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Finding Help for Pelvic Floor Dysfunction: Case Study on a Hypertonic Pelvic Floor


It is completely normal that pain can happen your first time having penetrative sex if you have a vagina, but excessive pain should never be looked past. It can be scary having pain down there, especially when you're young and having your first sexual experience. We caught up with a twenty-year-old college girl who is suffering from a pelvic disorder called a hypertonic pelvic floor. Having this disorder is nothing to dismiss, at least for her who has not been able to have a pleasurable sexual experience to date.

“I first noticed something was wrong when it was painful for me to put in a tampon in my teenage years,” she says. “Later in life, when I started to have sex it was painful, always. People always told me it would hurt the first time I had sex but after many failed attempts I knew something was wrong. I decided to get a pelvic exam, which was extremely painful”

This courageous young woman was diagnosed by a physical therapist in February 2021, after two disastrous pelvic exams attempted by a gynecologist. After seeing the doctor, she recommended a physical therapist. They gave her exercises and strategies to get through the pelvic exam. They were very helpful to her and were able to pinpoint where the pain was coming from. They explained further about pelvic disorders, which eased her mind even more.  

Pelvic Rehabilitation Medicine shares that a hypertonic pelvic floor includes the “pelvic floor muscles being contracted, tense, and weak. Blood flow is restricted, which can cause an acidic environment in the area and this, in turn, can create an inflammatory cascade. When this “inflammatory soup” is generated, it’s harmful to the region’s muscles and nerves. The muscles become tender and the nerves begin to fire inappropriately, causing subconscious chronic pain and tensing of the pelvic floor.”

Heba Shaheed, physiotherapist, co-founder and CEO of The Pelvic Expert says there is no one defining cause of a hypertonic pelvic floor, but there are several activities that can lead to the muscles tightening up which include working out frequently and high levels of stress. Poor pelvic health and abdominal health conditions can also result in hypertonicity of the pelvic floor such as endometriosis, holding your bladder for excessive periods, or birth trauma and scar tissue. 

“When the therapist told me about pelvic disorders, I felt relieved because I had experienced other symptoms like trouble urinating and lower back pain,” our source says. “I am glad I talked to my doctor about this as I want to be pain-free and enjoy the intimacy and pleasure that a sexual relationship brings.”

What are the signs and symptoms of a hypertonic pelvic floor?

  • constipation
  • incomplete emptying of the bowels
  • straining when emptying the bowels
  • pelvic pain
  • low back pain
  • hip pain
  • coccyx pain
  • painful sex
  • vaginismus
  • urinary incontinence
  • incomplete emptying of the bladder
  • slow flow of urine
  • hesitancy or delayed start of the urine stream
  • urinary urgency
  • urinary frequency
  • painful urination

It took a while for physical therapy to work her up to the invasive work. They gave her exercises using a q-tip; just circling the vaginal opening. They massaged her hips, lower back, and observed the vagina to look for any inconsistencies. That is when they discovered a tear in her opening. As the stages of therapy advanced, they gave her a dilator to start stretching her opening and getting through the anxiety part of her pain. 

“During one of my exams, the therapist noticed that I had a pretty deep tear down there. I still don’t know where it came from as most tears happen after you give birth which I have not. I was referred to the clinic for a consultation regarding noninvasive surgery to fix the tear. They showed me how common of an experience I was facing and how surgery could give me a full recovery.’’

Surgery is not necessary for all who battle pelvic floor problems, this is only needed when a tear has presented itself or the patient has been diagnosed with endometriosis which has caused the tear. Issues with the human body arise and they are perfectly normal. 

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