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What Should Physical Therapists Know About Female Sexual Pain?

Jan 09, 2017

What Should Physical Therapists Know About Female Sexual Pain?

Understanding the biopsychosocial aspects of sexual pain could help physical therapists treat women, according to a recent study in Sexual Medicine Reviews.

Female sexual pain is a common – but complex - problem for women. Physical causes can include gynecological, urinary, gastrointestinal, and muscular problems. Sometimes, a combination of these factors leads to sexual pain.

Cultural and religious beliefs may also be involved. Women may not feel comfortable with the ideas of discussing or treating sexual pain. Healthcare providers may feel uncomfortable too, and they might not refer patients to appropriate specialists.

The study authors pinpointed several areas to consider when assessing and treating female sexual pain.

First, a complete physical examination that includes the vaginal, rectal, vulvar, and anal areas is essential. Other medical conditions, such as hormonal and autoimmune disorders should also be evaluated.

Providers should also consider how the central nervous system responds to the anticipation of pain. If a woman perceives a threat to her body, her central nervous system may react with a “protective pain response that is unrelated to the health of the pelvic muscles, skin or the visceral systems and might be the driving force in the perpetuation of hypersensitivity,” the authors explained.

Second, it is important for patients to feel some hope that their pain can be successfully treated. Choosing certain words to describe the pain, such as persistent instead of chronic is one approach.

Third, taking a complete patient history can provide helpful clues that can inform treatment. “Through a careful history, the clinician might be able to identify personal challenges or threats that were present for the patient when the pain began,” the authors noted. A number of validated assessment tools can be used as well.

Fourth, patients can benefit from understanding pain biology and, in turn, re-think their responses to pain and become less fearful. “Educating patients about pain can change their pain levels more than any current modality for persistent pain,” the authors wrote.

They suggested that physical therapists undergo further training in these areas so that they can address the many complexities of female sexual pain.


Sexual Medicine Reviews

Vandyken, Carolyn, PT, Cred MDT, CCMA (Acup) and Sandra Hilton, PT, DPT, MS

“Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain”

(Published online: August 3, 2016)