Dyspareunia is the medical term for pain during sexual intercourse. For many women, this condition can be confusing, frustrating, and deeply isolating. But you’re not alone—and there are effective treatments available that don’t involve surgery or long-term medications. What Is Dyspareunia? Dyspareunia refers to persistent or recurrent pain in the genital area before, during, or after sexual activity. It can feel like burning, stabbing, tightness, or a deep ache. This pain might happen at the entrance of the vagina (superficial) or deeper inside (deep dyspareunia). What Causes It? Common causes include: Pelvic floor muscle tension or spasm Vaginal dryness or hormonal changes (e.g., menopause) Endometriosis or other gynecological conditions Scars from childbirth or surgery Emotional stress, anxiety, or trauma Sometimes, the cause is a mix of physical and emotional factors. You Are Not Alone Studies show that nearly 8% to 22% of women experience dyspareunia at some point in their lives, yet many do not seek help due to shame or fear of being dismissed. Pelvic Floor Physiotherapy: A Safe and Effective Solution Pelvic floor physiotherapy has emerged as one of the most effective, non-invasive treatments for dyspareunia. Pelvic physiotherapists are trained to assess and treat muscles and tissues in the pelvic region that may be contributing to your pain. What Does Treatment Involve? Gentle internal or external muscle release techniques Breathing and relaxation strategies Education about sexual function and pain pathways Exercises to improve muscle coordination and reduce tension What Does the Science Say? A high-quality randomized controlled trial by Morin et al. (2017) showed that 10 weeks of pelvic floor physiotherapy significantly reduced pain and improved sexual function in women with provoked vestibulodynia (a form of dyspareunia). Another RCT by Bergeron et al. (2001) found that pelvic floor therapy was more effective than general supportive therapy for women with pain at the vaginal entrance. These are just two examples from a growing body of evidence proving that physiotherapy works—and can help you reclaim your comfort and confidence. When to Seek Help If pain during intercourse is affecting your physical, emotional, or relational well-being, it’s time to speak up. You don’t have to suffer in silence. A pelvic floor physiotherapist can guide you toward healing with compassion and expertise. References: Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., Glazer, H. I., Meana, M., & Amsel, R. (2001). A randomized comparison of group cognitive–behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia. Pain, 91(3), 297–306. https://doi.org/10.1016/S0304-3959(00)00448-5 Morin, M., Carroll, M. S., Bergeron, S., & Dumoulin, C. (2017). Pelvic floor muscle function in women with and without provoked vestibulodynia: A prospective case-control study. The Journal of Sexual Medicine, 14(11), 1381–1389. https://doi.org/10.1016/j.jsxm.2017.09.002
When Intimacy Feels Impossible: Understanding and Treating Vaginismus
What Is Vaginismus? Vaginismus is a condition where the muscles around the vagina tighten up automatically when something tries to enter—whether it’s a tampon, finger, or during intercourse. This muscle reaction is involuntary and can make any form of penetration painful or completely impossible. This can be confusing, frustrating, and isolating. But you are not alone—and it is very treatable. What Does Vaginismus Feel Like? Burning or sharp pain during attempted intercourse or vaginal exam Feeling like something is “hitting a wall” Tightness or inability to insert a tampon Anxiety or fear around intimacy For some women, the fear of pain becomes so intense that they avoid relationships or medical care. Why Does It Happen? Vaginismus can happen for many reasons: Previous pain, trauma, or negative sexual experiences Fear of penetration or pregnancy Anxiety or past abuse Physical conditions like infections, menopause, or childbirth trauma Sometimes the original cause isn’t clear—but the muscle tension becomes a habit. There Is Hope: Physiotherapy Can Help Pelvic floor physiotherapy is one of the safest, most effective ways to treat vaginismus. A trained pelvic physiotherapist works gently with you to relax your pelvic muscles, reduce fear, and retrain your body. Treatment May Include: Breathing and relaxation techniques Education about pelvic anatomy and how fear affects muscles Gentle manual therapy inside or outside the vagina Use of vaginal trainers (dilators) guided by your physiotherapist Mind-body techniques to restore confidence and comfort What Does the Research Say? A randomized controlled trial by Van der Velde and Everaerd (2001) showed that women with vaginismus had overactive pelvic floor muscles even before penetration. Physiotherapy targeting this dysfunction can change muscle patterns and ease pain. A recent RCT by Brotto et al. (2015) found that women who received a combination of pelvic floor physiotherapy and education had better outcomes than those who received education alone. You Are Not Broken Vaginismus is not “in your head”—it’s a physical condition with emotional components. With support, knowledge, and professional help, healing is not only possible—it’s expected. If you or someone you love is experiencing this, reach out to a pelvic floor physiotherapist. We’re here to help you reclaim your comfort, confidence, and relationships—at your pace, with no judgment. References: Brotto, L. A., Yong, P., Smith, K. B., & Sadownik, L. A. (2015). Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia: A prospective study. Journal of Sexual Medicine, 12(1), 238–247. https://doi.org/10.1111/jsm.12721 Van der Velde, J., & Everaerd, W. (2001). The relationship between involuntary pelvic floor muscle activity and sexual pain in women with dyspareunia and vaginismus: An electromyographic study. Journal of Psychosomatic Obstetrics & Gynecology, 22(4), 205–212. https://doi.org/10.3109/01674820109049983
Pelvic Organ Prolapse: What It Is and How Physiotherapy Can Help You Feel Strong and Supported Again
Have you ever felt a heaviness or bulge in your vaginal area, especially after standing for a long time or lifting something heavy? You may be experiencing pelvic organ prolapse (POP) — a condition that happens when the organs in your pelvis (like the bladder, uterus, or rectum) drop or press against the vaginal wall. It can feel scary or uncomfortable, but the good news is: you are not alone, and you can get better without surgery. What Is Pelvic Organ Prolapse? Pelvic organ prolapse occurs when the muscles and connective tissues that support your pelvic organs become stretched or weakened — often due to childbirth, aging, heavy lifting, or hormonal changes during menopause. Organs such as the bladder, uterus, or rectum can slip down and bulge into the vaginal wall. You might feel: A feeling of “heaviness” or “falling out” A visible bulge near the vaginal opening Pressure or discomfort in the pelvic area Difficulty fully emptying your bladder or bowels Pain or decreased sensation during intimacy How Common Is It? POP is more common than people realize. According to large studies, up to 50% of women who have given birth vaginally will experience some form of prolapse, though not all feel symptoms (Hagen & Stark, 2011). Do I Need Surgery Right Away? Not at all. In fact, pelvic floor physiotherapy is now the first-line treatment for mild to moderate prolapse. A high-quality randomized controlled trial (Hagen et al., 2014) found that women who did 12 weeks of pelvic floor exercises had significantly improved symptoms and reduced prolapse severity. What Does Physiotherapy Involve? As a pelvic health physiotherapist, I guide women through a personalized, evidence-based plan that includes: Pelvic floor muscle training (PFMT) to strengthen internal support structures Education about safe lifting, posture, and breathing techniques Bladder and bowel management strategies Supportive devices like pessaries (if referred by a doctor) Guidance on returning to exercise safely How Long Before I See Results? Many women begin to notice improvement in symptoms like heaviness, pressure, and urinary leakage within 6–12 weeks, especially when exercises are done consistently. You Are Not Broken — You Just Need Support Pelvic organ prolapse is a physical condition — not a failure. With the right exercises, education, and support, your body has the power to heal and adapt. Takeaway Pelvic organ prolapse is common — but treatable. With guidance from a trained pelvic floor physiotherapist, you can feel stronger, more confident, and regain control of your daily life — naturally and without surgery. References Hagen, S., Stark, D. (2011). Conservative management of pelvic organ prolapse in women: A systematic review of randomized controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 868–878. https://doi.org/10.1111/j.1471-0528.2011.02955.x Hagen, S., Stark, D., Glazener, C. M., Dickson, S., Barry, S. J., & Logan, J. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): A multicentre randomised controlled trial. The Lancet, 383(9919), 796–806. https://doi.org/10.1016/S0140-6736(13)61977-7
Urge Urinary Incontinence: Why It Happens and How Physiotherapy Can Help You Take Back Control
Do you feel a sudden, strong need to urinate that’s hard to hold back — and sometimes, you can’t make it to the bathroom in time? This condition is called urge urinary incontinence (UUI). It’s one of the most frustrating types of bladder leakage and often feels like your bladder has a mind of its own. But here’s the good news: you’re not alone, and you can regain control without relying on medications or surgery. What Is Urge Urinary Incontinence? Urge urinary incontinence is caused by involuntary contractions of the bladder muscle (called the detrusor muscle). This can happen even when the bladder isn’t full. You may feel a sudden, overwhelming need to pee — and often, leakage happens before you reach the toilet. Common Triggers: Running water Putting the key in your front door Cold weather Anxiety or stress Drinking caffeine or alcohol What Causes It? There’s usually no single cause, but contributing factors can include: Nerve dysfunction Aging Overactive bladder (OAB) Pelvic floor