How pelvic floor physiotherapy can help with sexual dysfunction

The Silhouette sat down with McMaster University graduate and currently licensed physical therapist Dr. Iman Banerji to discuss pelvic floor physiotherapy and how it can help folks experiencing pain or discomfort with sex.

Banerji graduated from McMaster in 2017 with a bachelor of science and is now a pelvic and orthopedic physical therapist working in North Carolina after graduating from Duke University in 2020. Banerji always knew that she wanted to be in healthcare.

“I was always told as a child of immigrants that I need to become a doctor, but I never really thought about what that meant until I was actually in the thick of undergrad thinking about grad school,” said Banerji. “I started looking into other different realms of healthcare, other ways that I could be part of the healthcare team and combine my love for human connection and science with being a health care provider and upon looking into it a little bit more I realized that physiotherapy was actually more so the path that I wanted to take.”

“I started looking into other different realms of healthcare, other ways that I could be part of the healthcare team and combine my love for human connection and science with being a health care provider and upon looking into it a little bit more I realized that physiotherapy was actually more so the path that I wanted to take.”

When asked about how she became interested in pelvic floor therapy, Banerji said a friend brought her to a student-run pelvic health meeting where she learned about the different conditions and about the patient population.

She felt that through PFT, she could challenge the historical and present issue of women in healthcare not always being believed or taken seriously. She also wanted to be a healthcare provider for all genders.

“With pelvic floor physiotherapy there’s a great chance to work with the trans population, who also has a very difficult time navigating the healthcare system, unfortunately. Again, I wanted to be a part of that and I wanted to be a healthcare provider that was inclusive to all genders,” explained Banerji.

The pelvic muscles are an important part of urinary and digestive health as they support the bladder and bowels. They also play an important role in sexual dysfunction.

“So if you are having pelvic pain or pain with sex, sometimes these muscles can be the root of the cause. [If] you notice that insertion or penetration or ejaculation or arousal or anything of the kind feels a little bit painful, the culprit could actually be your pelvic floor muscles,” explained Banerji. 

PFT can help reduce pain and increase pleasure in sex through both emotional components and physical exercises. Banerji stressed that consent is essential in all physiotherapy and with consent, a physiotherapist may conduct a pelvic floor assessment to understand and intervene with the pain.

“We can see if your pain is reproduced and if it is, can we do some type of manual intervention to the pelvic floor to see if it can calm down and relax a little bit more, if we can relieve some of that pain . . . we find ways to exercise the pelvic floor in such a way that it can relax and lengthen and not feel so painful on its own. So, there [are] many different strategies and many different techniques that we can use to help reduce pain,” said Banerji.

PFT relieves pain through a multi-modal approach. Banerji emphasized that physiotherapy is holistic and often includes an acknowledgement of the different factors that contribute to pain, including past experiences and trauma. 

“I like to take an approach of: I’m your physical therapist and your guide, so I’m not here to fix you or change you or anything like that,” said Banerji. 

“I like to take an approach of: I’m your physical therapist and your guide, so I’m not here to fix you or change you or anything like that,” said Banerji. 

Part of this approach includes working to help her patients feel that they have a bit more control in their lives. She does a lot of education with patients to both help them understand their bodies and to empower them. 

Stigma, shame and systemic factors around sexuality and sexual dysfunction can contribute to patients feeling disempowered or prevent them from seeking care.

People with vaginas are often socialized to believe that pain with sex is inevitable, prioritizing a heteronormative and patriarchal notion that sex is only about men’s pleasure.

“I also think a lot of people don’t entirely know who to tell, which is why I love conversations like this. The more people can learn that you don’t have to deal with painful sex, this is not a forever thing, you can actually go to someone who can help you, I think can be really empowering and really exciting for a lot of people. I’m going to be very blunt but sex should not be painful, it shouldn’t. Really, it should be consensual and it should be fun and it should be pleasing and all these things, but it should not be painful,” said Banerji.

When asked what she would say to folks experiencing shame with their pain or sexual dysfunction, Banerji promised that no providers will judge or make you feel embarrassed.  

“For anyone who is thinking about going down this route, it’s okay if you’re not ready. Not everyone is ready to be part of the journey of being in pelvic PT. It is very personal and it’s very intimate for a lot of people and not everybody is ready for that and that’s okay. But, if some of the things that I talked about could potentially resonate with you, just know that there are pelvic-specific physios out there who would be more than happy to help you, with your symptoms whenever you are ready,” said Banerji.

Banerji explained that while PFT can be an important pain management tool for many, it may not be the only treatment. She also explained that though it may take some time to find a physiotherapist that you feel comfortable with, it’s worth it.

“This is not just you. There’s nothing wrong with you. This is just something that you’re experiencing, but it is not a defining factor of who you are and there are things that we can do about it together,” said Banerji.

Physiotherapy is direct access in Canada and the United States, meaning you do not need a referral from a physician and can reach out to a pelvic health physiotherapist directly.

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