I recently interviewed Sandy Hilton for the July issue of BossFit Magazine on the topic of sex from a Pelvic Health perspective. You can find that story here (the entire issue is devoted to sex – check it out!)
Sandy shared so much good information with me, and since the magazine articles are under 500 words I had to pare it down. I wanted to share the entire interview with you here. Enjoy!
Tell us about yourself:
I am a Doctor of Physical Therapy and have been practicing since 1988. I am the co-owner of Entropy Physiotherapy and Wellness, serving Chicago to restore hope and movement in those dealing with persistent pain, incontinence or painful sex. I serve as the Director of Programming of the Section on Women’s Health of the American Physical Therapy Association and am a member in several international organizations dedicated to providing top-notch health care.
What are some reasons that men and women might find sex to be painful?
Over 1 in 7 people experience pelvic pain and roughly 90% of those will have painful sex. There are multiple causes of pelvic pain in men and women. If it hurts in your pelvis, groin, belly, genitals or the hips during or after sex, you should see a physician for a good evaluation! Find a pelvic health specialist in your area, look for Urologists, Urogynecologists or Gynecologists who are experts in pelvic pain and sexual dysfunction. Common causes that we see in the clinic are related to stiffness of the muscles of the pelvic floor (those that you tighten when you do a Kegel), sensitive nerves in the area (from injury, repetitive use like long bike rides, following an infection or even sudden onset with no tracable cause), back pain and gut problems. Diagnosis like Vulvodynia, Dyspareunia, Pudendal Neuralgia, Prostatitis and Painful bladder Syndrome may all result in pain in the perineum and painful sex. Many endure this pain for years and treatment can be delayed by delayed diagnosis, insurance limitations or being incorrectly told that there is no help available.
What type of treatment can physical therapy offer for these issues?
Physical therapists provide essential care in eliminating painful sex. The right treatment plan starts with a thorough evaluation that includes your history, your goals and a full movement screen, check your strength and coordination and importantly, test the muscles and movements inside and around the pelvis.
It’s pretty common in painful situations to have a “non-relaxing pelvic floor”. We teach you to be able to tell when your pelvic muscles are contracted/held tight and how to relax those muscles again. This is the opposite of doing a Kegel contraction. Strength is important, but to be strong you need to be fluid, supple and coordinated.
Pain neuroscience education is an essential part of comprehensive treatment. Understand how the pain system works will give you daily reassurance and hope that the movements and function you have lost will come back with careful, coordinated treatment. We teach you to understand pain and ultimately, to change your pain. Part of this is learning to do Graded Imagery and Graded Exposure, tools that train your brain and your body (we really can’t separate those things!)
Other treatments may be using biofeedback (EMG) to show you on a screen the activity of the pelvic muscles, the use of dilators or vibrators for tissue stretch or relaxation, instruction in Mindfulness/Meditation and movement re-training that may include Yoga, Feldenkrais or Franklin Method exercises.
How long does it take to see progress?
I expect to see change from one visit to the next. It’s going to take some time, but really, you should see and feel measurable improvement each week. I think it’s faster to make change if you get to treatment quickly! I’d love to see people within the first 6 weeks of their condition rather than they typical “I haven’t been able to have comfortable or pleasurable sex for 5 years”. That’s way too long to wait before getting help!
What if the OB/GYN says the patient doesn’t need physical therapy (or says they need surgery?)
Some physicians don’t know what physical therapy can do to help. They may think that physical therapy for pelvic health is just teaching kegels – and I agree that wouldn’t be helpful for pelvic pain. When the doctor understands that physical therapy is a great way to get the brain, mind and body doing better, to bring the pain response down and restore healthy motion to the irritated parts, then they often are agreeable to a trial. If it isn’t a life threatening condition then a qualified pelvic health physical therapist is a sensible first try! See the Section on Womens Health “Find a PT” to locate one near you.
Besides pain, what are some other reasons that folks might avoid sex?
Incontinence will certainly play a part in wanting to avoid sex. Pelvic organ prolapse is another condition that may make it uncomfortable to have sex. For both men and women there may be changes in hormonal levels that make sex not interesting, not comfortable or you may be concerned with changes that come with age. There is help for many of these things, often with coordination between your MD and the physical therapist.
What if a patient says, “I had surgery to “fix” my problem, but I still have pain, why?”
Pain is a protective response that has to do with if your brain thinks the area where your hurt is in need of defense! If you’ve had a surgery and the pain persists, it may be less about what’s happening in the area and more about protecting it – this is all outside your conscious awareness, it’s a pretty cool system and we would die without the ability to feel pain. BUT – if you are stuck in pain, then you need to get to someone who can help you figure a path back to well being. It takes training the brain and the painful area both! There is hope. We wrote a bit about it here.
Anything else you want to mention about sex?
Sex and intimacy are an important part of life. It helps us to feel connected, wanted, appreciated and it is great for your pelvic muscles. Orgasms are helpful for staying healthy!
Thanks so much, Sandy, for sharing your expertise. You can find Sandy on Twitter at @SandyHiltonPT