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Sex and Sexuality

Painful periods

Painful periods. It may not be just cramps.

Endometriosis is a disease that affects over five million women and adolescent girls in the United States. It occurs when endometrial tissue, normally contained within the uterus, grows elsewhere in the body. This tissue may migrate outside of the uterus and into the ovaries, vagina, bowel, bladder, rectum, and diaphragm. During the menstrual cycle, endometrial tissue increases in blood vessels and surface area then sheds appropriately during menstruation. For a woman with endometriosis, abnormal tissue growth outside of the uterus may also respond with the hormonal cycle. The results of the displaced endometrial tissue is inflammation, scar tissue, and pain. Scar tissue builds bridges between organs and the adhesions decrease the ability of the organs to slide and glide. The restricted mobility of the nerves, muscles, viscera and surrounding connective tissue can cause blockages and pain.

These abnormal growths can cause debilitating symptoms including unbearable menstrual cramps, pain with sex, pain with voiding, fatigue, diarrhea, constipation, bloating, and nausea. Some women will experience infertility.

Treatment options for endometriosis include pain medicine, hormonal treatment, surgery, and physical therapy. Manual physical therapy has proven to be an effective treatment option for women with restrictions or decreased mobility due to endometriosis. Visceral mobilization and soft tissue mobilization help free the restricted structures and decrease secondary muscle tightness. Manual techniques do not prevent endometriosis, but decrease or eliminate pain by optimizing the available range of motion.

Surgical intervention is necessary for some women suffering from endometriosis. Two common side effects of surgical intervention include constipation and urinary urgency. Physical therapists trained in pelvic floor dysfunction are able to treat the musculoskeletal aspect of these voiding disorders. Abdominal adhesions typically occur after surgical intervention. Prophylactic post surgical physical therapy is beneficial to restore mobility, increase core stability, retrain posture, and advise appropriate therapeutic exercise.

March is endometriosis awareness month. Reach out to the women in your life in crisis. End the myth “it’s just cramps that I have to deal with” and encourage them to ask their physician about their symptoms. Sex doesn’t have to be painful. It is important to get a proper diagnosis. Musculoskeletal causes of pelvic and abdominal pain are very common and can be the reason for pain.

For more information please visit http://www.womenshealth.gov/health-topics/a-z-topic/pubs-orgs.cfm?topic=222 .

—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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