For all the strides in women's sexual health in the past few decades, we haven't come as far from the classic honeymoon advice, "Lie back and think of England," as we might wish.
One in five women can't have pain-free intercourse, whether it's due to vulvodynia (a chronic pain condition that affects the labial area, and which featured in the infamous "depressed vagina" scene in Sex and the City), vaginismus (an involuntary clenching of the vaginal muscles), or simply pelvic muscle tightness (also called "high-tone pelvic dysfunction").
Yet it wasn't until about 25 years ago that medical professionals began to address the problem in a hands-on fashion. Much in the same way that a physiotherapist will treat an injured hamstring, for instance, with manipulation and prescribed exercises, a pelvic physio treats the pelvic-floor muscles, both from the outside and the inside. Basically, they are vagina whisperers, experts at understanding what a nervous vagina needs and knowing how to gently tame it.
Claudia Brown is a physiotherapist who specializes in pelvic-floor treatment at McGill University. She also travels internationally, teaching other physios about pelvic pain. "In the past two or three years, [the field] has exploded," she says. "People are really talking about it."
In France, women are routinely given sessions of pelvic physiotherapy following childbirth to regain muscle tone and stop urinating every time they sneeze. Pelvic physiotherapy in Canada, though not as common, has traditionally been used to address the same issue. But Laura Disenhaus, a practitioner in Toronto, is primarily interested in helping people "with pain issues, or tightness that was misunderstood."
"Because we're in a hypersexualized culture, if you're a young woman and you find out that it really hurts to have sex, you feel completely inadequate," Disenhaus says. "You to go the doctor, and if your doctor doesn't have a clue, it just feeds that." She now sees about two dozen patients a week, most of whom are self-referred.
Dr. Caroline Pukall is a clinical psychologist with a focus on human sexuality at Queen's University. She recommends pelvic physiotherapists to many of her patients who endure painful sex. While ob-gyns "are masters of their universe in terms of checking for infections, palpating the uterus, and running tests and talking about sexual health," she says, "they are not generally very well trained in anything more than a cursory check for tension in the vaginal area."
"I want [patients] to be able to understand what their pelvic floor is doing so they can identify if it's spasming or contracting and have skill in learning how to make that relax," says Marcy Dayan of the Dayan Physiotherapy and Pelvic Floor Clinic in Vancouver.
"What has been found through both clinical findings and research is that hypertonic – i.e., tight – pelvic-floor muscles can be responsible for various pain complaints in women," Disenhaus says. "The only way to effectively stretch and release those muscles is to touch them directly."
Dayan also uses bio-feedback, which measures the muscle tension of the pelvic floor and displays a graph to help people understand when and if they are clenching or relaxing. "I teach the person different skills with how to be present in their body," she says.
"It's just another part of the body and it's so underserved," Disenhaus says.