At Enliven, we love to take a collaborative approach to sex therapy, which often means working with a team of professionals to ensure that you receive the absolute best care possible. It comes as no surprise to most that if I’m able to talk to your medical doctor, I’ll be able to get a better sense of the physical issues that impact your sexual or relational well-being. But there’s another medical professional I’ll often refer to that may be the most useful specialist you’ve never heard of: a pelvic floor physical therapist. That’s right; there are physical therapists who are specially trained to work specifically with the muscles that support your pelvic floor—and to do so in a way that’s respectful of the sensitive nature of these parts. If you’re struggling with pelvic pain, difficulty with intercourse, or a myriad of other uncomfortable symptoms, working with both a sex therapist and a pelvic floor physical therapist may make a world of difference.

But what exactly does that look like?  

Spoiler alert: It’s not just kegels!

Similar to any physical therapist who works with your muscles to correct maladaptive habits and recover from injury, pelvic floor PTs work specifically with the pelvic floor muscles that support the pelvic organs and assist in bowel and bladder control, plus they contribute to sexual functioning. Issues that may be helped by a pelvic floor PT include difficulty with urination, incontinence, constipation, chronic pelvic pain, painful intercourse or inability to have penetrative sex, vaginismus, vulvodynia, endometriosis, pregnancy and postpartum recovery, and, for men, painful or premature ejaculation, or difficulty with erection.

While sex therapists address relationship factors and dynamics, plus your thoughts and messages about sex, educate you about your sexual functioning, help change maladaptive patterns, and provide support, they can’t treat underlying medical conditions or provide hands on assistance. Unlike sex therapists, pelvic floor PTs are able to get up-close-and-personal, assessing the physical issues and habits that may be impacting your pain or discomfort. Then, they may use a combination of massage, biofeedback, and exercises to work on strengthening, stretching and relaxation. Since these PTs understand the complex nature of the muscles they’re working with—and often work with us, your sex therapists, to get a complete picture of what’s going on—they’re sensitive to the impact of physical or emotional trauma, and will respect your feedback if a vaginal or rectal exam feels too uncomfortable or painful. They’ll work with you to design a personalized treatment program. Sometimes that just means one or two visits to assess, educate, and teach a few exercises. And sometimes that may mean more consistent, long-term treatment.

While pelvic floor PTs can be crucial, they also can’t replace the work done in sex therapy—which is why collaboration is key. After all, years of pelvic pain, sexual or physical trauma, or a sudden shift in sexual functioning, arousal, or pain take a toll on you emotionally, on your feelings about sex, and on your relationships. Even as the physical aspects of pelvic pain begin to improve, a sex therapist will help you navigate your psychological world—plus, help you communicate with current and future partners about your experience. Although your mental health may not have caused your sexual dysfunction, it will almost definitely be impacted by it. When you can address the physical, mental, and relational at the same time, your potential to feel so much better improves exponentially.

If you’re intrigued, ask your doctor or sex therapist if a pelvic floor PT may be a good option for you. We’d be happy to refer you to someone we trust—and work with them to give you the support that you and your pelvic floor so desperately crave.