Vie Physio is Kildare’s first specialist pelvic and women’s health physiotherapy clinic. They are committed to providing exceptional care in a compassionate and friendly atmosphere. I invited Aoibhin McGreal and Caroline Gavin to talk to me about everything you need to know about attending your first pelvic physiotherapy appointment for vaginismus, dyspareunia and vulvar pain.

Women who experience vaginismus, pelvic pain or vulvar pain can benefit from understanding more about the nature of the problem and reaching out to the right professionals for support and intervention.

Sexual issues and concerns about sexual functioning can be challenging to open up about and discuss. Women with vaginismus, in particular, experience heightened feelings of loneliness, helplessness and anxiety.

However, caring and passionate professionals such as Gynaecologists, Pelvic Physiotherapists and Psychosexual therapists are available to help, dedicating their careers to helping women like you with these specific health conditions and associated fears.

Embracing a holistic approach to resolving primary and secondary vaginismus and related conditions can be transformative for you, changing not only how you address the problem but how you feel about yourself and your body.

‘We understand that pain and anxiety are closely related, so as women’s health physiotherapists, our aim is to never be the cause of anxiety.’ – Aoibhin & Caroline, Vie Physio 

Specialist pelvic physiotherapy is an effective therapeutic intervention for women experiencing vaginismus, genito-pelvic pain/penetration disorder (GPPPD) and vulva pain.

Working with a pelvic physiotherapist will provide compassionate support, education, assessment, and a treatment plan with home exercises and guidance, whatever stage you are at right now.

Vie Physio – The Specialist Pelvic & Women’s Health Physiotherapy Clinic

I invited the wonderful team at Vie Physio to help us understand the role of specialist pelvic physiotherapy in treating vaginismus and what to expect from your first pelvic physiotherapy appointment. Many women who attend psychosexual therapy for the condition also engage in pelvic physiotherapy treatment plans. This creates a wonderfully collaborative and integrative approach, increasing confidence and the support network for the woman and perhaps even her partner.

Aoibhin McGreal, founder and director of Vie Physio, is a physiotherapist and clinical specialist in pelvic health. Her areas of interest include pelvic pain and sexual dysfunction, male and female incontinence and pregnancy-related conditions. Caroline Gavin, a Pelvic Physiotherapist, Pilates Instruction and PINC Cancer Rehabilitation Therapist, answer some pressing questions to help you feel more reassured and empowered to take those next steps.

How does attending a pelvic physio benefit women experiencing vaginismus and GPPPD conditions?

Often women may not know how to move forward when they have symptoms or a diagnosis of vaginismus, for example, pain or difficulty with penetration and intercourse, inserting tampons and having medical vaginal examinations.

When a vaginal examination is performed, we can assess the patient’s baseline level of penetration. For example, someone may initially tolerate light touch with a fingertip at the perineum (the tissue between the vaginal opening and anus), they may tolerate superficial penetration of the vagina with one or two fingers, or, they may tolerate a deeper penetration with a level of discomfort. It is not a requirement to have a vaginal examination during the first appointment if the patient does not feel ready.

Then, we can begin a treatment regime with a goal in mind. That goal may be to tolerate wearing a tampon, to feel comfortable having a smear test, or to tolerate intercourse. Treatment aims to reduce the over-sensitisation and restore ‘normal’ sensation while teaching the person how to fully relax their pelvic floor muscles.

What can women expect from her initial pelvic physio consultation with Vie Physio? 

When a person comes in to talk to us about their pelvic health, we spend up to an hour with them. We discuss why they came to us and their desired goals from pelvic health physiotherapy. Alongside talking about lifestyle and medical background, we run through a pelvic health screening questionnaire.

In addition to finding out about their problems with sex, whether it be pain or inability to have penetration, we also establish their bladder and bowel habits, as this can also be linked to the pelvic floor muscles.

After talking, we will have a holistic picture of a person, and this will guide our examination. Together, we discuss the assessment options with the patient, who can then decide which type of assessment they would like.

‘We discuss why they came to us and their desired goals from pelvic health physiotherapy; alongside talking about lifestyle and medical background, we run through a pelvic health screening questionnaire.’ – Caroline Gavin, Vie Physio

While a vulvar and vaginal assessment is the most thorough way of establishing if the pelvic floor is a cause of their issue, we understand that for women experiencing problems having sex, they may not be comfortable undergoing this type of assessment.

