April Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
What are your favorite tools for addressing pain with penetrative sex?
My doctor said I should wait until after I give birth to see a PT but I’m in pain. Can I come in during pregnancy?
I’m interested in a VBAC. What can I do to prepare?
1. What are your favorite tools for addressing pain with penetrative sex?
Pain with penetrative sex has a number of causes, with the most common including pelvic floor muscle guarding, hormonal changes in vulvar tissue, scar tissue and underlying medical conditions. To learn more about the causes of pain with sex, read this blog post. Prior to using the following tools I’ll recommend below, please consider speaking with your medical provider and seeing a pelvic floor physical therapist for an in-person evaluation to determine the cause of your sexual pain as well as appropriate treatment options. Pain with sex is not a one size fits all approach and treatment will vary significantly based on the cause of your symptoms.
With that disclaimer aside, here are the tools I most often recommend to my patients experiencing pain with penetrative sex:
Pelvic Wands
I typically recommend the pelvic wand by Intimate Rose. You can purchase all Intimate Rose products for $5 off using code REBECCA8 but that’s not why I recommend them. Intimate Rose’s Pelvic Wands were created by a pelvic floor physical therapist. They’re comfortable to hold and are surrounded by a soft, smooth silicone material in appealing colors, unlike the hard plastic and glass wands that previously dominated the market. While they come with options like vibration and temperature therapy, I tend to recommend the base model. Pelvic wands are a great tool to use to address trigger points throughout the pelvic floor and can help you address tight muscles contributing to your pain. If you’re wondering how to use this tool, check out our instructional video on Youtube!
Dilators
Dilators are another excellent tool that can help you address pelvic floor muscle tension, scar tissue and even aversion to penetration. As with the wand, Intimate Rose is my favorite but Amazon has a number of different dilator options at different price points and made of different materials. While there are a number of ways to use dilators based on the reason you’re using them, some general rules of thumb include ensuring dilator use is not painful (discomfort is OK) and that you’re using sufficient lubrication. If you’re considering dilator use, this blog post is for you.
OhNut
The OhNut is a great tool for people who have pain with deeper penetration. These are soft, stackable silicone rings that allow you to manage the depth of penetration. I’m a huge fan of this product!
2. My doctor said I should wait until after I give birth to see a PT but I’m in pain. Can I come in during pregnancy?
It’s all too common for pregnant people to be told that they should “just wait” until after birth to seek help for pain, but there are so many reasons to treat pain during pregnancy rather than waiting until birth. Check out this video on the benefits of PT during pregnancy.
People are often told that their SI joint pain, pubic symphysis pain, back/hip/pelvic pain will improve after childbirth. Sometimes it does, but the reality is that’s not the case for everyone. In fact, pain during pregnancy is a predictor for pain following pregnancy. On a separate but related note, leakage during pregnancy is also a predictor of leakage following pregnancy.
The sooner you treat the pain you’re experiencing the sooner you start to feel better. Treating pain during pregnancy can not only improve your comfort during pregnancy but can help reduce the likelihood you continue to experience pain after your baby is born. The best time to seek treatment for pain is when you begin to experience the pain.
During pregnancy, small but meaningful changes to your daily activities, a few minutes of intentional movement a day and some support can make a huge difference.
3. I’m interested in a VBAC. What can I do to prepare?
My top recommendation for folks planning for a vaginal birth after cesarean (VBAC), if they have the access to do so, is to assemble the right team. If you have the financial and locational ability to do so, these are my top three recommendations for VBAC prep:
Find a provider who is truly supportive of VBACs. This is a game changer. The International Cesarean Awareness Network published a list of questions you can ask your provider to gain more clarity on how supportive of VBACs they truly are.
Hire a doula. Doulas can help you prepare for birth and act as a patient advocate and support system during birth itself. This can make a huge difference in your birth experience. If you’re in Austin, TX, Austin Doula Care is an AMAZING group of incredibly passionate, experienced, kind and badass doulas.
Work with a pelvic floor PT during pregnancy. Pelvic floor PTs can help you physically prepare for birth by identifying underlying muscular imbalances, coordination deficits and tissue restrictions that may impact labor and childbirth. From pelvic floor muscle tone, to your ability to effectively push, to hip mobility, there’s so much that we can do to help you prepare for birth, reduce the risk of perineal tearing and support your recovery. If you’re thinking about a VBAC and don’t have a pelvic floor PT near you, check out our Birth Prep course!
Working with a pelvic floor physical therapist prenatally and postpartum can help you manage pregnancy pains, prepare for birth and recover postpartum. If you’re interested in working with us in Austin, TX or virtually, contact us here.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.