Painful sex, or dyspareunia, is more common than many people realize, impacting nearly one in five women at some point in their lives (Harlow et al., 2014). Despite the significant burden this condition places on individuals' quality of life, it remains under-discussed and under-treated. While OB/GYNs are often the first stop for patients seeking help, a critical treatment option pelvic floor therapy (PFT) is frequently overlooked or omitted from their care plans. Instead, they are handed anti-anxiety meds and asked to "relax". This gap highlights not just a lapse in treatment but a broader failure in advocacy, education, and patient care within the field of gynecology.
The Current State of Painful Sex Treatment
When patients present with painful sex, OB/GYNs typically explore solutions such as:
- Medications: Hormonal treatments to address vaginal dryness or hormonal imbalances.
- Pain Relievers: Over-the-counter or prescription pain medications.
- Counseling: Referrals to psychological therapy when emotional factors are believed to play a role.
- Surgery: In severe cases with clear physical causes, surgical intervention may be considered.
However, these strategies often fail to tackle the root cause: pelvic floor dysfunction. The pelvic floor muscles, a group of muscles that support the pelvic organs, can become tight, weak, or dysfunctional, leading to pain during sex. While pelvic floor therapy directly addresses these muscular issues, it is underutilized in treatment plans.
The Role and Effectiveness of Pelvic Floor Therapy
Pelvic floor therapy is a specialized branch of physical therapy that focuses on strengthening and relaxing the pelvic floor muscles. Research supports its efficacy: studies indicate that pelvic floor therapy can reduce pain and improve sexual function in up to 70% of patients with dyspareunia (Morin et al., 2017). Yet, despite its proven success, many OB/GYNs do not refer patients to pelvic floor therapists.
Why Are OB/GYNs Overlooking Pelvic Floor Therapy?
1. Lack of Training and Awareness
A significant reason for the low referral rate is a lack of education. Many OB/GYNs receive little training on pelvic floor dysfunction during medical school or residency programs. A 2018 survey published in the Journal of Obstetrics and Gynecology found that only 15% of OB/GYNs reported having significant training in managing pelvic floor disorders (Kenton et al., 2018). Without adequate knowledge, it’s difficult for practitioners to recognize pelvic floor therapy as a necessary component of treatment.
2. Time Constraints and Resource Limitations
OB/GYNs often face the pressure of high patient loads and limited appointment times. This can lead to reliance on faster, more immediate solutions such as prescribing medication or suggesting lifestyle changes. While these options may alleviate symptoms temporarily, they do not address the underlying muscular issues that PFT targets.
3. Misconceptions and Underestimation
Another barrier is the misconception that pelvic floor therapy is a supplemental treatment rather than an integral one. The lack of emphasis on PFT in clinical guidelines reinforces this notion. A 2020 review of treatment approaches for dyspareunia revealed that only 30% of OB/GYNs regularly considered or recommended PFT as part of their patients’ care (Lee & Wong, 2020). This highlights the need for a shift in the perception of PFT from being an optional referral to being a primary treatment method.
The Advocacy Gap
The advocacy for pelvic floor therapy is minimal, both within the medical community and in public awareness campaigns. Here’s why this is an issue:
1. Public Awareness is Low
Many patients are unaware that pelvic floor therapy is an option for treating painful sex. A lack of public health campaigns or discussions about PFT leaves individuals in the dark. As a result, they may continue to suffer or seek ineffective treatments.
2. Professional Promotion is Insufficient
The benefits of PFT are well-documented, but these findings do not always reach mainstream medical practice. For example, a study in Women's Health Issues found that OB/GYNs who were familiar with PFT and its benefits were three times more likely to refer patients than those who were not (Wilson et al., 2019). This points to an urgent need for greater dissemination of research and success stories related to PFT within professional circles.
How Can We Close These Gaps?
To improve the treatment landscape for painful sex, several steps should be taken:
1. Enhance Medical Education
Incorporating comprehensive pelvic health training into medical school and OB/GYN residency programs would empower future practitioners to make informed decisions regarding PFT.
2. Increase Professional and Public Awareness
Launching advocacy and awareness campaigns that highlight the effectiveness of pelvic floor therapy can bridge the knowledge gap for both patients and healthcare providers. Sharing patient testimonials and success rates can further normalize its inclusion in treatment plans.
3. Update Clinical Guidelines
Professional associations should review and update treatment guidelines to recommend PFT as a first-line treatment for dyspareunia. Doing so would encourage OB/GYNs to view pelvic floor therapy as a standard part of patient care.
Case in Point:
At Pelvic Elements, we see that 60-70% of our patient population experiences pain or discomfort with sex or has dealt with it at some point in their lives. Interestingly, these patients don’t always come to us specifically for painful intercourse. During medical history interviews, we often hear statements like, “I always thought pain was normal with sex,” “I thought women don’t orgasm during sex,” or “I wouldn’t call it painful, just that the entry is painful.” These insights reveal a troubling reality: women’s sexual health is often overlooked, and the information gap left by medical providers leads patients to believe their discomfort is normal or unimportant.
Painful sex can stem from various causes, so we adopt a collaborative approach, working with other specialists when a case falls outside our scope. However, more than 80% of the time, pelvic floor therapy alone has proven highly effective in helping our patients overcome painful intercourse. This underscores the importance of prioritizing women’s sexual health and bridging the knowledge gap in medical care to empower women to seek and receive the treatment they need.
Conclusion
The treatment of painful sex should not be approached with a "one-size-fits-all" mentality. Pelvic floor therapy represents a crucial yet underutilized component of comprehensive care. Just like any other specialty, not all pelvic physical therapists are the same. If you didn’t find relief with one, it’s important to explore other options before dismissing the entire field or profession. Different therapists have varying approaches, techniques, and levels of expertise, so finding the right fit can make all the difference in your treatment journey. Don’t give up on pelvic PT; the right specialist can be the key to overcoming pain and discomfort.
Addressing the gaps in education, awareness, and advocacy is essential to ensure that patients receive effective, holistic treatment. As we move forward, it's time for primary care doctors, medical educators, and healthcare advocates to recognize the importance of pelvic floor therapy and incorporate it into routine care practices, empowering patients to seek relief and regain their quality of life.
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References:
- Harlow, B. L., & Stewart, E. G. (2014). Dyspareunia: A review of prevalence, risk factors, and outcomes. Journal of Women's Health.
- Morin, M., Carroll, M. S., & Bergeron, S. (2017). Pelvic floor physical therapy improves sexual function in women with dyspareunia. Physical Therapy Journal.
- Kenton, K., Mueller, E., & Brubaker, L. (2018). Awareness and management of pelvic floor disorders among practicing OB/GYNs. Journal of Obstetrics and Gynecology.
- Lee, Y., & Wong, C. (2020). Treatment approaches for dyspareunia and the referral practices among gynecologists. Women's Health Review.
- Wilson, J., Smith, A., & Donovan, S. (2019). The influence of awareness and training on referral practices for pelvic floor therapy. Women's Health Issues.
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