Tag Archive for: Overactive Pelvic Floor

How to Use Vaginal Dilators: A Gentle Step-by-Step Guide

Were you told to use vaginal dilators and have absolutely no idea what to do with them?

You are not alone.

Many women are handed a set of dilators by a doctor and sent home feeling overwhelmed, intimidated, or unsure where to even begin.

Sometimes the dilators themselves look huge compared with anything you have comfortably inserted before.

If this mirrors your experience, please hear this:

Your body is not broken.

You do not need to force your body through something painful just because someone told you to use a dilator.

Most women were never taught this: successful dilator work is not about pushing yourself through pain. It is about starting at a level where your body feels comfortable and gradually teaching your pelvic floor that touch and insertion do not have to hurt.

This is about more than symptom management. It is about helping your muscles and your brain become more comfortable with insertion over time.

Why Starting With the Right Size Matters

One of the first problems I see is that women are given dilators that feel far too intimidating.

Some sets stack together almost like Russian nesting dolls, and the smallest option may still be much larger than what your body currently tolerates.

If using a tampon is already painful, jumping directly to something much larger probably is not going to set you up for success.

Instead, start where your body is comfortable.

That might mean:

  • A slim tampon applicator
  • Your own clean finger
  • The smallest size in a gradual silicone dilator set

The goal is to choose something you can use without creating pain or fear.

Once that feels comfortable, you can slowly work your way up.

Why Pain-Free Practice Matters

One of the most important parts of learning how to use vaginal dilators is making the experience as pain-free as possible.

Pauli explains that when you are nervous, anxious, or afraid, your pelvic floor may respond by tightening.

That matters because if every attempt at insertion hurts, your body may begin expecting pain the next time.

Instead, we want to teach your brain and pelvic floor something different:

Touch and insertion do not always have to be painful.

Cleveland Clinic also explains that vaginal dilators can be used in gradually increasing sizes to help make penetration more comfortable over time.

https://my.clevelandclinic.org/health/diseases/15723-vaginismus

That is why forcing a larger dilator into your body before you are ready is not the goal.

Comfort and success come first.

Choose What Feels Comfortable to You

Not every woman needs to begin with a medical-looking dilator.

Some women feel much more comfortable starting with something familiar, like their finger or a tampon applicator.

That is completely fine.

If a silicone dilator feels comfortable to you, use one.

If a finger feels better, start there.

If a slim tampon applicator feels the least intimidating, use that.

The important thing is that you feel comfortable and successful with whatever you are using.

How to Use Vaginal Dilators

Once you have chosen a size or tool that feels manageable, keep the process simple.

1. Wash the Dilator

Wash your dilator with soap before and after use according to the product instructions.

Keeping the tool clean is an important part of using it safely.

2. Use Lubricant

Apply lubricant to help decrease friction and make insertion more comfortable.

You do not need to force a dry tool into sensitive tissues.

3. Start at the Opening

You do not even have to fully insert the dilator on your first attempt.

Let it rest gently at the vaginal opening.

Get comfortable there.

That may be all you do during your first few sessions.

And that is completely okay.

Keep Your Practice Short

Dilator work does not have to become a long, exhausting routine.

Pauli recommends starting with about 30 seconds to two minutes of practice.

You might simply allow the dilator to rest at the opening while you breathe and let your body become comfortable with the sensation.

Then you’re done.

Wash it.

Put it away.

Move on with your day.

You can practice this a couple of times each week rather than turning it into something stressful or overwhelming.

Slowly Progress the Position

Once you are comfortable inserting the dilator and letting it sit, you can begin allowing it to rest in slightly different positions within the vaginal canal.

Again, the goal is not to force a deep stretch.

It is to gradually introduce your tissues to different sensations while staying comfortable.

Once that size feels easy and successful, you can consider moving to the next size.

Then repeat the same process.

Start slowly.

Get comfortable.

Progress when your body is ready.

Bigger Is Not Automatically Better

A common mistake is assuming that the goal is to move through the dilator sizes as quickly as possible.

It isn’t.

The goal is not:

“How fast can I get to the biggest one?”

The better question is:

“Can I use this size comfortably and without pain?”

If the answer is yes, you may be ready to progress.

If the answer is no, stay where you are.

There is no prize for rushing.

Dilators Are a Tool, Not a Test

Vaginal dilators can be helpful because progressive sizes allow you to gradually become comfortable with increasing girth.

But the dilator itself is not the goal.

The goal is helping your body learn that insertion can happen without pain.

That is why your finger or a tampon applicator can also be useful starting points.

Choose the tool that helps you feel the most comfortable and successful.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If learning how to use vaginal dilators still feels intimidating or scary, that is okay.

You do not have to force yourself through it alone.

A pelvic floor physical therapist can help you understand where to start, what size may be appropriate, and how to progress without simply pushing through pain.

The goal isn’t temporary relief—it’s long-term strength, comfort, and confidence.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

You can also complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

Your body is not broken.

Start where you are comfortable.

Progress gradually.

And remember: successful dilator work is not about forcing your body to tolerate pain. It is about helping your body learn that touch and insertion can feel safe and comfortable again.

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Painful Speculum Exam? The Essential Guide to Preparing for a Pap Smear

Is it painful when you have a speculum exam for a Pap smear?

Or are you nervous just thinking about your next appointment?

If so, this is for you.

As a women’s health physical therapist, one thing that frustrates me is that women are expected to go in for important pelvic exams without ever being taught how to prepare for them.

A painful speculum exam can feel intimidating and uncomfortable, especially if your pelvic floor already has difficulty relaxing.

Most women were never taught this: your pelvic floor muscles need to be able to lengthen and accommodate the speculum during the exam.

The good news is that there are practical steps you can practice ahead of time to help you understand the process and feel more prepared.

First, Understand How a Speculum Works

A speculum can look pretty intimidating if you have never actually seen one.

During a Pap smear, the speculum is inserted vaginally and then opened to create enough space for your healthcare provider to perform the exam.

That means your pelvic floor muscles need to be able to lengthen and accommodate both the insertion and the opening of the speculum.

