The muscles at the base of your pelvic floor are like any other muscle in your body. They can weaken, hold tension and affect how your body works. Pelvic floor physical therapy can help those with Lichen Sclerosus keep their pelvic floor muscles healthy.
That’s where experts like Ashley Stump, PFPT, come in. As a pelvic floor physical therapist, she helps people with various problems, including painful sex, urinary and bowel issues, pelvic pain, and pain from LS.
I spoke with Ashley to learn more about what she does as pelvic floor PT and how it benefits those with LS.
How does Lichen Sclerosus affect your pelvic floor muscles?
If you have LS, you already know the condition affects various parts of your life. It also involves multiple parts of your body, including your pelvic floor.
Just like people can hold tension in their neck muscles, they can also have stress in their pelvic floor muscles. Lichen Sclerosus can contribute to tight muscles, thickened tissues, and less mobility.
“Whenever someone has pain, muscles naturally want to protect and guard. So they tense up trying to protect the body from what is coming at the muscles — this stimulus that the muscles are interpreting as danger,” explained Ashley. “Pelvic floor PT can help gently work on the tissues and the muscles there that might have tension to them and prevent people from having pain with intimacy or functional penetrative activities.”
The body’s automatic reaction to a fear of vaginal penetration is called vaginismus. The goal of pelvic floor PT is to get the tissues and muscles comfortable with a stimulus so that they stay relaxed and interpret it as a safe space. Afterward, activities can happen pain-free.
The mind-body connection is so essential that Ashley uses methods beyond treating just the muscles.
“I incorporate nervous system training, the mind-muscle connection, mind-body connection — especially for intimacy, whatever it looks like,” she said.
How does pelvic floor PT benefit those with LS?
If you have Lichen Sclerosus, having a pelvic floor PT on your health care team is so valuable. I’m always preaching that it takes a team of people, not just one, to address LS. You may need to see a gynecologist, a dermatologist, a therapist, a counselor, and a pelvic floor PT.
Even if you don’t have any active symptoms, the physical therapist can evaluate you to ensure everything works properly. And you’ll have someone ready to care for you should a problem arise. You need everyone working together to help you through this journey.
There are many benefits of pelvic floor PT, so let’s focus on the most common benefits for those with Lichen Sclerosus. Pelvic floor PT may help with painful fusing/scarring, painful sex, urinary issues, bowel issues, and problems during pregnancy.
Treating Fused/Scarred Skin
Pelvic floor physical therapy may be helpful for those with clitoral adhesions or scarring around the vulva or vagina. When adhesions and scarring occur, the skin becomes fibrous or thicker. PT can help the skin move easier and with less pain using a technique called myofascial release.
“Gentle scar tissue release is basically like a soft tissue massage in a sense to try and decrease that fibrotic tissue.”Ashley Stump
Some pelvic floor PTs can also help treat issues from anal LS.
“We can also do manual techniques to help peri-anal tissue to help decrease the tension there,” explained Ashley. “I’m also trained in intra-rectal. Just like intra-vaginal, there are rectal treatments and assessments of that side of the pelvic floor muscles.”
Not all pelvic floor PTs are trained in intra-rectal techniques, so talk with your PT in the beginning to learn more about what they can help treat.
Treating Painful Sex
Pain with intimacy is common but not normal. You don’t have to just suck it up and push through it; there’s help available.
Pelvic floor physical therapy can help reduce vaginismus so that your body reacts differently to a stimulus. At first, the PT may just use a single finger, but they will help you progress to other stimuli, such as different-sized dilators/trainers.
Treating Bowel and Bladder Issues
Pelvic floor muscles affect your bowels and bladder functions, too. If your urine stream has changed since having LS — it’s dribbling more than usual, deviating to one side, or you empty your bladder but more dribbles out later — it’s time to check in with a pelvic floor PT.
The same is true if your bowel movements have changed since being diagnosed with LS. For example, if you have frequent constipation. These things could indicate that your pelvic floor muscles are underactive, overactive, or shortened/tense.
Pelvic Floor PT During Pregnancy
Ashley recommends pelvic floor PT during pregnancy with the doctor’s consent and recommendation. During pregnancy, pelvic floor PT may include perineal stretching to help the baby's delivery.
Even if someone has past pregnancies/deliveries where they’ve torn and now have episiotomy scar tissue, pelvic floor PT may help.
What does a typical pelvic floor PT evaluation look like?
Treatment will look different for everyone, but an initial evaluation typically involves a lot of talking and allowing the PT to get to know you.
“I always tell patients: I’m going to figure out your whole health journey. The floor is yours, so tell me from the very beginning of your journey. What does it look like for you?” said Ashley.
