1 in 5 women experience pelvic or sexual pain.

Persistent pelvic pain is a condition where persistent or recurrent episodes of pain is experienced for more than 6 months. This pain can be experience in the abdomen, pelvic region, pelvic floor and/or pelvic organs.

Pelvic pain and sexual pain can have simple causes such as vaginal tissue dryness from breastfeeding or menopause

However, often persistent pelvic pain has complex causative mechanisms that involve not only muscles and pelvic structures, but sometimes also the peripheral nervous system and central nervous system (nerves and brain)

Signs and symptoms of persistent pelvic pain

  • Painful sex, penetration, feeling ‘too tight’ or a ‘blockage’
  • Pain when using tampons / having an internal examination
  • Pain with arousal
  • Twitching and/or spasm in your pelvic floor muscles
  • Pain or burning anywhere in the vulva, genitals, lower abdomen region
  • Tailbone pain

Common causes of persistent pelvic pain

  • Skin conditions of the vulva such as eczema, dermatitis and lichen sclerosus
  • Conditions such as vulvodynia, vaginismus, pudendal neuralgia, endometriosis,  bladder pain syndrome or interstitial cystitis
  • Changes during menopause and childbirth
  • Ehlers-Danlos Syndrome (EDS) – 30-57% of women with EDS experience pain with sex
  • Recurrent UTIs and/or thrush
  • Psychological factors such as stress, anxiety, low mood and relationship problems
  • Things that have occurred in your past, such as a history of trauma and/or abuse

How can physiotherapy help?

  • Physiotherapy involves assessing all the potential contributing factors for your pain and can include:
    • A comprehensive assessment of the pain history, patterns and onset will be performed to help guide treatment
    • Retraining of the pelvic floor muscles and nerves
    • Lubricant and vaginal moisturisers
    • Relaxation strategies and down regulation of the central nervous system drivers
    • If indicated, manual techniques to desensitise the nerves and muscles of the pelvic floor which can include self massage, pelvic trainers and/or wands
    • A musculoskeletal assessment of your posture, breathing, thorax, abdomen and pelvis
    • Bladder and bowel retraining  
    • If indicated, the use of a TENS machine to manage your pain
    • Advice on lifestyle factors including general exercise, sleep, diet and stress management

We work in conjunction with your specialist healthcare team which will normally include your GP, gynaecologist, pain specialist and psychologist.  If you don’t have a healthcare team already we work with some of the best pelvic pain caregivers in Melbourne and are happy to refer you for your overall care.


[1] Tinkle, B. T., Castori, M., Berglund, B., Cohen, H. S., Grahame, R., Kazkaz, H., & Levy, H. (2017). Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. American Journal of Medical Genetics Part C: Seminars in Medical Genetics175(1), 48–69.