Cleveland Clinic also explains how speculums work, the different sizes available, and why some women may experience discomfort during an exam:

https://my.clevelandclinic.org/health/articles/24238-speculum

One of the first things I recommend is purchasing a small, plastic child-sized speculum.

Even before you use it, simply hold it.

Look at it.

Learn how it opens and closes.

Understanding what is actually being inserted into your body can take away some of the mystery surrounding the exam.

Start Smaller With a Tampon Applicator

Before practicing with a speculum, start with something smaller.

If insertion is uncomfortable, begin with a slim tampon applicator.

Once that feels comfortable, progress to:

  1. A slim tampon applicator
  2. A regular tampon applicator
  3. A super-size tampon applicator
  4. A child-sized speculum

The goal is to gradually become more comfortable with insertion rather than immediately jumping to the largest tool.

Practice Pressing “Around the Clock”

Once the tampon applicator is inserted comfortably, practice applying gentle pressure around the vaginal opening.

Think of the opening like the face of a clock.

You can gently explore different directions around that clock to help your pelvic floor become more comfortable accommodating pressure from different angles.

Once the smaller applicator feels comfortable, move up gradually through the different sizes.

You do not need to rush.

Get Comfortable With the Speculum Before Opening It

Once you feel comfortable using the tampon applicators, you can begin practicing with the child-sized speculum.

Start by simply practicing insertion and removal.

Before trying to open it while it is inserted, practice the mechanism with the speculum outside of your body.

Learn how it clicks open.

Learn how to release it.

Practice operating it from the same angle it would be positioned during a pelvic exam.

The goal is to understand exactly how the tool works so there are fewer surprises.

Try the One-Click Method

Once insertion feels comfortable and you understand how the mechanism works, Pauli recommends progressing gradually.

Insert the lubricated child-sized speculum slowly.

Then give it one click open.

Allow yourself a moment to adjust to that sensation.

Then release the click and slowly remove the speculum.

You do not need to immediately open it to its full capacity.

This gradual practice gives you more control over the experience and allows you to work at your own pace.

Put Yourself in the Driver’s Seat

One of the biggest benefits of preparing ahead of time is that you understand what feels comfortable for your body.

Pauli shares that many of her patients in Utah have brought their own child-sized speculum to their medical appointments.

Some doctors have been willing to use the smaller speculum, and some have even allowed the patient to insert or open the speculum herself.

That can be especially meaningful for women who have a history of trauma or who feel anxious about pelvic exams.

Instead of feeling like everything is happening to you, you can have more input into:

  • The pace of the exam
  • Your comfort level
  • How much time you need
  • The size of the speculum
  • When you are ready to proceed

A Pap smear is important.

But that does not mean you have to completely give up control of your body during the process.

Talk to Your Healthcare Provider

At your appointment, communicate what you need.

You can tell your provider that you have pelvic floor tightness or a history of painful exams.

If you have practiced with a smaller speculum and would like your provider to use it, ask whether they are comfortable doing so.

You may also need a little extra time before the exam begins.

The important thing is that you communicate rather than silently trying to endure discomfort.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If these steps still feel intimidating or scary, that is important information too.

You do not need to force yourself through the process alone.

A pelvic floor physical therapist can help you work through insertion, pelvic floor relaxation, and preparation for a speculum exam in a more supported setting.

A painful speculum exam does not have to be something you simply dread every time your next Pap smear approaches.

Preparation can help you understand what is happening, become more familiar with the tools involved, and feel more in control of your body.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

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Straining to Poop? Your Pelvic Floor Might Be the Problem

One of the things I love most about being a pelvic floor physical therapist is helping women understand parts of their bodies that no one ever explained to them.

And yes…sometimes that means talking about poop.

If you’re reading this and thinking, “I can’t believe I’m reading an entire article about bowel movements,” you’re not alone. But here’s the truth:

Your pelvic floor plays a huge role in how you poop.

Most women were never taught that.

Instead, if you’re constipated, you’ve probably heard advice like:

  • Drink more water.
  • Eat more fiber.
  • Take a stool softener.
  • Try a laxative.

While those things certainly have their place, they’re only part of the picture.

As a pelvic floor physical therapist, I always tell my patients there are two pillars to treating constipation. One pillar involves looking at the stool itself—things like hydration, nutrition, and consistency. The other pillar is something many people have never heard of:

How your pelvic floor functions.

In this article, I want to help you understand why your pelvic floor matters every time you have a bowel movement—and why pushing harder may actually be making things worse.

If you’d rather hear me explain it myself, you can also watch Episode 33: Pooping & Your Pelvic Floor on YouTube.

Why Your Pelvic Floor Matters When You Poop

When I explain constipation to my patients—including the children I treat—I use a very simple analogy.

Imagine one of those toddler shape-sorting toys.

You know the ones.

There’s a box with different-shaped holes—a star, a triangle, a square—and your child tries to fit each shape into the correct opening.

One of the hardest things to watch is when they keep trying to push a triangle through the star-shaped hole.

No matter how hard they push…

It isn’t going to fit.

That’s exactly what I think about when someone tells me they’re constantly straining to have a bowel movement.

Sometimes the problem isn’t that you’re not pushing hard enough.

The problem is that the opening isn’t working the way it’s supposed to.

Understanding What Happens Before You Feel the Urge to Go

Let’s simplify what’s happening inside your body.

Think of your intestines like a long series of pipes.

At the end of those pipes is what I like to call a trap door.

This trap door opens automatically and allows stool to move into a “holding room.”

That holding room is your rectum.

As stool fills your rectum, sensors tell your brain:

“It’s time to have a bowel movement.”

Isn’t that incredible?

Your body is designed to wait until there’s enough stool before interrupting your day.

It’s an incredibly efficient system.

But here’s where your pelvic floor enters the story.

At the very end of that holding room sits part of your pelvic floor—the muscles you can control.

These muscles help control whether the outlet relaxes enough for stool to pass comfortably or whether it meets more resistance.

Understanding your body creates confidence.

The Real Reason Straining Doesn’t Always Work

Here’s where I see so many women struggle.

When it’s time to have a bowel movement, your pelvic floor shouldn’t squeeze.

It should lengthen.

I like to describe it like a trampoline.