muscle weakness Bladder irritants (e.g., coffee, acidic foods) History of pelvic surgeries or trauma How Common Is It? According to high-quality randomized trials, UUI affects more than 20% of women over 40, and the numbers rise with age (Vaughan et al., 2019). It can also affect men, especially after prostate surgery. Can Physiotherapy Help? Absolutely! A physiotherapist trained in pelvic health can teach you to calm the bladder and strengthen the muscles that support your bladder and urethra. A 2018 Cochrane Review found that bladder training and pelvic floor exercises significantly reduced urgency, frequency, and leakage episodes in people with UUI (Wallace et al., 2018). Another RCT by Burgio et al. (2011) showed that behavioral training (including bladder retraining and urge suppression techniques) was as effective as medication — but without side effects like dry mouth or constipation. What Does Physiotherapy Involve? Bladder training: Learning how to gradually delay urination and retrain the bladder Pelvic floor muscle training (PFMT): Strengthening muscles that support bladder control Urge suppression techniques: Relaxation and breathing strategies to manage sudden urges Lifestyle coaching: Managing bladder irritants, fluids, and bathroom habits When Will You See Results? With weekly sessions and consistent home practice, many people improve within 6 to 8 weeks. You Don’t Have to Plan Your Life Around the Bathroom Many people silently suffer or restrict their fluid intake to avoid leakage. But the truth is: your bladder can be retrained. A pelvic floor physiotherapist can help you take back your confidence — naturally and safely. Takeaway Urge urinary incontinence is common but treatable. Physiotherapy offers effective, drug-free strategies to retrain your bladder, reduce leakage, and help you feel in control again. References Burgio, K. L., Goode, P. S., Locher, J. L., Umlauf, M. G., Roth, D. L., & Richter, H. E. (2011). Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: A randomized controlled trial. JAMA, 291(9), 1163–1170. https://doi.org/10.1001/jama.291.9.1163 Wallace, S. A., Roe, B., Williams, K., & Palmer, M. (2018). Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews, (1). https://doi.org/10.1002/14651858.CD001308.pub3 Vaughan, C. P., Burgio, K. L., Goode, P. S., Markland, A. D., Redden, D. T., & Johnson, T. M. (2019). Behavioral therapy to improve urinary symptoms and voiding patterns in older adults: A randomized controlled trial. Annals of Internal Medicine, 170(8), 535–541. https://doi.org/10.7326/M18-2395
Stress Urinary Incontinence: What It Is, Why It Happens, and How Physiotherapy Can Help
Do you leak urine when you cough, laugh, sneeze, or lift something heavy? If so, you’re not alone. This is called stress urinary incontinence (SUI), and it affects 1 in 3 women at some point in their lives—especially after childbirth or menopause. But here’s the good news: you don’t have to live with it, and surgery isn’t your only option. Evidence shows that pelvic floor physiotherapy is a safe and highly effective first-line treatment. What Is Stress Urinary Incontinence? Stress urinary incontinence happens when the muscles and tissues that support your bladder and urethra become weak. This can happen due to: Pregnancy and childbirth Hormonal changes during menopause Aging Obesity Chronic coughing High-impact sports When these muscles are weakened, they can’t hold back urine during sudden pressure (or “stress”) on the bladder — like sneezing or lifting groceries. How Common Is It? According to a high-quality randomized controlled trial by Dumoulin et al. (2018), up to 35% of women worldwide experience SUI, and many suffer in silence due to embarrassment. Can It Be Treated Without Surgery? Yes! One of the most effective non-surgical treatments is pelvic floor muscle training (PFMT) — guided by a trained physiotherapist. A landmark 2014 Cochrane Review concluded that women who did PFMT were 8 times more likely to report being cured compared to those who did nothing (Dumoulin et al., 2014). Another randomized trial by Bø et al. (2017) found that a 3-month physiotherapy program reduced leakage episodes by 70%. What Does Pelvic Floor Physiotherapy Involve? Your physiotherapy treatment is private, gentle, and customized. It includes: Assessment of pelvic floor strength (externally or internally) Tailored exercises to improve muscle tone and coordination Education on bladder habits, posture, and breath control Biofeedback or electrical stimulation if needed How Long Until You See Results? With commitment to the home exercises and regular sessions, many people see improvements within 6–12 weeks. You Are Not Alone, and Help Is Available If you’re dealing with stress incontinence, talk to a pelvic floor physiotherapist. We are trained to support you with compassion, confidentiality, and evidence-based care. Takeaway Stress urinary incontinence is common, but it’s not something you have to accept as “normal.” Pelvic floor physiotherapy is a powerful, natural, and evidence-backed way to take control of your bladder again. References Bø, K., Berghmans, B., Mørkved, S., & Van Kampen, M. (2017). Evidence-based physical therapy for the pelvic floor: Bridging science and clinical practice (2nd ed.). Elsevier Health Sciences. Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, (10). https://doi.org/10.1002/14651858.CD005654.pub4