Ashley likes to look at the body from head to toe. She looks for muscle imbalances, flexibility, and strength. If the patient is comfortable, she may do an intra-vaginal assessment.
The intra-vaginal assessment is not like what you’ll find at an OB-GYN’s office. There’s no speculum; there are no stirrups. It’s just a finger with lubricant. Ashley will do an intra-vaginal assessment and feel the vulva internally to look for fibrotic scar tissue.
For a pelvic floor PT, this initial evaluation tells a lot about the pelvic floor muscles and how they are functioning.
Another important aspect of pelvic floor PT is open communication, starting with the initial evaluation. There’s an initial screening to let Ashley know if a patient has any trauma or injuries to the pelvis, any history of sexual abuse, sexual trauma, or STDs/STIs. She always offers a chaperone in the room if it’s more comfortable for the patient.
What is pelvic floor physical therapy like?
Everyone’s body is different, so pelvic floor physical therapy will look different for everyone based on their situation. However, some common tools are used, including lubricants and dilators/trainers.
Using Lubricants in Pelvic Floor PT
Using lubricant is crucial for those with Lichen Sclerosus. It can help reduce friction and reduce tearing and pain. But which kind is best?
“There are so many different lubricants out there. My recommendation would be to stay away from the ones that have a ton of ingredients. Stick with basic, good, clean lubricants,” explained Ashley.
Some brands that Ashley recommends include:
- Uberlube: This water-based lubricant helps with dryness during intimacy.
- Good Clean Love: This organic lubricant has all-natural ingredients.
- Desert Harvest: This company has lubricants with lidocaine specifically in it to help with pain.
- Slippery Stuff: Ashley uses this lubricant at her clinic.
Ashley recommends using lubricant and any topical medications separately, as one could affect the effectiveness of the other. You can talk with your pelvic floor PT about finding a good schedule for you.
Also, if you have a lubricant that works well for you, ask your PT about using it during your pelvic floor PT session.
Using Dilators/Trainers for Lichen Sclerosus
Vaginal trainers, also called dilators, help muscles adapt to penetrative or functional penetrative activities, such as inserting speculums or tampons. Dilators are penis-shaped devices made of silicone or plastic and come in various sizes.
When Ashley uses dilators, she just uses one finger for pressure at the end of the dilator.
“I’m not forcing it, ever,” assured Ashley. “If I feel resistance, I’m just meeting the resistance where it’s at. One finger pressure, just enough that the muscles can know something is there, but not enough to where it’s dangerous to them.”
The goal is to go at most a three out of 10 in pain. “Anything more than that, the nervous system will sense it as a threat, and that’s not helping us at all because we want to keep our nervous system in a relaxed state,” explained Ashley.
As time passes, the pelvic floor muscles will adapt to what is being inserted and relax. If the dilator glides in with no tension, then the patient gets the green light to move on to the next size. However, Ashley only advances up to three in one session.
When dilators are used at home as part of pelvic floor PT, Ashley recommends that patients get in a comfortable position. “Play some music, do it in the bathtub, prop yourself up with pillows on your bed or on the floor — make it an experience that is relaxing in a sense,” she said.
Ashley will also have her patients use dilators before intimacy to help the muscles adapt to the stimulus in a non-threatening way before moving on to intimacy.
Two dilator brands to consider are Hope & Her and Intimate Rose. You can also work with your pelvic floor PT to find suitable dilators/trainers to meet your needs and preferences.
Can I do my own at-home treatments without a PT?
Although many free resources exist, Ashley recommends working with a pelvic floor physical therapist before trying dilators/trainers.
“There’s so much out there and everyone presents differently,” said Ashley, “Even if a person thinks they’re ready for dilators, they might benefit a lot with just finger/manual work on the scar tissue and tension before going right to the trainers.”
People with Lichen Sclerosus will have very sensitive tissue, and guidance and education about dilators may be needed.
“There’s all of these different factors coming into play that you wouldn’t get if you just watched YouTube and went for it,” explained Ashley.
How do I find a great pelvic floor physical therapist?
Finding the right pelvic floor PT for you boils down to two things: your comfort and their experience.
“Find someone that you vibe with,” said Ashley. “If you don’t feel comfortable, you have the total right to keep searching, because that’s going to ultimately help your health journey.”
You have to trust and connect with your PT to feel confident in what they’re doing, that they are looking out for your best interests, and that you feel confident in the education they give you.
You also want someone who is experienced, especially with Lichen Sclerosus. Before the initial evaluation, ask about their experience treating patients with LS. You can also ask if there’s a chance of an intra-vaginal assessment on the first visit and what your evaluation will look like.