Imagine stretching a trampoline downward.

As it stretches, the opening in the middle becomes wider.

That’s what should happen with your pelvic floor.

When it lengthens, it creates less resistance so stool can pass more comfortably.

But many people experience pelvic floor dysfunction, where the opposite happens.

Instead of lengthening…

The pelvic floor tightens.

Instead of relaxing…

It pulls upward.

Now imagine trying to push stool through an opening that’s actually getting smaller.

It’s just like trying to shove that triangle through the star-shaped hole.

No wonder it feels frustrating.

Myth: If You Push Harder, You’ll Finally Go

This is one of the biggest misconceptions I hear.

When stool doesn’t come out easily, our natural instinct is to strain harder.

Unfortunately, for some people with pelvic floor dysfunction, that can make the coordination problem worse.

Instead of opening the pathway…

Your body creates more resistance.

That’s why so many people feel like they’re fighting their own bodies every time they sit on the toilet.

Your body is not broken.

It may simply be using the wrong muscle strategy.

Cleveland Clinic explains that pelvic floor dysfunction can involve difficulty relaxing and coordinating the pelvic floor muscles during a bowel movement, which may contribute to constipation and straining.

https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction

This is about more than symptom management.

Root-cause healing matters.

The Missing Piece: Teaching Your Pelvic Floor to Let Go

One of the first things I work on with many of my patients is helping them relearn a movement their bodies were designed to do naturally.

It’s called Balloon Breathing.

You may have heard of diaphragmatic breathing before.

Balloon breathing is my way of helping you understand what’s happening with your pelvic floor while you breathe.

Here’s how I explain it.

Imagine there’s a balloon inside your abdomen connected to a helium tank.

As you inhale:

  • Your belly gently expands.
  • Your ribs widen.
  • Pressure moves downward.

Now here’s the important part.

That gentle pressure should encourage your pelvic floor to drop, just like that stretched trampoline.

When you exhale:

  • Your diaphragm rises.
  • Your belly relaxes.
  • Your pelvic floor naturally comes back up.

This up-and-down motion is part of how your diaphragm and pelvic floor work together.

Pregnancy Can Change This Natural Pattern

One teaching point I want every mom to understand is that pregnancy and childbirth can change breathing, abdominal pressure, and pelvic floor coordination.

As your baby grows, everything inside your abdomen shifts.

Your ribs change.

Your diaphragm changes.

Your breathing changes.

Your organs have less room to move.

After delivery, many women are never taught how to reconnect with that normal breathing pattern.

That’s one reason pelvic floor coordination may become part of the constipation picture after pregnancy.

Most women were never taught this.

One Simple Exercise I Give My Patients

One strategy I often give my patients is to practice Balloon Breathing 60–80 times throughout the day.

The goal is not to force anything.

Instead, focus on noticing whether your pelvic floor gently drops as you inhale.

Once that becomes easier, I have them practice the same breathing while sitting on the toilet.

Instead of straining…

Instead of holding their breath…

Instead of pushing…

I encourage them to use their breath to help the pelvic floor lengthen naturally.

I jokingly tell my patients to “breathe your poop down.”

It usually gets a laugh.

But it also helps make the concept easy to remember.

One of my students once admitted she thought I had completely lost my mind after hearing me teach this.

The next day she came back and said she tried it herself.

She couldn’t believe how much easier—and honestly more satisfying—her bowel movement was.

That’s exactly what I want for my patients.

You should stand up after a bowel movement feeling like your body worked the way it was designed to.

Your Action Steps

If constipation has become your normal, I want you to start with these simple steps:

Practice Balloon Breathing Every Day

Practice multiple repetitions throughout the day and focus on noticing your pelvic floor gently drop with the inhale.

Stop Assuming Straining Is the Answer

If you’re constantly pushing, your pelvic floor may actually need to relax and coordinate better—not simply work harder.

Pay Attention to How You Feel After a Bowel Movement

An efficient, comfortable bowel movement can give you useful information about how well your body is coordinating.

Learn the Root Cause

If you continue to struggle with straining, incomplete emptying, or constipation, pelvic floor physical therapy can help evaluate whether pelvic floor coordination may be part of the problem.

Your Next Step

If constipation has become something you’ve simply learned to live with, I want you to know there may be another answer.

The goal isn’t temporary relief—it’s long-term function.

Healing isn’t about pushing harder.

It’s about helping your body do what it was designed to do.

If you’re ready to stop guessing and start understanding your body, fill out Your Pelvic Floor’s Next Step Form so we can identify what’s really contributing to your symptoms and determine the best path forward.

https://www.beyondthevbypauli.com/nextstep

You deserve better than fear-based advice.

You deserve to understand your body.

And when your pelvic floor functions the way it was designed to, even something as ordinary as having a bowel movement can become easier, more comfortable, and something you no longer have to think twice about.

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Pelvic Floor Physical Therapy for Endometriosis: How It Can Help

One of the most common questions women ask is:

“If pelvic floor physical therapy doesn’t treat endometriosis, why would it help my symptoms?”

It’s a fair question.

Because most of the time, endometriosis is talked about as something that exists only in the uterus or pelvic organs.

So it makes sense to wonder why working with muscles, breathing, and movement would matter.

But what many women discover is this:

Their pain is not coming from just one place.

And their healing doesn’t have to either.

Your body is not broken.

Let’s talk about what’s actually going on.

Endometriosis Is More Than a Tissue Problem

Endometriosis is often described as tissue similar to the uterine lining growing outside the uterus.

But the symptoms women experience are rarely just from the tissue itself.

Pain is also influenced by:

  • Inflammation
  • Adhesions or scar tissue
  • Muscle guarding
  • Nervous system sensitivity
  • Changes in movement patterns

The Cleveland Clinic explains that endometriosis can lead to chronic pelvic pain due to inflammation and irritation of surrounding structures—not just the lesions themselves.

This is where the pelvic floor becomes a major part of the picture.

The Pelvic Floor Responds to Everything Happening in the Pelvis

Your pelvic floor muscles sit at the base of your pelvis and support your bladder, uterus, and rectum.

They are constantly adapting to what is happening above them.

