Treating Female Pelvic Pain Disorders Using a Combination of Pelvic Floor Physical Therapy and Sex Therapy

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Treating Female Pelvic Pain Disorders Using a Combination of Pelvic Floor Physical Therapy and Sex Therapy

Editor's note: Updates of Clinical and Educational Sexology are intended to provide state-of-the-art education for AASECT members and other professionals on matters relevant to the practice of sexuality education, counseling and therapy. At the direction of AASECT's Professional Education Committee, and with the oversight of AASECT's president, executive director and Board of Directors, these Updates will offer readers who fulfill certain designated criteria an opportunity to receive AASECT Continuing Education credits relevant to AASECT certification procedures.

We publish Updates on a bi-monthly basis as a special eature of Contemporary Sexuality.


When patients present with disorders of pelvic pain they are often met with a variety of circumstances that neither inspire hope nor help to alleviate the disorder. These dysfunctions are typically very difficult to diagnose, and without an adequate etiology, treatment is haphazard at best. Women who present with such disorders are usually scared, angry, and/or frustrated with the conventional methods of evaluating and treating their pain. Often they have been prescribed medications to take orally or apply transdermally, and occasionally they have been directed to have surgical excision of the painful area. These approaches may sometimesactually worsen the problem, leaving a woman feeling completely distraught about ever finding relief. If she is in a relationship, the sexual activity has usually been painful or even intolerable, creating even more tension for the woman and her mate.

Recently, a newer approach, using physical therapy to address the musculoskeletalcomponents of pelvic floor muscle dysfunction and pain combined with the psychoeducationalinterventions of a sex therapist or counselor, has enabled more women with these problems to achieve relief and to resume their sexual lives.

This paper will present an overview of the anatomy and physiology of the pelvic floor structures and a brief description of the physical therapy approach to managing pelvic floor dysfunction. Using traditional and emerging sex therapy methods, the sex therapy approach to teaching a woman to understand her body's sexual functioning and to gradually change the experience of vaginal containment from a negative to neutral to a positive experience will be presented. The authors recognize that either a sex therapist or a sex counselor may provide these interventions. Whenever one provider is mentioned in this paper, the authors assume that the information may pertain to both providers, unless a specific disclaimer is described.


Pelvic pain disorders can have multiple causes, making them very difficult to accurately diagnose. In general, they can be divided into ones of physical origin or of psychogenic origin or a combination of the two. In reality, the cause is frequently not known. Physical disorders are further classified as arising from dermatologic, infectious, vascular, or neuromuscular causes. Due to brevity, this article will include only a general discussion of the variety of disorders other than those of neuromuscular origin.

Sexual health providers have been describing their interventions for these problems for several years. (Kessler, 1998; Koehler, 2002). Unfortunately, many sex therapists and counselors practice in office settings separate from other potential treatment team members, so it may be difficult to collaborate in person.

Physical therapists are skilled in evaluating and treating a wide variety of musculoskeletal conditions. Recently some physical therapists have undergone additional training in pelvic pain assessment and treatment to be able to better help their clients overcome sexual pain problems using a "hands-on" approach. (Rosenbaum, 2002). …