knowledge that we provide all our PTs at Beyond Basics.

Get help now from a pelvic floor therapist.

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