Frequently Asked Questions

Nicole Niu, PT, DPT, WCS
Pelvic Floor Physical Therapist
Pelvic Wellness Physical Therapy 

1. How does your clinic/organization address sexual health and intimacy? 
   As Pelvic Floor Therapists and Certified Women’s Health Specialists we are well-versed in treating both men and women for sexual health and intimacy concerns. Treatment looks very different for each individual and where they are at on their journey. The first priority is gaining insight about what concerns or difficulties they are having with intimacy. We seek to determine if their blocks are more emotional or physical or a combination of both, as well as what intimacy looks like to them. We then develop a treatment plan from there to help reach their specific goals. 
    
2. How does breast cancer and treatments (chemo, radiation, etc) affect the pelvic floor? 
   Treatment from cancer can cause changes in the muscles and tissues surrounding the pelvic floor which can result in pain, dysfunction, and weakness. While these treatments may be necessary, their aftereffects can impact organ function, posture, and overall stability. Weakness or tightness in the hips, abdomen, pelvis, and lower back can make daily activities more difficult. Some cancer treatments leave behind soft tissue restrictions, painful scarring, and altered sensation.  
   1.  Depending on the type of cancer and treatment received, survivors may experience factors that influence their pelvic and sexual health including: 
   2. Pelvic floor muscle tension or weakness – from surgery, radiation, or guarding patterns developed due to pain. 
   3. Vaginal dryness & tissue changes – common after chemotherapy, radiation, or hormone therapy. 
   4. Pain with intimacy (dyspareunia) – often caused by scar tissue, nerve sensitivity, or hormonal shifts. 
   5. Decreased libido & body confidence – cancer treatment impacts not just the body, but also emotions and self-image. 
       
3. What can patients do at home now to determine if pelvic floor PT is appropriate to address their sexual health concerns?           
   Understanding what we treat as pelvic floor physical therapists is helpful in knowing if we can help. Below are some common symptoms we help with after cancer treatment. Going through these and asking if they are experiencing any of these would be helpful in knowing if pelvic floor therapy would be a good fit. These symptoms include, but are not limited to sexual health concerns. 
   1. Sexual Health Challenges 
      1. Pain or discomfort during intimacy (dyspareunia). 
      2. Vaginal dryness, irritation, or reduced sensation. 
      3. Difficulty with arousal, orgasm, or penetration. 
      4. Erectile dysfunction or penile pain. 
   2. Pelvic Pain & Discomfort 
      1. Pain in the pelvic region, hips, lower back, or abdomen. 
      2. Pain with sitting, walking, or certain movements. 
      3. Sensations of tightness, burning, or pressure in the pelvis. 
   3. Bladder & Bowel Dysfunction 
      1. Increased urinary urgency or frequency. 
      2. Leaking urine (incontinence) with sneezing, coughing, or exertion. 
      3. Painful urination or difficulty fully emptying the bladder. 
      4. Constipation, straining, or fecal leakage. 
   4. Post-Surgical or Radiation-Related Changes 
      1. Abdominal or pelvic scar tissue that feels tight or painful. 
      2. Pelvic muscle weakness or lack of coordination. 
      3. Changes in posture or core strength affecting balance and stability. 
   5. Emotional & Nervous System Symptoms 
      1. Feeling disconnected from your body or avoiding certain movements. 
      2. Fear of pain leading to muscle guarding and tension. 
      3. Stress, anxiety, or reduced confidence related to intimacy or body changes. 
          
4. What educational resources does your organization provide patients on intimacy and sexual health during cancer treatment and survivorship? 
   We provide resources based off of each patient’s unique needs. This may include books about reclaiming connection to the body or ideas for seeking new ways of arousal. Other times this may include dilators to help with vaginal tissue mobility or handouts on intimacy positioning based on their specific findings. We also have a handful of sex therapists we refer out to and understand how valuable this piece can be as adjunctive treatment to what we are working on.  
    
5. Are there precautions or contraindications to pelvic floor PT during breast cancer treatment and survivorship? 
   There are times during active radiation or the immediate post operative period where PT would be contraindicated. Most times we are “in the clear” around 6-8 weeks after treatment has concluded but this is on a case-by-case basis and we are happy to discuss this with each of our patients.