ROLE OF PELVIC

FLOOR REHAB
PHYSIOTHERAPIST IN SEXUAL
DYSFUNCTION
Dr. M . Manimozhi PT,
Pelvicfloor Rehab Specialist
ATTUR HUD
KARIPATTI GPHC
 VAGINISMUS
Vaginismus is a type of sexual dysfunction, It
occurs when the vaginal muscles involuntarily
or persistently contract.

While it doesn’t interfere with sexual arousal,

it can cause pain during sexual intercourse,
making penetration difficult.
 CAUSES OF VAGINISMUS
 Childbirth injuries, such as vaginal tears.
 Prior surgery.
 Physical psychological and sexual issues.
 Bladder infections.
 UTI.
 Yeast infections.
 Anxiety disorders.
 Fear of sex or negative feelings about sex, perhaps due to
past sexual abuse, rape or trauma.
 Hypertonous of pelvic floor muscles.
 Vaginal atrophy
• Lack of estrogen after menopause makes the lining of the
vagina thinner and drier (vaginal atrophy).
• Vulvar vestibulitis (provoked vestibulodynia): 
• This condition causes painful sex (dyspareunia). People may
have pain from initial penetration throughout the entire
experience symptoms of vaginismus.
• Discomfort or pain during vaginal penetration.
• Inability to have sex or have a pelvic exam due to vaginal
muscle spasms or pain.
• Painful intercourse.
 Pudendal Neuralgia

It can cause pain, irritation and spasm of muscles.

Sensory symptoms may extend till groin.

Abdomen legs and buttocks.

Discomfort wearing tight clothes.

 Types of vaginismus
Primary vaginismus: 
when vaginal penetration has never been achieved.

Secondary vaginismus: 
when vaginal penetration was once achieved, but is no longer
possible, potentially due to factors such as gynecologic surgery,
trauma, or radiation.
Assessment by Pelvicfloor rehab Physiotherapist
• SUBJECTIVE ASSESSMENT:
• Every Assessment starts with taking proper history and asking about the chief complain.
• The subjective assessment should include, Name, Age, Occupation, Lifestyle,Habit, Chief
complain
• History related to childbirth, urine leak, perineal injury, surgery, sexual activity, pelvic
organ prolapse should taken in detail.
• Any other history related to chronic low back pain especially which is not responding to
treatment should also be noted.
OBJECTIVE ASSESSMENT
• It starts with observation.
• Posture
• Gait
• Perineal observation  
 STATIC OBSERVATION

 The perineal observation can be further divided into Static

observation and Dynamic observation.
 The static observation consists of Observation of skin. 
 Identification of the structures and their symmetry.
 Scar, oedema, redness.
 Episiotmy.
 DYNAMIC OBSERVATION

• The dynamic observation consists of, -contraction and relaxation

of pelvic floor muscles-movement of clitoris and perineal body,
anal wink-observation of PFM during coughing-Bulge, Drop
etc. Perineal movement Contract PFM
• Perineal elevation inward movement of perineum, vulva &
anus. Relax PFM. 
• Perineal descend downwards & opening movement of perineum.

* Don’t forget to look for accessory muscle movement during

contraction and relaxation.
Oxford Grade Scale
 Grading according to Het’s SERF Assessment

• S= STRENGTH / RELAXATION (+3/-3)

• E= ENDURANCE (How many seconds hold) (10sec)

• R= REPETITION 10/10

• F= FAST TWITCH MUSCLE MOVEMENT (8-9 /10 SEC)

 Het’s ASSESSMENT Scale/MMT
GRADE 3 STRONG UPWARDS AND INWARDSPULL AGAINST RESISTANCE

CONTRACTION GRADE 2 GRIP WITH COMPLETE CIRCUMFERENCE

GRADE 1 MILD CONTRACTION (FROM ANY SIDE)

0 GRADE 0 BASE LINE TONE

GRADE -1 INABILITY TO PENETRATE

  SYMPTOMATIC PENETRATION
GRADE -2
RELAXATION (PAIN, TIGHTNESS, DISCOMFORT OR ANY OTHER SYMPTOM)

GRADE -3 ASYMPTOMATIC PENETRATION (EASY PENETRATION)

 TREATMENT FOR VAGINISMUS
As we have seen earlier the hypertonus dysfunction occurs
due to pelvic floor muscle tightness.
So the most important thing in this protocol will be to focus
on sustained relaxation of the pelvic floor muscles.
Patient may need some pain relieving treatment and bio feed
back for proper understanding of the muscles

FOR PAIN RELIEF

 Modalities like Vulvar US, IFT, Heat therapy or cryotherapy
can be used for pain relief.
 IFT & US
 IFT can be used for the pain relief as it is used for other areas.

 The placement will be two electrodes on the medial 1/3rd of

inguinal ligament on each side and other two electrodes near
the ischial tuberosity.

 US can be given to the vulvar area or the Mons if they are

painful, use the water bag method.
VAGINAL DILATORS
 Stretches
Adductors.
Hip Flexors.
Piriformis.
Happy baby pose
Breathing exercise for relaxation.
Hipcurling
Puppy pose.
Pigeon pose.
Lateral stretch.
Glutei rolls.
Butterfly stretch.
Straddle stretch.
Relaxed squat.
Spinal twist.
So a proper stretching of these muscles will help the patient to reduce the heaviness
in the whole pelvis..
 BENEFITS OF RELAXATION OF PFM
 It relives your back pain,
It helps you relive from painful sex such as Dysperunia and vagisnimus.
It increase blood supply and oxygen to the pfm, moreover, increase
your sexual health.
Increase pleasure and reduces pain during sex.
Making the child birthing process easier and decreases chances of
incontinence after childbirth.
Makes passing urine and feces through the body easier.
Prevents pelvic floor prolapse.
Help to treat urinary incontinence
Strengthen and support for your baby during pregnant.
Statistics of Vaginismus in worldwide

From the Year X axis 1980 to 2019 for the Y axis 20 to 180
Graph of publications about vaginismus and female sexual disorders by years
 ACKNOWLEDMENT
I would like to thank to Almighty and I express my special thanks and gratitude to
Dr.DHARA Chief clinical Instructor at WOW IIPRE , who gave me the golden opportunity
to do this wonderful topic “ ROLE OF PELVIC FLOOR REHAB PHYSIOTHERAPIST IN
SEXUAL DYSFUNCTION – VAGINISMUS.
And also I am extremely thankful from to Mr. V. Senthilkumar my well-wisher who
guided me to complete my presentation.
References
• WOW IIPRE International Institute of pelvic Floor Research, rehap and
Education.
• GLOBAL RESEARCH TRENDS ON VAGINISMUS AND FEMALE SEXUAL DYSFUNCTION
IN 1980-2019: A SCIENTOMETRIC ANALYSIS DOI:10.24938/kutfd.776949.

Thank you.