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Trauma, Painful Sex & Your Pelvic Floor

The female body is an extremely powerful entity, but at the same time it can also be very sensitive and rightfully so. Throughout the course of a woman's lifetime they can experience a multitude of traumatic events, from sexual assault to a traumatic medical exam to trials of giving birth–vaginally or belly birth – the female body’s ability to heal is both powerful and necessary. For trauma survivors, the journey to healing can be complex and should involve a broad support network that might include everything from psychologists like our friends at Traumastery to support groups to physical therapy.

Trauma in the body

Your pelvic floor is the natural guardian – think of it as the first line of defense – against trauma in your body. It naturally contracts and tightens when a person is experiencing trauma (Van Der Velde & Everaerd). Your pelvic floor is literally your body’s center and involved in your most basic bodily functions like breathing and going to the bathroom, so as you might imagine, if that tenses up there can be a whole host of negative side effects. Similarly, doing work to release the tension in your pelvic floor can hold enormous benefits.

When your pelvic floor reflexively tightens up during trauma you might ultimately feel that tightening impact all sorts of functionality and day-to-day activities including (but definitely not limited to) painful sex. Your brain/body remembers that initial trauma and then instinctively tenses up to try to protect the body from that happening again. And that makes sense! Your body intuitively wants to protect you. However, tension all of the time isn’t ideal for anyone. Physical therapy can retrain your mind-body connection and teach your brain that something being near or in your vagina does not have to be a threat and can ultimately help you (and your body) regulate this response.

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Birth Trauma

Giving birth is a huge undertaking, after all many scientists compare the act of labor and delivery to that of an Ironman or a 100-mile marathon. It’s unsurprising then that your body is susceptible to injury during that process. From perineal tearing or scarring, c-section scarring, POP (pelvic organ prolapse), to super tight muscles inside and outside the pelvis.

The aftermath of birth trauma depends on every person, your experience and what kind of recovery support you have but it’s extremely common postpartum to face difficulties with doing daily activities such as caring for your child, exercising or even going to the bathroom – but with the right support systems and physical therapy recovery plan it does not have to be your “new normal.” Living through these symptoms can often feel both scary and isolating, from either not knowing how to deal with it, feeling like you’re the only one, not knowing what to do or who to turn to, not to mention caring for a newborn on top of all of this. But you’re not alone and physical therapy is a great foundation for improving both your overall function and for some major wins in the quality of your daily life.

Getting back in your body

In the words of Maggie Rogers, let’s figure out how to get you back in your body – feeling in control of whatever your physical goals are on your personal recovery journey. So, what does physical therapy look like for a person who has experienced trauma? We’ll walk you through what you might expect and how it can work to make you feel better in your day to day.

If you’ve experienced a trauma of any kind, it’s really helpful and important to communicate that up front to your physical therapist so they can make sure to check in with you during your initial evaluation and respect any boundaries or areas that might be extremely sensitive or off limits for you. Consent is key–always, but especially in physical therapy dealing with such a sensitive part of the body – so our team wants to make sure they’re never doing anything that would make you uncomfortable.

Physical therapy can be great for addressing some of the results of trauma being held in the body, that can be everything from hypertonic (this really tight) muscles, prolapse, c-section scar sensitivity work and perineal tearing.

In addition to manual massage and muscle work we believe that movement is medicine, so our team will walk you through a series of exercises and stretches that you can do during your session as well as at-home on your own that are targeted at reaching your specific goals. The power of these exercises can support everything from reducing muscle tension, to lengthening muscles, improving strength, and even improving overall body mechanics.

Last but not least, sometimes tools beyond a physical therapist’s hands can be helpful in achieving your goals, which can be especially helpful outside the clinic (which is where the majority of your time is spent). There’s a ton of tools out there to help your body on the path to healing. Dilators can help the pelvic floor muscles relax, which can help decrease pain with sex, pelvic trainers and biofeeback tools can help you get a visual representation of what’s going on with your muscles when you don’t have your PT there to give you that feedback, and last but not least devices like the Ohnut can limit the amount of insertion if and when you’re ready to return to sex. With all of these devices (and others out there) it’s really important to first get evaluated by a physical therapist and discuss these options with them so you know if, when, and which one might be helpful for your specific body and goals.

It’s easy to feel stuck after experiencing a traumatic event but you deserve to feel good in both your body and mind. Finding the right emotional support network – Traumastery s a great example – and working with a pelvic floor physical therapist, can both be powerful tools once you’re in a place where you feel comfortable to seek healing inside and out.

Bre Stuhmuller Headshot
Dr. Bre Stuhlmuller

Bre is a California native and grew up in the Bay Area. She worked her way down the coast, first studying psychology and communication at UC Santa Barbara, and then getting her Doctorate in Physical Therapy from Azusa Pacific University. She was first introduced to women’s health and pelvic floor PT during her last year of school where she quickly realized how beneficial and necessary this line of work was. She decided she wanted to work with and educate women about their bodies so that she could help improve their quality of life. She has become especially interested in helping women through their pregnancy/postpartum journey after having recently gone through that herself.

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