So when there is:

  • Ongoing pain
  • Inflammation
  • Surgical history
  • Limited movement
  • Fear of movement

Your pelvic floor often responds by tightening or guarding.

This is not random.

It is protective.

But over time, protection can turn into dysfunction.

That’s when symptoms begin to show up as:

  • Pelvic pain
  • Pain with intimacy
  • Constipation
  • Bladder urgency or frequency
  • A feeling of tightness or pressure
  • Difficulty relaxing

Understanding this connection is one of the first steps toward meaningful healing.

Understanding your body creates confidence.

Why Pelvic Floor Physical Therapy Helps (Even Without Treating Endometriosis)

Pelvic floor physical therapy does not remove endometriosis.

It does not replace medical or surgical care.

But it does something equally important:

It helps your body function better around the pain.

This is where real change begins.

The https://www.aptapelvichealth.org/ supports pelvic health physical therapy as an evidence-informed approach for treating pelvic floor dysfunction and chronic pelvic pain conditions often seen alongside endometriosis.

Here’s how it helps.

1. It reduces pelvic floor guarding

When your body has been in pain for a long time, your muscles often stay slightly “on” all the time.

They are trying to protect you.

But constant protection becomes tension.

Pelvic floor physical therapy helps:

  • Teach muscles how to relax again
  • Reduce overactivity
  • Improve coordination
  • Break the pain–tension cycle

This is not about forcing relaxation.

It’s about retraining safety into the system.

2. It restores the core–pelvic floor connection

Your diaphragm, deep core, and pelvic floor work together every time you breathe and move.

When pain, surgery, or inactivity disrupts this system, symptoms can increase.

You may notice:

  • Shallow breathing
  • Core weakness or instability
  • Avoidance of movement
  • Increased pelvic tension

PT helps retrain this coordination so your body can function as a connected system again.

This matters more than most women are ever told.

3. It calms the nervous system

Pain is not just a structural issue—it is a nervous system experience.

When pain persists, your body becomes more protective over time.

That can lead to:

  • Increased sensitivity
  • Muscle guarding
  • Fear of movement or intimacy
  • Feeling like your body is “on alert”

Pelvic floor physical therapy uses:

  • Gentle movement
  • Breathwork
  • Gradual exposure to activity
  • Education and reassurance

to help your system shift out of protection and back into safety.

This is where symptoms often begin to change.

4. It rebuilds trust in your body

This may be the most important part.

Many women with endometriosis begin to feel like their body is unpredictable or unreliable.

They stop exercising.

They avoid intimacy.

They fear symptoms returning.

But when you begin to understand what your body is doing—and why—it changes everything.

You begin to realize:

  • Movement is not dangerous
  • Pain does not always mean damage
  • Your body is adaptable
  • Healing is possible, even with endometriosis

This is about more than symptom relief.

It is about rebuilding confidence in your body.

Myth: PT Only Helps After Surgery

Pelvic floor physical therapy is often misunderstood as something you only do after surgery.

But it can be helpful at every stage:

  • Before diagnosis
  • After diagnosis
  • Before surgery
  • After surgery
  • Alongside medical treatment

Because it is not focused on the disease itself.

It is focused on how your body is functioning.

Root-cause healing matters.

What This Means for You

If you are living with endometriosis and experiencing:

  • Pelvic pain
  • Pain with intimacy
  • Bladder or bowel changes
  • Tightness or pressure
  • Difficulty exercising
  • Ongoing unexplained discomfort

Your pelvic floor may be playing a much larger role than you’ve been told.

And the encouraging part is:

This is something you can work on.

Not by pushing harder.

But by retraining how your body moves, responds, and functions over time.

Your Next Step

If you are struggling with endometriosis symptoms and want clarity on what is driving your pelvic pain, you do not have to figure it out alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can help you understand your body and identify your best next step.

https://www.beyondthevbypauli.com/nextstep

If you are ready for a structured approach to rebuilding core and pelvic floor strength without relying on endless Kegels, explore the No Kegels University® Method.

Healing is not about perfection.

It is about understanding, consistency, and progression.

Your body is capable of adaptation, strength, and change—even with endometriosis.

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Pelvic Floor Breathing Exercises: How Balloon Breathing Helps You Relax

When you are managing a chronic pelvic condition, your body can easily get trapped in a state of high alert. Constant physical discomfort can make your breathing shallow, your posture tense, and your baseline stress levels skyrocket. Before you know it, you are preferring to head to bed early to just try and sleep through the discomfort rather than enjoying your life.

Most women were never taught this, but chronic pain can change how you breathe and how your body holds tension. You deserve better than generic advice that tells you to simply “relax” without giving you the physical tools to do so. Learning how to direct your breath into your lower abdomen can be a simple, effective way to calm your nervous system and restore natural movement to your pelvic floor.

The Power of Three-Dimensional Breathing

Standard breathing advice usually focuses entirely on filling your lungs and expanding your upper chest. While that keeps you oxygenated, it can leave out what is happening through your abdomen and pelvic floor.

To safely manage internal tension, think of your torso as a three-dimensional chamber. When you take a deep inhale, your diaphragm—the large muscle sitting right under your ribs—descends downward. As it drops, the structures below it respond to that movement.

This creates a natural, responsive pressure change that reaches all the way to the base of your pelvis, allowing your pelvic floor muscles to gently stretch, drop, and lengthen. When you exhale, the system reverses and the pelvic floor naturally recoils.

Belly Breathing vs. Chest Breathing

A massive misconception across general fitness and women’s wellness is that a flat, rigid, tucked-in stomach is a sign of a healthy, functioning core.

The Breathing Fact: Constantly gripping or sucking in your abdominal muscles can interfere with relaxed diaphragmatic breathing and may contribute to increased pelvic floor tension.

Many people also believe that therapeutic pelvic floor exercises always have to involve active, forceful contractions like Kegels.

In reality, if your pelvic muscles are already tight or guarded, adding more forceful contractions may not be what your body needs and can sometimes aggravate symptoms.

Shifting Out of the Fight-or-Flight Lock

Why can shallow breathing and stress make pelvic symptoms feel worse?