Understanding Overactive Bladder (OAB): A Guide to Regaining Control
As a pelvic health physiotherapist, I often meet patients who quietly suffer from sudden urges to urinate, frequent trips to the bathroom, or unexpected leakage. These symptoms may be signs of a condition called Overactive Bladder (OAB)—and the good news is, it’s treatable. What is Overactive Bladder? OAB is a condition where the bladder muscle (called the detrusor) contracts involuntarily, causing a sudden and powerful urge to urinate—even when the bladder isn’t full. People with OAB may: Feel urgent, frequent urges to urinate (8+ times per day) Leak urine before getting to the bathroom (urge incontinence) Wake up multiple times at night to urinate (nocturia) You are not alone—studies show that nearly 30% of adults over age 40 experience some form of OAB (Hsu et al., 2019). Why Does It Happen? There’s no single cause for OAB. Common contributors include: Age-related changes in bladder or nervous system Neurological conditions (e.g., stroke, multiple sclerosis) Tight or weak pelvic floor muscles Stress or anxiety Medications or bladder irritants (like caffeine or alcohol) Sometimes, the bladder muscle becomes overly sensitive or “trained” to signal urgency too often, even if it’s not truly full. Common Coping Strategies That Backfire Some people try to manage symptoms by: Toilet mapping (always knowing where the nearest washroom is) Fluid restriction “Just in case” urination These seem logical but can actually worsen symptoms by training the bladder to hold less and become more sensitive over time. What Actually Helps? 1. Bladder Retraining (with Physiotherapy Support) This is a proven method that helps you gradually increase the time between bathroom visits using: Scheduled voiding (e.g., every 90 minutes instead of every hour) Urge suppression techniques, like: Deep breathing Mental distraction Reverse Kegels (relaxing pelvic floor muscles) In a randomized controlled trial, behavioral therapies (like bladder training) improved urgency and leakage with minimal side effects, often matching or exceeding medication benefits (Scaldazza et al., 2017). 2. Pelvic Floor Physiotherapy As a physiotherapist, I assess whether your pelvic floor is: Too weak (needs strengthening) Too tight (needs relaxation) Both can contribute to OAB. A personalized program, often including biofeedback and exercises, can make a big difference. 3. Lifestyle Changes Hydrate smartly: Sip fluids throughout the day but reduce intake 2–3 hours before bedtime. Avoid bladder irritants: Caffeine, alcohol, spicy foods, and artificial sweeteners. Manage constipation and stress: Both can increase pressure on the bladder. 4. Medical Options (When Needed) When lifestyle changes aren’t enough, your doctor might recommend: Anticholinergic medications (e.g., oxybutynin) Beta-3 agonists like mirabegron—shown to have fewer cognitive side effects in older adults (Welk & McArthur, 2020). If medications don’t help, advanced options like tibial nerve stimulation or Botox injections into the bladder wall may be considered (Keller et al., 2017). Takeaway OAB is not a normal part of aging. It’s a treatable condition that responds well to physiotherapy, behavior change, and, if needed, medication. If you’re constantly searching for bathrooms, waking up at night, or feeling anxious about leaking—know that you can take control again. A pelvic health physiotherapist can be your first step toward regaining confidence and comfort. References Benner, J., Nichol, M., Rovner, E., Jumadilova, Z., Alvir, J., Hussein, M., & Brubaker, L. (2010). Patient‐reported reasons for discontinuing overactive bladder medication. BJU International, 105(9), 1276–1282. https://doi.org/10.1111/j.1464-410x.2009.09036.x Fontaine, C., Papworth, E., Pascoe, J., & Hashim, H. (2021). Update on the management of overactive bladder. Therapeutic Advances in Urology, 13, 17562872211039034. https://doi.org/10.1177/17562872211039034 Hsu, Y. P., Chuang, F. C., Chang, S. J., & Yang, S. S. (2019). Prevalence and associated factors of overactive bladder among the elderly in Taiwan. International Urogynecology Journal, 30(7), 1091–1099. https://doi.org/10.1007/s00192-018-3776-4 Keller, N., Schmid, S., & Haemmerle, B. (2017). Successful therapy of overactive bladder syndrome with percutaneous tibial nerve stimulation: A case report. The International Annals of Medicine, 1(11), 387. https://doi.org/10.24087/iam.2017.1.11.387 Scaldazza, C., Morosetti, C., Giampieretti, R., Lorenzetti, R., & Baroni, M. (2017). PTNS vs. pelvic floor muscle training in women with OAB: A randomized study. International Braz J Urol, 43(1), 121–126. https://doi.org/10.1590/s1677-5538.ibju.2015.0719 Welk, B., & McArthur, E. (2020). Dementia risk in patients treated for OAB: Anticholinergic vs beta‐3 agonists. BJU International, 126(1), 183–190. https://doi.org/10.1111/bju.15040