Sometimes women have health conditions–like vaginismus, incontinence, or other pain–that a pelvic floor physiotherapist is uniquely qualified to help with.

This month I want to cover more about how the female body actually works when it comes to sex, and frequently I get questions from women whose bodies are distinctly NOT working.

Here, for example, are a few that I’ve received recently from women suffering from vaginismus and other pain:

Reader Question

I have struggled with painful sex for most of my marriage (it was better once I started sleeping more once kids were older and we had more sex, but then got more difficult again with early onset of menopause). We haven’t had intercourse for 3 years now because I finally said it burns and the gels etc don’t work. And although it was often painful, I miss it. Are we doomed to the rest of our marriage with no intercourse and just pleasuring each other in other ways?

Here’s another:

Reader Question

When I first got married, sex was amazing. Fun, able to have orgasm, all of the above. Within a few months I began having pain and even during the times that it’s not painful, it’s only “meh”. I have stopped the pill (likely a contributor to health problems I was having). I have cut out all “irritating” food and drink after Dr diagnosed vestibulitis. Still not much improvement. And there doesn’t seem to be any rhyme or reason. It’s not a lack of lubrication (although that is an issue at times, we use a lubricant) What can I do!?

The simple truth is this:

Sex, while it is more than just physical, is DEFINITELY physical. And like any other parts of our bodies, our pelvic and genital regions can cause problems that make sex difficult.

The problem is that when we have problems sexually, we usually assume the problem is with us–something about our emotions or our relationship. We rarely seek out help, or at least we wait a long time to do it (I’m glad the second woman did see a doctor!). And so we often suffer in silence.

I shared my own story of vaginismus in The Good Girl’s Guide to Great Sex. I said:

The Good Girl's Guide to Great Sex:

When I walked down the aisle, I was carrying a huge amount of baggage related to trust. I had been left by my dad as a baby, abandoned by my step-father as a teen, and rejected just two months before my wedding by my fiancé. The latter man eventually changed his mind and came crawling back, and I welcomed him with open arms. Unfortunately, the rest of my body didn’t cooperate. As much as I loved my husband and wanted to make love, I was scared to get too vulnerable, and my body wouldn’t relax. And when you can’t relax, sex hurts.

…[A]fter confiding to a close family member about my problems, I was marched off to a gray-haired gynecologist, who explained to me that I just needed to get in touch with my vagina. He would conduct a full examination, with my husband present, inviting me to touch everything and name everything so I wouldn’t be scared of anything anymore. Apparently magically saying the word “vagina” is supposed to eradicate deep-seated trust issues. … I hyperventilated and beat a hasty retreat, never to darken the door of that particular doctor again.

I saw a doctor–a doctor who was supposed to be an expert in this. But even he didn’t realize what I really needed.

Thankfully, treatments have come so much further today, and the most trained medical practitioners for this are not actually physicians but instead physiotherapists with a specialty in pelvic floor issues.

Two years ago I gave my Girl Talk presentation about marriage & sex in a church in southern Ontario, and Sheela Zelmer, a pelvic floor physiotherapist, was in attendance.

I told her about my passion for getting women help in this area, and last week she sent me some information I’ll be sharing with you tomorrow about what to expect from an appointment with a pelvic floor physiotherapist. To start us off, though, I asked her to share with me some stories of people that she has helped, to show you that there often is treatment for some of these conditions.

Here’s Sheela: (It’s so hard to type that name with that spelling! 🙂 )

As a pelvic floor physiotherapist, I am so grateful to be able to work with women and men through issues that are often seen as very private, embarrassing and isolating.

Jessica’s Story: A Woman Suffering from Vaginismus

Jessica came to see me because she has been experiencing significant pain whenever she and her husband try to have intercourse. She told me that they have never had any penetration because of the pain, and now she can’t even bring herself to be intimate with her husband because she is always thinking ahead, worrying it will lead to penetration and more frustration and disappointment. Jessica and her husband waited until they were married to become sexually active and now that they want to start a family, she feels let down and that its somehow her fault. Her husband, who loves her very much, tries to understand and not pressure her, so he initiates intimacy very rarely. They both feel alone and worried.

When I asked a few more questions, I learned that this has been going on for almost 3 years.

Jessica told me she’s mentioned it to her family doctor who suggested she have a glass of wine to relax before sex, which didn’t work at all. She waited 8 months for a referral to a gynecologist who gave her the diagnosis of Vaginismus, but no treatment ideas. Frustrated, Jessica turned to Dr. Google and came across pelvic floor physiotherapy and that’s how she found me.

Jessica’s story is unfortunately, quite common. Women’s pelvic pain costs the Canadian Health Care system over $25 million per year. Of that, painful intercourse accounts for approximately 10%. (1) The challenge is many family doctors and primary care practitioners aren’t familiar with vaginal pain and so they don’t ask the question or perform a thorough gynecological examination (2). Without the correct diagnosis, it is hard to get correct treatment. On the flip side, many women don’t realize there is help, so they don’t bring it up to their doctor. This under reporting leads to under treatment, which all serves to further delay recovery. It isn’t uncommon to hear it took 3-4 years for a diagnosis to be made.