It comes down to the relationship between your nervous system, your breathing, and the way your muscles hold tension.

When you experience ongoing pelvic discomfort, or navigate a complex postpartum recovery, your nervous system may become more protective and alert. Your abdomen, hips, and pelvic floor may begin holding additional tension as part of that protective response.

Over time, that guarding can contribute to symptoms associated with a tight or overactive pelvic floor.

Diaphragmatic breathing can support relaxation and help your pelvic floor practice moving through a fuller range instead of remaining constantly guarded.

APTA Pelvic Health explains how diaphragmatic breathing and pelvic floor relaxation can be used together to help reduce pelvic floor muscle tension.

https://www.aptapelvichealth.org/info/relaxation-of-the-pelvic-floor-muscles

Root-cause healing matters, and learning better breathing mechanics can be one useful tool for helping your body shift toward a calmer, more relaxed state.

How to Practice Balloon Breathing

To help your nervous system let go of some of its protective tension and restore natural movement through your pelvic floor, try practicing this balloon visualization method:

  1. Visualize the Internal Balloon: Lie down comfortably on your back or side. Imagine there is a soft balloon sitting deep inside your lower abdomen, right between your hip bones.
  2. Fill the Balloon Symmetrically: Take a slow, quiet inhale through your nose. Instead of letting all of the movement happen in your upper chest, focus on filling that internal balloon. Imagine it expanding three-dimensionally—stretching the front of your belly, widening into your sides, pressing gently into your lower back, and expanding down toward the bottom of your pelvis.
  3. Monitor the Lower Abdomen: Place a hand between your belly button and your pubic bone. Notice whether this lower section gently rises along with your upper belly rather than remaining completely flat or rigid.
  4. Allow a Passive Pelvic Drop: As you fill the bottom of the balloon, imagine your pelvic floor softly dropping and lengthening away from your ribs. Exhale slowly and comfortably, letting the balloon deflate naturally without forcing the air out.

The goal isn’t temporary relief—it’s long-term strength.

True pelvic wellness means giving your body the space and permission to let go of unnecessary guarding. By practicing three-dimensional balloon breathing, you can support your nervous system, improve your breathing and pelvic floor coordination, and become more connected to what your body is doing.

You don’t need more generic core workouts.

You need a strategy that respects your symptoms, your boundaries, and your individual goals.

If chronic pelvic floor tightness is affecting your daily life, fill out Your Pelvic Floor’s Next Step Form so we can help determine what kind of support may be right for you:

https://www.beyondthevbypauli.com/nextstep

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Stress and Painful Sex: How Fight-or-Flight Affects Your Pelvic Floor

Are you the honorary queen of the stress club?

If you constantly find yourself rushing through a never-ending daily checklist, balancing work deadlines, managing a household, and carrying the mental load of motherhood, you are definitely not alone.

Many women spend their days running on pure adrenaline, only to face a frustrating hurdle at night: when they attempt to connect intimately with their husbands, physical intimacy feels uncomfortable or even painful.

When sex hurts, it is natural to worry that something is fundamentally wrong with your anatomy. You might wonder if your hormones are failing or if your body is simply incapable of enjoying intimacy after childbirth.

Your body is not broken.

Most women were never taught this: stress can be one important contributor to painful intimacy. When your nervous system stays on high alert, your muscles—including your pelvic floor—may have a harder time fully relaxing.

This is about more than symptom management. To understand why stress and painful sex can be connected, it helps to understand how your nervous system influences both arousal and pelvic floor tension.

The Science Behind the High-Stress Shutdown

To understand why stress can change your physical experience, we have to look at the two sides of the autonomic nervous system.

The Sympathetic State: Fight-or-Flight

When you are nervous, anxious, overwhelmed, or under pressure, your sympathetic nervous system helps prepare your body to respond.

Your heart rate may increase.

Your breathing may change.

Your muscles may become more tense.

This system is incredibly useful when you actually need to respond to a threat.

But your body can also respond to everyday stressors—deadlines, a chaotic house, lack of sleep, family responsibilities, and mental overload.

When your mind is still racing, shifting into desire and arousal may become much more difficult.

The Parasympathetic State: Rest-and-Digest

The parasympathetic nervous system is associated with rest, recovery, and relaxation.

You do not need to be perfectly calm in order to enjoy intimacy.

But if your body is already tense and overwhelmed, it may be harder to transition into a state where physical connection feels comfortable.

Mayo Clinic notes that stress can cause the pelvic floor muscles to tighten and may contribute to pain during sex. Mayo Clinic

The Pelvic Floor Connection: Chronic Muscle Tension

The second reason stress can affect intimacy involves the pelvic floor itself.

Think about what happens elsewhere in your body when you’re stressed.

You may:

  • Clench your jaw
  • Raise your shoulders
  • Tighten your stomach
  • Hold your breath

Your pelvic floor can also respond to stress by holding more tension.

Cleveland Clinic lists stress and anxiety among factors associated with a hypertonic pelvic floor—a condition in which the pelvic floor muscles stay overly contracted and have difficulty relaxing. Pain during or after sex can be one of the symptoms. Cleveland Clinic

One of the important jobs of the pelvic floor during intercourse is to relax and accommodate.

If those muscles are already holding significant tension before intimacy even begins, comfortable penetration may become more difficult.

This does not happen exactly the same way for every woman, and stress is not the only possible cause of painful sex.

But it can be an important part of the picture.

Myth-Busting: “Just Push Through It”

Let’s bust an incredibly common and harmful piece of advice:

If you just force yourself to relax or push through the initial pain, your body will eventually catch up.

You deserve better than fear-based advice that tells you to ignore what your body is communicating.

If sex has already become associated with pain, forcing yourself through another painful experience may increase your anticipation of pain the next time.

That can create a cycle:

Stress or anticipation → pelvic floor guarding → pain → increased fear of pain → more guarding

The goal is not to train yourself to tolerate pain.

The goal isn’t temporary relief—it’s long-term strength, comfort, and a body that feels safe enough to relax.

Practical Steps to Shift Toward Rest-and-Digest

Shifting your body out of constant high alert does not mean eliminating every source of stress from your life.

That probably isn’t realistic.

