Patients with Pelvic floor muscles myalgias as well as associated fibromyalgias, undergo 6-8 sessions of physical therapy and biofeedback. Anti-inflammatory and desensitization therapies are usually offered along when vulvar vestibulitis syndrome is also present. The physiotherapy/biofeedback services are provided by the highly qualified Johns Hopkins Physical Therapists .

When you begin physical therapy or pelvic floor rehabilitation for dyspareunia, we recommend that you abstain from intercourse for at least the first 4 to 6 weeks of service. We anticipate the need for a total of 6 to 8 visits usually scheduled 1 time per week, 1 hour sessions. We ask you to abstain from intercourse to allow the pelvic floor muscles to relax and respond appropriately to treatment. Our goals for treatment are to improve your control and awareness of the pelvic floor muscles and enhance your sexual appreciation. Treatment consists of several techniques to promote increased circulation, oxygen and nutrients to the pelvic floor muscles supporting the vagina and internal organs. Your therapist can provide manual techniques, therapeutic exercise, and pelvic floor biofeedback to enhance function in this region. Some clients may require further vaginal muscle stretching and training in the home setting. If this is the case, you may be issued a vaginal dilator with instructions on home use. The vaginal dilator is a white plexi-glass device that looks similar to a candle and comes in various sizes.

Physiological quieting exercises or relaxation exercises may be of some benefit to clients. For example, visual imagery strategies might be employed during intercourse to reduce anxiety. Another strategy may be breathing exercise awareness during intercourse to help with pelvic floor relaxation and ease of penetration. During actual treatment sessions with your therapist, she may use thermal (warm) modalities, relaxation CDs, and aromatherapy to help comfort you during the process of pelvic floor rehabilitation.

Once the therapist and the client determine that the pelvic floor muscles are adequately relaxed and the client's awareness and control of these muscles have improved, intercourse may be gradually resumed with recommendations from the therapist or physician.

Talk to your physical therapist about any questions or concerns you may have regarding dyspareunia. Whatever we can do to make this an easier process for you, please let us know.

Outpatient physical therapy referrals for pelvic floor rehabilitation require a signed prescription from your physician. Most insurance companies provide coverage and physical therapy benefits. Any questions or concerns can further be addressed at our downtown location, The Johns Hopkins Hospital, 410-614-3234 or our Greenspring location, 410-583-2665. Additional information regarding our physical medicine and rehabilitation services can be found at www.hopkinsmedicine.org/rehab/services/women.htm

Submitted by Jackie Welch, MPT,Physical Therapist II,Pelvic Floor Rehabilitation