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Pelvic Floor Therapy as a Survivor of Sexual Assault

By Dr. Brooke Meinema, PT, DPT, FAFS, PCES

It is reported that 16-25% of females will experience sexual assault in their lifetime. Women who experience sexual assault are at an increased risk for pelvic floor disorders, especially chronic pelvic pain or dyspareunia (pain with intercourse), but it can also lead to increased pelvic muscle tension and guarding at rest leading to bladder hesitancy or difficulty with urination, pain with bowel movements/anal fissures, difficulty with use of tampons, as well as other pelvic floor ailments. Many women who experience this pain are referred for pelvic floor physical therapy, but this can be a bit stressful due to the personal nature of this treatment as well as not knowing what to expect. If you are considering physical therapy to address symptoms brought on by sexual assault but are apprehensive, here are a few of the more common questions we get asked:

  • What can I expect?
    • The first visit is usually trying to gather information and establish a plan. We’ll ask questions about your symptoms (how long you have experienced this, when you notice symptoms, what makes them better, what makes them worse, etc.), medical history, and any other information you want to share. We will want to gather as much information as we can about your posture, strength, muscle tension, breathing, or any other physical assessment we can perform in the time we have allotted. During the initial visit, we will also want to establish goals for you based on what you are hoping to achieve with therapy.
  • Do I need to share the details of what happened?
    • You only have to share with us what you want to share. We never want you to feel pressured to disclose any information that you do not feel comfortable discussing. If you want to inform your physical therapist about what exactly happened, you can, but we hope you know there will never be any judgment from us or expectations for what you tell us.
  • Do I have to have an internal evaluation?
    • At no point is an internal pelvic assessment required, but it is an option for treatment. An internal assessment uses a single finger (not a speculum or other tool) to assess the resting tone, sensitivity, coordination, and strength within the pelvic floor. It can be very helpful for both assessing and treating your pelvic floor, but it will never be expected or required. We have many patients who are comfortable with this and want to perform internal pelvic floor work in their sessions, and we also have patients who are not interested in this form of treatment. Either way, we will work with you in any way you are comfortable to help you reach your goals.
  • What if I change my mind during a treatment?
    • We always want our patients to know they are in control during their sessions. If at any point you change your mind about a form of treatment or assessment, let us know! We are always trying to get a good read on our patient’s comfort to avoid any triggering treatments or activities, but we want all of our patients to know they can stop treatment at any point in our sessions. We will respect any decision you come to and always want you to feel comfortable and confident.
  • What kinds of things will we work on?
    • What we work on depends on your symptoms and goals. If we are working on internal pelvic floor tension, we will work on not only reducing tension within the pelvic floor through the use of light pressure and massage but also on desensitizing the irritated area. If your pelvic floor has had a traumatic or painful experience, your body remembers this pain and can create a similar pain response later on. If your pelvic floor is hypersensitive, anything that comes near it (tampon, penis, toy, etc.) can cause the muscles to spasm and tighten leading to pain and guarding, which is why we work to reduce this response. We also work on breathing during activity to encourage the fight/flight/freeze center of our brain to deescalate. Lastly, we work with each patient to develop a home exercise program involving hip and pelvic opening, breathing, and stretches/activities to address their symptoms. We can even provide book recommendations for self-help as well as handouts for partners to provide a well-rounded experience. Our goal is to prevent future flare-ups, but also give our patients the confidence to know that if they have a future flare-up, they know what to do to be in control of the symptoms.

While we can work with you to address the physical symptoms that may be present due to sexual assault, it is still very important to work through the emotional trauma by speaking with a professional.  We want all of our patients to be getting well-rounded care to address this fully, and that often means addressing both their physical and emotional needs.

If there are other questions or concerns you may have surrounding pelvic floor physical therapy, feel free to reach out to us! We offer free phone consultations or 30-minute assessments to make sure physical therapy is the right step for you.



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