Instead, look for small opportunities to help your nervous system transition into a calmer state.

1. Schedule Intimacy During Lower-Stress Windows

Stop waiting for the magical spontaneous moment when your life suddenly becomes perfectly calm.

Look at your calendar.

When is your workload lighter?

When are family responsibilities usually easier?

When do you tend to have more energy?

Consider protecting those windows for connection instead of waiting until the end of your most exhausting day.

Scheduling intimacy does not mean you are required to have penetrative sex.

It simply creates space for connection without forcing your brain to shift from full-speed productivity into intimacy with no transition.

2. Practice Yoga Nidra or Guided Relaxation

Consider adding Yoga Nidra or another guided relaxation practice a few times each week.

Yoga Nidra usually involves lying comfortably and listening to a guided meditation or body-awareness practice.

There is no strenuous exercise required.

If Yoga Nidra isn’t your thing, you could also experiment with:

  • Slow breathing
  • Meditation
  • Gentle yoga
  • Guided imagery
  • Progressive muscle relaxation

The point is not finding the “perfect” relaxation method.

Find something that actually helps you slow down.

3. Perform a Daily Brain Dump

Sometimes your body is in bed while your brain is still working.

Before trying to connect with your husband, spend a few minutes writing down everything taking up mental space.

That might include:

  • Tomorrow’s grocery list
  • Work tasks
  • Appointments
  • Things you don’t want to forget
  • Family responsibilities
  • Worries running through your head

You don’t have to solve any of them.

Simply get them out of your head and onto paper.

Think of it as giving your brain permission to stop holding onto every responsibility for the rest of the night.

When Stress Isn’t the Whole Story

Stress can contribute to pelvic floor tension, but it is not the only reason sex may hurt.

Painful intercourse can also be related to:

  • Vaginal dryness
  • Pelvic floor dysfunction
  • Endometriosis
  • Scar tissue
  • Infection or irritation
  • Hormonal changes
  • Other pelvic health conditions

Mayo Clinic emphasizes that painful sex can have several physical and emotional causes, which is why persistent pain deserves evaluation rather than simply being blamed on stress. Mayo Clinic

If pain continues, a pelvic floor physical therapist can help determine whether muscle tension, coordination, nervous system sensitivity, or another factor may be contributing.

Understanding Your Body Creates Confidence

Understanding your body creates confidence.

Your pelvic floor is not betraying you.

If your muscles are guarding, they may simply be responding to the stress and demands your body is carrying.

That does not mean you have to accept painful intimacy.

It means your recovery may need to include more than physical stretching or strengthening alone.

Pay attention to your stress.

Give your nervous system opportunities to slow down.

Create transition time before intimacy.

And get individualized support when your symptoms continue.

Your body is not broken.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form: https://www.beyondthevbypauli.com/nextstep

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Endometriosis and Pain With Sex: Why Your Pelvic Floor May Be Involved

Do you have endometriosis and experience pain with sex?

If you’ve been wondering why intimacy hurts, you are not alone.

As a women’s health physical therapist, one of the things I want women to understand is that endometriosis can affect the way structures inside the pelvis move.

Most women were never taught this.

And when those structures cannot move the way they are supposed to during intimacy, pain can become part of the experience.

How Endometriosis Can Affect Movement Inside the Pelvis

One of the things we know about endometriosis is that it creates lesions that can be black, tarry, and sticky.

These lesions can be found on different structures throughout the body, including:

  • The bladder
  • The uterus
  • Ligaments
  • Other areas inside the pelvis

They have even been found in other areas of the body.

The important piece when we’re talking about pain with intercourse is this:

Where those lesions are located can affect how well the organs and tissues around them move.

Your body is designed to move internally.

Your organs are not supposed to stay completely fixed in one position.

During intimacy, that movement matters.

Mayo Clinic notes that endometriosis can cause pain during or after sex and may also lead to scar tissue and adhesions that cause pelvic tissues and organs to stick together.

Learn more from Mayo Clinic about endometriosis

What Happens During Arousal

As the female body becomes aroused, the uterus lifts and pulls away from the vaginal canal.

This is not a huge movement, but it is still an important part of how the body prepares for intercourse.

If the uterus has lesions on it, or if lesions on the bladder, ligaments, or ovaries limit how those structures move, the uterus may not be able to shift as freely.

The body is trying to do what it is supposed to do.

But if that movement is restricted, dysfunction can occur.

And that dysfunction can contribute to pain.

The Pelvic Floor Connection

The pelvic floor also plays an important role during intercourse.

The pelvic floor muscles need to part and accommodate during penetration.

That allows space for a penis, finger, or other form of penetration.

If those muscles are not functioning well because of what is happening in the structures above them, they may not be able to do their job as effectively.

Instead of comfortably making room for penetration, the system may become restricted.

That can contribute to pain with intimacy.

Why This Matters

For many women, this connection has never been explained.

They know they have endometriosis.

They know sex hurts.

But no one has helped them connect those two experiences through the way their internal tissues and pelvic floor function together.

Understanding what may be happening inside your body can help the symptoms feel less mysterious.

Understanding your body creates confidence.

What to Do Next

If you have endometriosis and pain with sex, consider working with a provider who understands both women’s health and pelvic floor function.

A pelvic floor physical therapist can help evaluate how your pelvic floor is functioning and whether it may be contributing to the pain you are experiencing.

If you’re local, schedule an appointment. If you’re not, look for a pelvic floor physical therapist in your area who can help you better understand what your body needs.

Your body is not broken.

Pain with intimacy deserves attention, answers, and support.

If you’re ready to stop guessing and start understanding your body, complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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Pelvic Floor Therapy for Painful Sex: The Missing Link Most Women Miss

Pelvic floor therapy for painful sex often starts with relaxation, stretching, breathing, or dilator work. But what happens when you’ve been doing all of those things and your progress suddenly stalls?

If you experience sharp pain, burning, or a sensation of hitting a “brick wall” during intimacy, inserting a tampon, or undergoing a routine speculum exam at the gynecologist, you know how incredibly isolating it feels. It’s easy to feel like your body is failing you, or to worry about the toll it’s taking on your marriage.

