This week, long-time colleague Lorraine Faehnedrich guest blogs for PHRC. Lorraine’s bio and information on her courses can be found at the end of the post. On April 2 Lorraine will be interviewing our own Katie Hunter about how pelvic floor physical therapy can help women recover from painful sex. Stay tuned to our social media for more details!
From Lorraine:
One of the most difficult parts of vulvar pain or any type of pelvic pain can be the inability to enjoy sex and intimacy, and the impact that that can have on our relationships, wellbeing, and sense of self.
When intercourse or orgasm are painful, have been painful in the past, or cause burning or pain afterward, it makes sense to stop having sex, or even avoid intimacy.
But letting go of sex, pleasure, and intimacy can not only impact your relationships, it can impact your mental, emotional, and physical wellbeing.
Pleasure (of all kinds) supports healing and feeds your soul.
What I see is that finding ways to enjoy sex (alone or with a partner), can be an important step in reclaiming intimacy and joy, and ultimately in healing pelvic pain.
So I want to share some practices with you that I have seen help my clients not only enjoy sex again, but in many cases enjoy it more than they did before pelvic pain.
These are things you can do now, on your own or with a partner to bring pleasure back into your body and your life.
You don’t have to wait until your pain is gone.
As one of my clients recently shared…
“My partner and I realized that without intending to we had both mostly focused on his desires to the point that my body had shut down. I had lost connection to what I wanted, my desire and passion. Now, we make lots of room for my tears and laughter because my feelings are connected to my pleasure. I notice my pelvic floor softening and relaxing. I enjoy sex so much more now and always want to have this intimacy time. That wasn’t always true before. If I stay curious and don’t have a goal in mind…I can talk to my body and the sensations are fluid and change a lot. This is the most exciting part for me…to feel the sensations and the changes happening inside my body. It’s amazing and fluid. The tightness, tension, defensiveness in my pelvic floor can change and dissipate in minutes…when I’m really honoring myself and paying attention.”
If you’re willing to get curious and explore…you may also find that the process of learning how to enjoy sex while you’re healing from pelvic pain can be a blessing that has lasting positive impacts on the quality of your relationships and sex life.
At least that was the case for me, and it is for many of the women I work with.
Four Practices to Help You Enjoy Sex, While You’re Healing From Pelvic Pain
The following practices will help you begin exploring sexual pleasure in your body while you’re healing from pelvic pain. They are also fantastic for reconnecting with your sexuality after relieving pelvic pain, and for anyone who wants to enjoy sex more!
1. Redefine Sex
For some reason in this culture we’ve been conditioned to think of the ideal of heterosexual sex as intercourse, and sexual pleasure and orgasm as coming primarily from vaginal intercourse.
On top of that, we tend to have a very limited idea of what intercourse “should” look like.
The model of friction-based vaginal intercourse is just not the optimal way to experience sexual pleasure and orgasm even if you’re not in pain, especially for women.
Of course it can be a pleasurable part of sex, but it’s certainly not the whole thing, not even close. Holding it up as a goal or ideal can be very limiting, and especially frustrating if your experiencing pelvic pain.
Luckily, the reality is that there is a wide range of sexual pleasure available beyond this typical idea of intercourse. Taking the time to explore all of this is an opportunity to discover your full range of sexual pleasure potential. In fact, taking intercourse off the table it’s a strategy used to help couples discover new ways to connect and enjoy sex.
Expanding your definition of sex and sexual pleasure, and approaching sex with a new attitude of curiosity and openness, is the first step to enjoying sex while you’re healing from pelvic pain.
2. Slow Down
When you are having sex (alone or with a partner), slow down and let go of goals and preconcieved ideas of what should happen or what you should do.
Be present.
When you move more slowly, with presence and intention, you will be able to feel more. Pleasure is sensation in your body, and slowing down helps you tune into those sensations.
Of course, when you slow down you will be more aware of other sensations as well, including any emotional sensations or discomfort you may not have been aware of. Welcoming all of this connects you to your body and it’s guidance, and opens up the flow of energy and sensation in your body. All of this helps you to discover what actually feels good to you, how your body responds, and what it needs to enjoy the experience.
3. Body Love
Start a practice of giving your body loving touch. You can do this yourself or with a partner. I recommend beginning with yourself so that you can stay 100% present with your own experience without being distracted, but it is also a wonderful way to build intimacy and connection with a partner.
Stroke your hair, your face, your neck, arms, chest, belly and legs with love and care. Move slowly, breathe into your low belly, and stay present with sensation.
What sensations do you notice at the point where your hand makes contact with your body? What sensations do you notice in the rest of your body? Don’t try to make anything happen, simply welcome whatever you notice.