Suppose a vaginal assessment is not something the patient wishes to have on that day; the focus will be on assessing their movement, their abdominal (tummy) muscles and how they breathe, with an option of using an ultrasound machine which also gives us feedback on how the muscles are moving.

Many women do wish to have a vulvar and vaginal assessment at their first appointment because often, they have been living with the problem for a long time and are keen to understand if the pelvic floor muscles are part of the issue.

We aim to only assess within comfort limits; for some, this will simply be light touch at the perineum. The reason for this is those women with dyspareunia or vaginismus experience hypersensitivity of the nerve endings at the entrance to the vagina. This can then cause the muscles to tense up in order to protect them from further discomfort or pain.

Based on the person’s goals and exam findings, we will recommend a treatment plan with a timeline and an aim and purpose for a subsequent follow-up.

On leaving the first appointment, we will teach home exercises and techniques as this brings about much improvement between appointments.

What does a physio treatment for vaginismus look like?

For pelvic pain, the foundation of our treatment will usually address breathing dynamics. Often, without realising, a person may hold their breath, or they may breathe predominantly in their upper chest or they may clench their jaw or suck in their tummy, this can contribute to tension in the pelvic floor.

Depending on each person, we may recommend a range of interventions such as abdominal massage, perineal massage using their fingers to massage the superficial pelvic floor muscles, dilator training and the use of dilators to gradually introduce normal sensation to the pelvic floor, which helps in terms of penetration and breathing techniques.

We also recommend specific movement exercises for the back, pelvis and hips. At each visit, we would re-examine a person to determine what their penetration status may be and change or progress their treatment plan as appropriate.

You might also like to read... [Everything you need to know about choosing a dilator for dilator training]

How often do I need to attend pelvic physiotherapy sessions initially? 

For vaginismus or dyspareunia, we might expect to review a person 4-5 times (on average) over a three-month timescale. This varies from person to person depending on many factors, but we would expect to see a fifty per cent improvement over twelve weeks.

When a person’s goals have been met, they don’t need to continue attending physiotherapy, though they always have the option of coming back to see us if they deem it necessary.

‘Women who feel particularly anxious, fearful, avoidant and even phobic about getting help can consider gently exploring these concerns to create curiosity and comfort in a compassionate and meaningful way with an experience Psychosexual therapist.‘ – Orlagh Reid

What insight and reassurance can you share with women who feel nervous about attending their first pelvic physiotherapy appointment?

Firstly, at Vie Physio we are committed to providing exceptional care in a compassionate and friendly atmosphere. We believe that our patients deserve the best care, and we make an effort to make sure you always feel welcome and at ease. It is not a requirement to have a vaginal examination. There is much information and advice a women’s health physio can give to women without doing a vaginal assessment.

We have the option of using an ultrasound, which can be used externally on the tummy or perineum, to look at the movement of the pelvic floor, if someone declines an internal examination.

If the patient does decide to have an internal exam – it is carried out only within her comfort levels at all times. We understand that pain and anxiety are closely related, so as women’s health physiotherapists, our aim is to never be the cause of anxiety. We provide reassurance that the patient is in control, and at any point, they can pause or stop an examination until they feel ready to proceed or stop. The full picture shows us where the woman holds tension, not just in the pelvic floor region, and looks at her breathing patterns.  

You might like to read… [9 Health Professionals for a Holistic Integrative Approach to Resolving Vaginismus & Penetration Pain]

Get in touch with Vie Physio

To book an appointment with Vie Physio located in the Vista Primary Centre, Naas, Co. Kildare, Ireland, visit their website www.viephysio.ie for more information or email info@viephysio.ie Appointments can be booked directly online using the platform CLINKO here. You do not need a referral letter. Health insurance cover may cover physiotherapy and psychotherapy services, so make sure to check your policy. Follow on Instagram @vie.pelvic.physio and Facebook @Viephysio 

Coming to terms with sexual-related problems can give rise to many types of feelings and thoughts, both positive and negative. Women who feel particularly anxious, fearful, avoidant and even phobic about getting help can consider gently exploring these concerns to create curiosity and comfort in a compassionate and meaningful way with an experience Psychosexual therapist. If you would like to take those first steps or work together an create an integrative holistic plan to manage and resolve vaginismus – get in touch with me at info@orlaghreid.com or book an online therapy session and let’s get started.