Even when women finally build up the courage to seek help, they often get stuck in a repetitive cycle of treatment that yields incomplete results.

As a pelvic floor physical therapist, I am on a mission to change this conversation because no woman should have to struggle when there are real answers. Even within the physical therapy world, there is a massive component that can sometimes get missed when treating pain during sex.

If you have been diligently stretching, using dilators, or practicing deep breathing but your progress has completely plateaued, you might be missing another piece of the puzzle: strategic pelvic floor strengthening.

The Core Functions of Your Pelvic Floor

To understand why your current approach might be stalling, we have to look at how muscles actually function. Your pelvic floor is a hammock of muscles sitting at the base of your pelvis. Just like any other muscle group in your body, a healthy pelvic floor must be able to move through a full, dynamic range of motion.

A healthy pelvic floor has three primary movement patterns.

First, it must contract, moving upward and inward to support your organs and maintain continence.

Second, it needs to relax completely back to its resting baseline.

Third, it must be able to lengthen, allowing the muscles to accommodate things like penetration, bowel movements, and childbirth.

When women suffer from pain with penetration, the natural instinct—for both patients and therapists—is to focus heavily on the downward motion. We spend weeks trying to get the tight pelvic floor muscles to relax, unwind, and tolerate insertion.

That makes sense.

Cleveland Clinic explains that a hypertonic pelvic floor occurs when the pelvic floor muscles stay overly contracted and have difficulty relaxing. This can contribute to pelvic pain and pain during or after sex.

Learn more from Cleveland Clinic about hypertonic pelvic floor

While relaxation is absolutely important to breaking the initial pain cycle, most women were never taught this: recovery may eventually require rebuilding more than relaxation alone.

For some women, once the muscles can relax and lengthen more comfortably, restoring strength and coordination can become part of the next phase of healing.

The Paradox: Why Strength and Relaxation Can Work Together

It sounds entirely counterintuitive at first.

If your muscles are already too tight and causing pain during sex, why would you ever want to strengthen them?

The answer is timing.

Healthy muscles need to be able to move through their full range—not just stay clenched and not just stay relaxed.

When the pelvic floor has begun regaining the ability to lengthen and release, gradual strengthening may help restore:

  • Coordination
  • Endurance
  • Support
  • Confidence with movement

The goal is not to squeeze an already guarded muscle harder.

The goal is to help the muscle learn how to contract and then fully let go again.

By strategically strengthening the pelvic floor at the right stage of recovery, some women can begin rebuilding the stability and coordination needed for everyday movement.

Understanding your body creates confidence, and knowing that strength and relaxation can both matter changes how you view your recovery.

APTA Pelvic Health explains that pelvic pain treatment may involve addressing muscle tightness, weakness, flexibility, coordination, breathing, and individualized movement—not just one single exercise.

Learn more from APTA Pelvic Health about pelvic pain and physical therapy

Myth-Busting: “Start Doing Kegels Immediately to Fix Pelvic Pain”

With the rise of pelvic health awareness on social media, there is a common piece of misinformation floating around the internet: the idea that if you have pelvic issues, you should immediately start squeezing your pelvic floor through repetitive Kegels.

The Important Warning: If you have a tight pelvic floor and begin aggressive, unguided strengthening too soon, you may make your symptoms worse.

If your muscles are already locked in a shortened state and struggling to relax, clenching them tighter may reinforce that guarded pattern.

You deserve better than fear-based advice or generalized internet workouts.

The timing of your recovery strategy matters.

Some women need relaxation first.

Others may eventually need strengthening.

Many need both at different stages.

The Rule of 30–40%: When Is It Time to Strengthen?

How do you know when your body is actually ready to transition from pure relaxation into strategic strengthening?

In my clinical approach, I often use 30% to 40% symptom improvement as a practical checkpoint to start thinking about the next phase.

This is not a universal medical rule for every woman.

It is simply a clinical guide I use to help assess whether someone may be ready to add more strengthening and coordination work.

During the initial phase of healing, when you experience high pain with penetration and cannot tolerate tampons, your strategy may need to focus more heavily on:

  • Diaphragmatic breathing
  • Relaxation
  • Gentle mobility
  • Dilator work when appropriate
  • Reducing muscle guarding

Once you begin feeling noticeably better—perhaps around that 30% to 40% range—you may be ready to start gradually building strength.

That might look like:

  • Less pain with insertion
  • Better ability to relax your pelvic floor
  • Less bracing
  • More confidence with touch
  • Better tolerance of movement

The key is not the exact percentage.

The key is that your pelvic floor is beginning to relax and move more normally before you add more load.

Practical Action Steps for Long-Term Strength

If you are ready to move past temporary fixes and build a more resilient body, here is your roadmap:

1. Assess Your Progress Honestly

Ask yourself:

  • Is penetration less painful than when I started?
  • Can I relax my pelvic floor more easily?
  • Are tampons or exams becoming more comfortable?
  • Do I feel less fearful or guarded?

If yes, it may be time to talk with your pelvic floor physical therapist about progressing your routine.

If no, continuing to focus on relaxation and down-training may still be appropriate.

2. Avoid Isolated Squeezing

Do not sit at your desk or in your car mindlessly squeezing your pelvic floor because you assume more contractions will automatically create better results.

Your pelvic floor works with your breathing, core, hips, and movement.

Strengthening should be intentional and appropriate for your stage of recovery.

3. Keep Relaxation in the Program

Adding strength does not mean you stop practicing relaxation.

A healthy pelvic floor needs both.

Continue using:

  • Diaphragmatic breathing
  • Gentle mobility
  • Body awareness
  • Nervous system calming strategies

The goal is a muscle that can contract when needed and relax when needed.

4. Partner With a Specialized PT

The timing of this transition can trip up almost everyone.

A specialized pelvic floor physical therapist can evaluate your resting muscle tone, strength, coordination, and ability to relax and help determine when your body is ready for the next stage.

That is much more effective than trying to guess based on generic advice online.

Building Strength Without Losing Relaxation

Painful intimacy recovery is not about choosing between strengthening and relaxation.

Pelvic floor therapy for painful sex eventually needs to include both relaxation and carefully timed strengthening.