Be curious and playful. This is about exploring your body and what feels good to you. Your goal is to re-discover all the ways your body can experience pleasure. How does your body like to be touched? How does it respond to kind words and appreciation? How does it like to move?
4. Breathe
Conscious breathing is one of the fastest ways to drop out of your mind and into your body. It connects you with the felt sense in your body, and can be focused anywhere, increasing movement and flow.
Breathing moves energy.
You can use the pace and depth of your breath to soothe and nourish your body as well as to welcome and expand sensations of pleasure. Like the body love practice, breathwork can be used on your own, or with a partner.
- Start by tuning into your body. Breathe gently into your low belly and check in with yourself. How is your body doing right now?
- Now choose a part of your body to practice with. It can be easier to start with somewhere you’re not having symptoms, but can be incredibly helpful to breathe into symptoms as well. For now, start with somewhere more neutral like your heart or low belly.
- Begin a slow, gentle, continuous breath – in through your nose and out through your mouth. Imagine breathing through this part of your body feeling it expand with each inhale and relax with each exhale.
- Keep your attention focused on the sensations in your body as you breathe.
All of these practices can help you to be more present with the sensations of pleasure in your body without unknowingly shutting them down or rushing towards climax. This can move you towards a more full body experience of pleasure and orgasm, which is a key to enjoying sex more, both while you’re experiencing pelvic pain, and after you relieve it. I hope you will give these a try!
Lorraine Faehndrich is a Pelvic Health and Pain Relief Coach and the creator of the mind body pain relief program Healing Female Pain. She specializes in helping women find lasting relief from chronic pelvic and sexual pain.
If you’d like to learn more about how a mind body approach can help you relieve chronic pelvic pain and experience more pleasure, joy, and connection while you do, register for Lorraine’s upcoming free training, Say Goodbye to Pelvic Pain, or visit her website.
Additional Resources
Past podcasts with Lorraine and PHRC Cofounder Stephanie Prendergast:
Katie Hunter’s Vulvodynia Resource Guide
Katie Hunter’s Vulvodynia Webinar
Pelvic Pain Explained by Elizabeth Akincilar and Stephanie Prendergast
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
How can you apply these techniques to men?
We are so much more focused on women with pain and we men feel left out.
Like trying to find a PT who treats men.
Hi Mike,
I can see how men could feel left out by the focus on women. In this instance, all of these principles apply to men as well, and can be very helpful. I encourage you to give them a try.
All the best,
Lorraine
Great post. Such helpful tips. Thank you!
Hi Jocelyn. I’m glad you found it helpful!
Warmly,
Lorraine
Excellent article! I like the accepting attitude you display and encourage in the reader.
Hi Debbie,
Thank you!
Lorraine
Excellent article!! I love how you incorporate using the breath to help one become more present, and slow down. I wish you had written this 15 years ago when my pelvic pain journey began. My husband totally shut down, and there’s been no “sex” in our lives ever since. Sex IS an important part of a couple’s life, important for that special type of intimacy. I don’t understand why people have this preconceived notion that intercourse is the holy grail. “Sex” can take on so many different flavors, if only people would open their minds and their hearts. Coming from one who has experienced it, taking sex off the table 100% is not the answer. I was the pelvic pain patient, not him.
Hi Kimberly,
I agree! Thanks for sharing your thoughts.
Warmly,
Lorraine
I have Pudendal Neuralgia and Pudendal Nerve Entrapment and received not only numerous medical procedures but had Decompression Surgery with very little change. The pain is unbearable and sexual intercourse, orgasms or heightened sexual excitement places me in worst pain for days. No research or treatment available to me in Canada,. We who suffer with this, suffer alone and have no oneto talk to, no research and no treatment here. I suggested to many Dr’s setting up a support group and was told by the last treating Dr. that research has proven talk therapy does not help as all pain medication was being reduced to nothing leaving us with no Doctor, no treatment and no quality of life, while they dismantled the Wasser Pain Clinic which was the only place I knew studied the disease. I have only ever run into two other patients with this and found in common our husbands not believing we had this pain thinking we were avoidingthem sexually, hence reason why so many divorces and suicides amongst us. We need help in this area, somebody we can talk to,.
Please help
I am having trouble engaging in intimacy also because when I think of it all I can be reminded of is the pain that will follow the next day. Your suggestions are helpful!
Hi Lauren. Yes. That is unfortunately a common experience to avoid intimacy all together. I’m so glad you found my suggestions helpful.
Warmly,
Lorraine
Thank you for this article, well written and supports what I tried to voice to spouse, he now has more of an understanding
That’s wonderful to hear Lorien.
Warmly,
Lorraine