Making My Case for Pelvic Floor Rehabilitation Therapy

I haven’t had sex since in over nine months. And yet, I still had to practically beg my doctor for what should be common practice after labor—PT for your private parts.

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At first, it didn’t seem like I was going to have any problems in the postpartum recovery department.

After what was apparently twelve hours of relatively routine laboring, coupled with an hour and a half of pushing, I required “only” two stitches. According to the doctors, I had an easy birth. The OB/GYN who sewed me up even went so far as to brag about what a great job she had done. “That’s going to heal like nothing ever happened,” she told me and colleagues within earshot. I was lucky, she said, that it was a such an uneventful labor.

My doctor confirmed all was well during my first follow up appointment and cleared me for all activity. She said I was in great shape and therefore could do whatever my body would let me do. She didn’t need to regulate my activity; I would be able to do so myself.

Of course I can, I thought to myself. After all, I’m an athlete—a junior Olympian who was an NCAA All-American in gymnastics. I’m used to being in full control of my body and pushing the boundaries of what I and others thought possible. After hearing that validation in my postpartum appointment, I felt energized and confident. My fit body had overcome the birth hurdle just like I’d overcome all the other past physical hurdles. I nailed it—easy peasy.

And that was basically the start of my nine months of involuntary celibacy. No one saw it coming—especially me. And because the medical care I needed to solve my sexless existence is seen as an “optional” treatment in this country, I had to identify the problems myself and seek the appropriate help.

Despite an “easy labor,” I still had a lot of postpartum pelvic pain.

As I soon found out, my labor hadn’t been seamless. And nothing about it had felt easy. I pushed a baby out my vagina. Turns out that can sometimes do damage that’s hard to detect from the outside.

I had heard about pelvic floor rehabilitation therapy in London, where I spent half my pregnancy. There, resources to help women tighten up their pelvic floor muscles after childbirth are very much a priority. I knew I wanted to ensure a seamless recovery, but it wasn’t until I continued complaining about the pain around my stitches that my doctors finally granted me a referral.

When I first started pelvic floor physical therapy, my goal was to not accept that after having kids, it’s “normal” to experience urinary incontinence. My bladder control felt weakened, but I wasn’t having real troubles holding it in yet. Still, I wanted to get ahead of it. So when the therapist asked me my goal during my first appointment, that was it. “I don’t want to pee myself,” I told her. She told me that was a good start.

She did a manual therapy assessment of my so-called pelvic floor, and it was exactly what you would imagine—uncomfortable fingering to remind you that there’s no longer anything sexual about this area of your body. She did some breathing exercises with me that allowed me to properly fill my stomach instead of my chest, which expands your pelvic floor and starts to teach it to fully relax.

As I learned, part of my problem was that—likely due to gymnastics and being "fit"—my muscles never fully relaxed. "I have a small bladder, so I pee a lot," was not acceptable to my physical therapist. She saw it as a symptom of a larger issue—muscles that were "too tight" in my vagina. I took that breathing exercise home as homework.

At my next appointment, she once again asked me what my goal was. I said I felt good about what the prior week would do for my ability to control my bladder. This week, I wanted to focus on being able to have sex again.

See, I had several new mom friends who were already having post-baby sex only a couple of months postpartum. I wanted in. I love sex. I’m a sexual person. And, believe it or not, I still look at my husband and think, “Damn, he’s sexy.” But after the birth of my son, that was quickly followed with, “Nope, zero interest in involving my vagina in anything.” It’s still too painful to even think about.

Internal scar tissue was the root of my postpartum sex problems.

After another examination, my physical therapist explained that I actually had a lot of scar tissue inside my uterus. The exterior stitches and scar tissue on my outer lady parts were healing nicely, she added—with some gentle massaging they would recover fully and quickly. Inside, however, was a different story. I asked if I just need to push through it like a virgin. But no, scar tissue doesn’t work like that.

After several physical therapy appointments over the course of two months that included internal massages (which are exactly what they sound like), coupled with new take-home kegel and breathing exercises, which I practiced regularly, I still had no sex in my sights. It was just too painful. A finger was fine, but—for better or worse—my husband’s penis isn’t finger-sized.

Because of the holidays, I had to miss a couple of regular appointments, so my pelvic floor physical therapist sent me home with what she called “the wand”—a medical device that’s used for self-guided internal poking and prodding. She also recommended a dilator (which is also exactly what it sounds like).

Or, if I didn’t want to spend on more medical devices, I could simply go to my nearest grocery store to “buy some carrots and condoms.” To be clear, different-sized carrots to be used with condoms (because let’s not be disgusting here!), so that I could slowly stretch out the scar tissue that was causing me to keep asking my husband, “Are you in?” when he hadn’t even started.

A finger was fine, but—for better or worse—my husband’s penis isn’t finger-sized.

While intrigued, I didn’t end up going the carrot route. I have a fantastic collection of dildos and sex toys that would do the job, so I never had to explain to my husband why I was hoarding produce in my bedside table.

Over the break, I diligently did my exercises, as well as my internal prodding and massaging. I even remembered to do my breathing exercises, which are recommended, as stress exacerbates the problem.

After a few weeks, it started to work. I started to feel less pain and only a strong discomfort. Then the holidays came and went, and with all the travel and family time, my vagina was no longer top of mind through rest of December and most of January.

Pelvic floor rehabilitation takes time—so you have to roll with it.

My most recent appointment confirmed that there’s still a lot of work to do. Though my primary goal remains to have sex, I now am experiencing bladder control issues when I sneeze and laugh. Sometimes it feels worse than before.

The pain is sometimes accompanied by feelings of failure. Though they weren’t ill-intended, the assertions of those who told me that my labor had been easy and my body was fine were the most damaging part of the whole experience. Every week after my initial postpartum appointment that my body couldn’t function normally made me feel like something was wrong with me. I was supposed to be healed. I had been cleared. So why was I in such pain and discomfort?

Some days I feel like I’m falling apart. Then my physical therapist reminds me that the changes are temporary. If I stick with my exercises and take care of myself, we’ll get through this scar tissue and rebuild my pelvic floor in a way that may make it even more functional than before.

The point is that I’m getting help. It’s actually so common for women to experience the same issue but never get the care they need—thereby delaying their recovery.

Here in the United States we're left to our own devices a lot of the time, having to research issues such as pelvic organ prolapse, pelvic floor dysfunction, or a number of other pelvic floor disorders. I would encourage any woman to push for PT and get the treatment plan they need. I learned that any time you experience pain, it shouldn’t considered normal.

Beyond the physical, my appointments have been extraordinarily helpful emotionally. On weeks when I feel like I'm going backward, I have my appointments and I’m reinvigorated by the progress. That's because my therapist reminds me to be patient with myself and to stop beating myself up, and she reinforces that this is just temporary. Even though it’s not as much fun as hearing that my body is perfect and I’m impressively breezing through recovery, these are the most supportive, helpful messages I could possibly hear now.

And, eventually, my husband and I are going have sex again. For now, we’ll just continue making out like teenagers.

Lesley Howe is a writer for Woman Born and mother to a new baby boy.