Women's pelvic health
Why does sex hurt, and can physical therapy help?
Pain with intercourse is most often driven by pelvic floor muscles that have learned to guard: they tighten in anticipation, and the tightness itself causes pain. Pelvic floor physical therapy treats that pattern, with relaxation training, desensitization, and self-treatment techniques, and it works alongside the gynecologist who manages hormonal or skin causes.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
Pain can be at the entrance or deep inside, can follow childbirth, menopause, endometriosis, infections, or a painful experience, or can have no clear origin. Vaginismus is an involuntary tightening that makes penetration difficult; vulvodynia is persistent burning at the vulva. In all of these, the muscles are usually tender and overactive.
Treatment teaches the pelvic floor to relax and lengthen, breaks the fear-tension cycle, and uses graded, patient-controlled techniques including dilators when appropriate. Progress is paced entirely by the patient.
This is one of the conditions patients most prefer to treat from home. Over video, nothing is on camera that the patient does not choose, and the self-treatment techniques are taught verbally with the patient's own feedback guiding the pace.
Where you live
Tell us where you are
Insurance, referral rules, and booking depend on where you live. Choose your area and we take you to the right page.
Not listed? Dr. Shalem can only treat patients located in a state where she holds a license. Send a message and we will tell you what is possible.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed physical therapist.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.