My First Visit to Pelvic Floor Therapy
I picked my latest OBGYN because she works with a pelvic floor clinic. Before my appointment, I already knew I wanted to try physical therapy. But she agreed I should check it out after an ultrasound showed — yet again — that there wasn't a growth on my right ovary causing my pain. (That isn't to say there isn't endometriosis around — like in my appendix — but there isn't a visible cyst to remove.)1,2
And after my first visit, I knew I'd made the right decision. The pelvic floor therapist said some of my symptoms — aching that radiates after sex and shooting pain in my hips, legs, and tailbone — were pretty typical signs of muscle tightness. "I think we can help you," she told me.
How a tight pelvic floor causes pain
The pelvic floor is a sling of ligaments, tissue and muscles that hold up your bowel, bladder, and uterus. If you have endometriosis, you may also have pelvic floor dysfunction because your muscles get too tight, resulting in secondary pain that isn't directly coming from endo. And the more your body hurts, the more you may contract those muscles.3 (I later realized I do this when my cramps get worse.)
Pelvic floor tension can make normal things like sitting, peeing, pooping, or having sex difficult, painful, or impossible. And research shows that your pain may not be from endo tissue. That's partly because conditions like endometriosis can make your nervous system overly sensitive, which can change how your body and brain process pain (you may feel it more often), and also because of "trigger points" in your muscles.4,5
My first visit
I filled out a form with very specific questions: Does it hurt when you have sex? Can you masturbate without pain? Do you experience back and tailbone pain? Does it hurt to sit for long periods of time? Can you walk long distances? They wanted to figure out exactly where and what kind of pain I had so they could tailor my treatment.
Then I talked with the pelvic floor specialist, 40 minutes of which were basically just a therapy session. Her whole job is to help people like me feel better, so she earnestly asked me how the pain affected my life. And she wanted to know my goals for treatment; less pain with sex was at the top of the list.
There was no speculum involved, so the assessment was already more comfortable than a pap smear. Instead, the therapist manually pressed outside on my legs and hips and inside the walls of my vagina. When she poked internally on my right side — what I would describe as "ovary" pain — it immediately hurt. When I told her it almost felt bruised, she said that can happen when muscles are tense for a long time. (It feels similar to a sore muscle after a hard workout.)
When she asked me to tighten my vagina — otherwise known as a Kegel — she said she didn't notice much of a difference because I was already so contracted. A vaginal sensor later confirmed this. I was at an 11. I should be a 2, she told me.
Your organs should melt
"People think relaxing should be effortless," my therapist told me. "But it's not. It takes work."
I have a habit of tensing my shoulders when I get stressed, but I didn't realize I was doing the same thing with my vagina. It had become automatic, like my body was trying to pull itself away from the pain.
My therapist prescribed forced relaxation — 30 minutes a day, twice a day. "Think about your organs melting into the floor," she said. "And don't hold your stomach in." This last part is unfortunately something a lot of women do, she told me.
Excited for what's next
Armed with a new awareness of my body, and several exercise worksheets, I left her office feeling hopeful and ready to get to work. While I don't think muscle tension is the sole source of my pain, I'm excited to try anything that might help me feel better.
Has intimacy with your partner been affected because of endometriosis symptoms?