What Is Pelvic Floor Massage?

Like your arms, legs, and stomach—your vagina sometimes loses muscle tone. Similarly, there is a way to strength-train. Pelvic floor physical therapy (PFPT)—which is sometimes called pelvic floor muscle training (PFMT) or "vaginal massage"—is a well-rounded regimen for rehabbing the muscles of the pelvic floor, according to MedlinePlus.

Why Would You Need This Exercise?

One of the reasons you may need PFPT is if you are experiencing pain during sex, according to a 2019 review from Current Opinion in Obstetrics and Gynecology. About 75% of women experience pain during sex at some point in their lives, according to the American College of Obstetricians and Gynecologists (ACOG). PFPT is a great resource for treating this kind of pain and can also be used to treat the following symptoms and conditions:

• Incontinence (both urinary and fecal)
• Pelvic pain
• Tailbone pain
• Constipation
• Pelvic organ prolapse
• Peripartum and postpartum pelvic floor dysfunction
• Painful intercourse
• Vaginismus (involuntary muscle spasm with vaginal penetration)
• Vulvodynia (chronic pain near the vagina)

Collectively, these issues are called pelvic floor dysfunction. Luckily, PFPT is a program that can help pelvic floor dysfunction by training the muscles of the pelvis to improve strength, endurance, and relaxation, according to a 2019 review from Current Opinion in Obstetrics and Gynecology.

Pelvic pain can be a huge drag on a person's quality of life, too. Pain during sex can be distressing and become a major strain on a relationship, explained Lauren Tadros, PT, DPT, a former physical therapist at Thrive Integrated Physical Therapy in NYC.

What Causes Pelvic Pain?

Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day, for example, can affect the nerves in your pelvic area and translate into a burning pain in your vulva, said Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction and owner of Kotarinos Physical Therapy in the Chicago area.

The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to "walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry," said Kotarinos.

How Does Pelvic Floor Physical Therapy Work?

It's highly unlikely that someone will head into a therapist's office for a stand-alone "vaginal massage." Why not?

"It's one small aspect of the whole therapy," said Laura Y. Huang, MD, a physician specializing in electrodiagnostic medicine, physical medicine, and rehabilitation at the University of Miami Health System. Dr. Huang noted that pelvic floor physical therapy treatments could include: pelvic floor muscle training, biofeedback, soft tissue release, and education. These treatments are used to relieve pain or retrain muscles. Learning techniques and strategies to manage the condition at home is also part of the treatment.

PFPT treats the musculoskeletal system of the pelvic floor, said Dr. Huang, sometimes internally through the vagina or anus, though the target isn't the vagina itself but rather the muscles. "Some muscles, like hip rotator and pelvic floor muscles, are better accessed internally," said Dr. Huang.

If your therapist determines that internal manipulation should be part of your treatment protocol, one finger may be used to stretch and mobilize the pelvic floor muscles, said Tadros (hence, the term "vaginal massage"). While it may seem off-putting, Tadros finds "that patients are so desperate for help, they're more than okay with having it done. We don't use a speculum or stirrups. This isn't invasive, it's designed to keep someone as comfortable as possible."

Where Should You Go To Find Treatment?

Finding help isn't exactly easy, especially since people are often hesitant to reveal their discomfort. "My patients often express that doctors have told them that their pain is normal or that it'll go away. Or various testing comes back inconclusive," said Tadros. "They hit a dead end, and it sometimes takes women a year to get to us."

If you're dealing with pelvic pain, Kotarinos recommended researching the International Pelvic Pain Society (IPPS) or the American Physical Therapy Association (APTA) to find a qualified pelvic floor physical therapist. You can also see a healthcare professional for a referral.

A 2019 study published in the International Urogynecology Journal discussed how pelvic floor dysfunction in women could result from many causes, including physical, psychological, and social factors. Because of this, the treatment also should be multifactorial—or holistic—as Dr. Huang said.

Dr. Huang suggested focusing on your health holistically, with measures such as stress management, regular exercise, and a well-balanced diet. "We want to educate and empower women to be in control."

Summary

If you're experiencing pelvic pain, whether it's during sex or not, talk with your healthcare provider. And while it might seem embarrassing, know that you are not alone—many people each year have pelvic pain. "You'd be surprised at how many people deal with this pain. There is help out there," said Tadros.