When Jessica came in to see me she was understandably upset. After her assessment, we set up a treatment plan that would cover the next 3 months. The first thing we needed to address was her self talk.

It had taken several years and multiple doctor visits before she walked through my door. By now this issue was more than a physical problem. Her symptoms were affecting the way she saw herself: as a woman, as a wife, and as a future mom. And naturally, it was impacting the relationship with her husband. Our brain is our biggest sex organ, but one that is often neglected.

Throughout her program we kept circling back to her thoughts.

I encouraged her to speak positively about her body and to focus on her improvements rather than setbacks. We spent a lot of time talking about the connection that occurs with intimacy and we discussed other ways to build that intimacy that didn’t involve penetration.

Part of her treatment plan involved using vaginal dilators. Dilators are a set of smooth plastic or silicone wands that progressively get larger to gently stretch the vagina. She used them at home in conjunction with weekly visits, where I manually stretched her vagina gently and without pain.

Her treatment program also included guidelines about how much water to drink, how to maintain regular bowel habits, how to become more active and even how to care for her vagina.

Jessica’s program was modified over time and after 12 weeks we reduced her treatment frequency to every 3 weeks. Her recovery was not a straight road; there were times that life got busy and hectic and she noticed the effect stress and tension has on her pelvic floor, but she persevered and we celebrated every success.

Her whole treatment program took a year, and that is common in vaginismus. Jessica and her husband are intimate on a regular basis and penetration is part of that intimacy. She recently emailed me that they are now ready to start a family, and I’m so happy for them!

Bethany’s Story: A Woman Suffering from Post-Childbirth Incontinence

Bethany had her second child 4 months ago and feels that things aren’t the same “down there”. She notices that she will leak a few drops of urine when she coughs or sneezes and recently when she started working out she noticed her underwear was wet. She has started wearing a pantiliner everyday. She has shared this with her girlfriends but they all laugh it off and attribute it to having two kids.

Incontinence is the involuntary leakage of urine. It can be like Bethany’s experience: leaking with coughing, sneezing, laughing or even sex. Or it can be leakage that occurs with a sudden urge to void, maybe you can’t quite get to the bathroom in time. In either case, the urine in the bladder is squeezed out and the pelvic floor muscles can’t hold it in.

Bladder incontinence is common after childbirth, but just because something is common doesn’t mean it is normal.

Incontinence affects up to half of all women over the course of their lives (3). But only a third of women mention it to their primary care practitioner (4). It has huge implications: how can you be healthy and active when you are worried you will wet yourself? How can you be fully present and intimate with your husband if you are worried you smell like urine?

A lot of women try to manage incontinence on their own, which is a great idea. There are all sorts of pads, briefs and even devices that can be inserted into the vagina to prevent leakage. Many women try kegel exercises and there are even Bluetooth exercisers. But like anything, you should notice improvements if it is working. In Bethany’s case, she had been doing kegel exercises for a long time but was still leaking.

The truth is, not everyone needs to do kegels. In fact, in some cases, kegels make incontinence worse because the muscles aren’t activating properly-simply squeezing more isn’t helpful. Bethany needed to learn to relax her pelvic floor muscles in order to allow them to work more effectively. Her exercises were combined with information about staying hydrated, keeping regular bowel habits and how to workout without straining her pelvic floor. Her symptoms resolved quickly. Within 6 weeks she was no longer wearing a pad and was doing online exercise videos-all with dry underwear.

Should you see a pelvic floor physiotherapist? Two stories of women who overcame their health issues with the help of pelvic floor physiotherapy.

The moral of the story is that if you’re suffering with a condition that is hampering your sex life, seek help! 

There ARE treatments available, and thank you, Sheela, for sharing those stories. Remember that you aren’t the only one going through this struggle, and that there are steps you can take to help get some relief!

Tomorrow we’re going to be talking about what to expect after you’ve booked that first appointment so you can be prepared. So make sure you don’t miss that!

Have you ever heard of pelvic floor therapy before? Have any of you used pelvic floor therapy and found it helped you? Let’s talk about it in the comments! 

Sheela Zelmer, Pelvic Floor Physiotherapist. Sheela is a pelvic floor physiotherapist in the Greater Toronto Area treating women, men and children with pelvic floor dysfunction. She is also an instructor and teaching assistant with Pelvic Health Solutions, educating physiotherapists and other health professionals as they foster pelvic health with their clients.


(1)Chen, I et al, Hospital-associated Costs of Chronic Pelvic Pain in Canada: A population based Descriptive Study, JOGC, March 2017, Vol. 39, Issue 3, 174-180

(2) Dr. Lev-Sagie (Israel), 1st World Congress 2013

(3)The Canadian Continence Foundation: Promoting a Collaborative Consumer-Focused Approach to Continence Care in Canada, Westmount, Quebec, July 2001.

(4) Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306:14; discussion 1314-5. Epub 2006 Oct 2.

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