A women’s health physiotherapist can be extremely helpful for pelvic floor muscle rehabilitation. They would typically combine some stretching, massage, trigger point treatment, myofascial release or breathing techniques and often lifestyle and nutritional changes could be incorporated.
There is a professional group of physiotherapists interested in women’s health and vulval pain called Pelvic Obstetric and Gynaecological Physiotherapy, or POGP – see their website to find a professional local to you. Additionally, you can find directories of pelvic health physiotherapists on the Pelvic Physiotherapy website and on the SqueezyApp website.
We feel that a women’s health physiotherapist needs to evaluate each person and tailor their treatment to each individual, so we would not encourage most physiotherapy self-help techniques without a consultation, diagnosis and treatment plan.
However, the one exception to this would be desensitisation of the pelvic floor muscles.
Pelvic floor muscles desensitisation
The protective guarding response that can occur in women with vulval pain needs to be unlearned, so that the body begins to remember that inserting something into the vagina does not need to be painful. This can be achieved by gradually and progressively inserting bigger items into the vagina (such as one finger, then two fingers, then a small vaginal dilator) to desensitise the area and gently stretch any contracted vaginal tissues. Desensitising these muscles is a crucial part of the management of conditions such as vulvodynia and vaginismus when sex is painful. This procedure should be used in conjunction with the medical treatments if necessary.
Vaginal dilators (also known as vaginal trainers)
Dilators are smooth cylinders made of plastic or silicone which are inserted one at a time into the vagina to help develop confidence with penetration. Designed to help desensitise the area and make you less phobic about touch, dilators are used to relax the muscles around the entrance to the vagina and to gently stretch the area. They come in a set of different sizes, or sometimes can be bought individually. The dilator sizes are graded for use at different stages of treatment, with the smallest size being used first, then gradually moving up in size until the largest can be easily and comforably inserted.
Many women find the traditional plastic dilators hard and clinical and prefer to use a simple vibrator or even self-massage of the vulval area. However, dilators now also come in silicone, and some have a vibration option as well, so you can use whatever type works best for you. Online retailers can have a good choice of smaller products for vaginal insertion or items that vibrate and can be used externally.
How to use dilators
Starting with the smallest dilator, lightly coat it with a vaginal lubricant, then insert it in and out for a few minutes. When ready, you should move on to using the next largest dilator in the set, then increase by one size every week until you are either using the size of dilator which matches your partner’s body or you feel comfortable to resume intercourse (whichever happens first). The time that the vaginal dilator should spend in the vagina is the same on each occasion, i.e. around 10 minutes. If you can manage it, use the dilators regularly. If using the larger ones is painful, then get used to using the smaller ones each day.
After use, the dilators can be rinsed under the tap between applications and dried off, but no other specific treatment is necessary to cleanse them.
When using the dilators, make sure that you use a good lubricant that suits you and doesn’t aggravate your condition.
Editor’s note: for discussion of one particular study examining the use of vaginal dilators, please see our Published research page. Alternatively, for further or more recent research on physiotherapy for vulval pain, you can visit the PubMed database, which allows you to search for studies online.
Page last updated on 3 February 2020