What Is Pelvic Floor Massage?

Technically, it's called pelvic floor physical therapy, and it's a legit treatment for pain during sex and other conditions.

Like your arms, legs, and stomach, your vagina sometimes loses muscle tone. Similarly, there is a way to strength-train. Pelvic floor physical therapy (PFPT)—which is sometimes called pelvic floor muscle training (PFMT) or non-technically, "vaginal massage"—is a well-rounded regimen for rehabbing the muscles of the pelvic floor.

Certified specialists in this field can help people who are dealing with pain during sex, something about 75% of women experience at some point in their lives, according to the American College of Obstetricians and Gynecologists (ACOG).

Therapy can also combat general pelvic pain, incontinence (both urinary and fecal), tailbone pain, and constipation, said Lauren Tadros, PT, DPT, a physical therapist at Thrive Integrated Physical Therapy in NYC.

Collectively, these issues are called pelvic floor dysfunction. PFPT is a program that can help pelvic floor dysfunction that includes "functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation," according to a 2019 review of the literature published in the journal Current Opinion in Obstetrics and Gynecology.

Researchers found strong evidence that PFPT improves or cures the symptoms of a host of conditions including urinary incontinence, pelvic organ prolapse, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic (having rigid muscle tone) pelvic floor disorders—including pelvic floor myofascial pain, dyspareunia (painful intercourse), vaginismus (fear of vaginal penetration), and vulvodynia (chronic pain or discomfort around the opening of the vagina that's lasted at least three months).

Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day, for example, can affect the nerves in your pelvic area and translate into a burning pain in your vulva, said Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction and owner of Kotarinos Physical Therapy in the Chicago area.

The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to "walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry," said Kotarinos.

Finding help isn't exactly easy, especially since people are often hesitant to reveal their discomfort. "My patients often express that doctors have told them that their pain is normal or that it'll go away. Or various testing comes back inconclusive," said Tadros. "They hit a dead end, and it sometimes takes women a year to get to us."

Pelvic pain can be a huge drag on a person's quality of life, too. Pain during sex can be distressing and become a major strain on a relationship, explained Tadros. Some patients with general pelvic pain can't wear tight pants without being uncomfortable. And standing for an extended time might hurt, impacting all sorts of work and social activities.

How pelvic floor physical therapy works

It's highly unlikely that someone will head into a therapist's office for a stand-alone "vaginal massage." Why not?

"It's one small aspect of the whole therapy," Laura Y. Huang, MD, a physician specializing in electrodiagnostic medicine, and physical medicine and rehabilitation at the University of Miami Health System told Health. Dr. Huang noted that pelvic floor muscle training, biofeedback, soft tissue release, and education are some of the many pelvic floor physical therapy treatments used to relieve pain or retrain muscles. Learning techniques and strategies to manage the condition at home is also part of the treatment.

PFPT treats the musculoskeletal system of the pelvic floor, said Dr. Huang, sometimes internally through the vagina or anus, though the target isn't the vagina itself, but rather the muscles. "Some muscles, like hip rotator and pelvic floor muscles, are better accessed internally," said Dr. Huang. Imbalances in other muscles like those found in the abdominal wall or hip girdle are best treated from the outside.

If your therapist determines that internal manipulation should be part of your treatment protocol, one finger may be used to stretch and mobilize the pelvic floor muscles, said Tadros (hence, the term "vaginal massage"). While it may seem off-putting, Tadros said that she finds "that patients are so desperate for help, they're more than okay with having it done. We don't use a speculum or stirrups. This isn't invasive, it's designed to keep someone as comfortable as possible."

Finding help for your pain

If you're dealing with pelvic pain, Kotarinos recommended researching the International Pelvic Pain Society (IPPS) or the American Physical Therapy Association (APTA) to find a qualified pelvic floor physical therapist. You can also see your primary healthcare provider for a referral.

Dr. Huang also suggested focusing on your health holistically, with measures such as stress management, regular exercise, and a well-balanced diet. "We want to educate and empower women to be in control."

One 2019 study published in the International Urogynecology Journal discussed how pelvic floor dysfunction in women can result from many causes, including physical, psychological, and social (biopsychosocial) factors. Because of this, the treatment also should be multifactorial—or holistic—as Dr. Huang said.

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If you're experiencing pelvic pain, whether it's during sex or not, talk with your healthcare provider. And while it might seem embarrassing, know that you are not alone—millions of people each year have pelvic pain. "You'd be surprised at how many people deal with this pain. There is help out there," said Tadros.

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