For many women, it is about learning when each one belongs in the process.

Early on, your body may need:

Relaxation. Lengthening. Reduced guarding.

Later, it may need:

Strength. Coordination. Movement.

The goal isn’t temporary relief—it’s long-term strength.

Reclaiming intimacy without fear requires a comprehensive strategy that respects how your body is designed to move.

Your body is not broken.

If your progress has plateaued, it does not mean you have failed.

It may simply mean your recovery plan needs to evolve.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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Endometriosis and Chronic Pain: Why “Nothing Is Wrong” Isn’t the Whole Story

If you have endometriosis, there’s a good chance you’ve experienced something frustrating—and unfortunately, incredibly common.

You’ve described your pain.

You’ve explained how it affects your daily life.

You’ve shared how it impacts your work, exercise, relationships, or intimacy.

And then you’ve heard something like:

“Your scans look normal.”

“We didn’t find much.”

“Everything looks fine.”

“Maybe it’s stress.”

For many women, these conversations leave them questioning their own experiences. They start wondering if they’re overreacting or imagining things.

But here’s what every woman with endometriosis needs to hear:

Your body is not broken. And your pain is real.

As a women’s health physical therapist, I see women who have spent years searching for answers. Some have been told that the amount of endometriosis found doesn’t seem severe enough to explain how much pain they’re experiencing.

The truth is that endometriosis and chronic pain are complex, and pain can involve much more than what appears on a scan or during surgery.

Understanding your body creates confidence, and understanding why pain occurs is often the first step toward finding a better path forward.

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining inside the uterus grows outside of the uterus.

It most commonly affects structures within the pelvis, including the ovaries, fallopian tubes, and surrounding pelvic tissues.

Common symptoms may include:

  • Painful periods
  • Chronic pain
  • Pain during or after intercourse
  • Lower back or abdominal pain
  • Pain with bowel movements or urination
  • Digestive symptoms
  • Fertility challenges

Mayo Clinic explains that endometriosis can irritate surrounding tissues and contribute to scar tissue and adhesions. These adhesions are bands of fibrous tissue that may cause pelvic tissues and organs to stick to one another. Pain during or after sex is also a common symptom of endometriosis. Mayo Clinic

Mayo Clinic: Endometriosis Symptoms and Causes

One of the confusing parts of endometriosis is that the amount of visible disease doesn’t always explain the entire pain experience.

That disconnect is where many women begin to feel dismissed.

Why “Nothing Is Wrong” Is Often the Wrong Conclusion

One of the biggest misconceptions surrounding endometriosis is the belief that more visible disease automatically means more pain.

Pain is much more complicated than that.

Chronic pelvic pain can involve several factors at once, including:

  • Endometriosis
  • Tissue irritation
  • Pelvic floor muscle tension
  • Connective tissue restrictions
  • Nerve irritation
  • Bladder or bowel conditions
  • Nervous system sensitivity
  • Stress and previous pain experiences

Mayo Clinic describes chronic pelvic pain as a complex condition that may have more than one contributing cause. In some cases, testing may not identify one single explanation for the symptoms. Mayo Clinic

Mayo Clinic: Chronic Pelvic Pain

When providers focus only on what can be seen on imaging or during surgery, they may miss other contributors to the pain experience.

The Missing Piece: Your Pelvic Floor

One of the most overlooked contributors to chronic pelvic pain is the pelvic floor.

The pelvic floor is a group of muscles at the bottom of your pelvis.

These muscles support your:

  • Bladder
  • Bowel
  • Uterus and other pelvic organs

They also contribute to:

  • Bladder and bowel control
  • Core stability
  • Sexual function
  • Movement
  • Pressure management

When endometriosis creates ongoing pain or irritation within the pelvis, the surrounding muscles may begin responding protectively.

Your body’s natural response to pain is often to guard the painful area.

Think about what happens when you hurt your back.

You don’t consciously decide to tighten every surrounding muscle.

Your body does it automatically to protect you.

The pelvic floor can respond the same way.

At first, this tension may serve a protective purpose.

But if pain continues for months or years, those muscles may begin having difficulty fully relaxing.

That can contribute to:

  • Chronic pelvic pain
  • Pain during intercourse
  • Tailbone pain
  • Hip or low back pain
  • Urinary urgency
  • Constipation
  • Feelings of pelvic tightness or pressure

Most women were never taught this.

Many don’t realize that the pelvic floor muscles themselves can become another piece of the chronic pain puzzle.

How Endometriosis Can Affect Tissue Movement

Your organs, ligaments, and connective tissues aren’t designed to remain completely rigid.

Your bladder fills and empties.

Your bowel moves.

Your reproductive organs and surrounding tissues shift as your body changes position.

Healthy movement requires tissues to glide against one another.

Endometriosis can sometimes contribute to inflammation, scar tissue, or adhesions that affect this normal mobility.

Instead of thinking of the organs as literally being covered in “sticky glue,” a more accurate picture is that fibrous adhesions may restrict normal movement between tissues.

Those restrictions may become another source of discomfort within an already sensitive pelvis.

And when surrounding tissues hurt, the pelvic floor may become even more protective.

This is about more than symptom management.

Root-cause healing matters.

Myth-Busting: “If Doctors Don’t See Much, the Pain Must Be in Your Head”

Let’s address one of the most harmful conclusions women with chronic pelvic pain can hear.

If testing doesn’t reveal a simple explanation for your pain, that does not mean the pain isn’t real.

Myth: Normal imaging means nothing is wrong

Reality: Chronic pelvic pain can involve muscles, nerves, connective tissues, the bladder, bowel, reproductive organs, and the nervous system.

Myth: Pain that seems “too severe” must be psychological

Reality: Pain is a real nervous system experience. Emotional stress can influence pain, but that does not make the physical experience imaginary.

Myth: Treating endometriosis should automatically eliminate every pelvic symptom

Reality: For some women, muscle guarding or other contributors may continue even after the underlying endometriosis has been treated.

APTA Pelvic Health notes that pelvic pain can involve pelvic floor muscle tightness or weakness, tender muscle areas, nerve involvement, scar tissue, and conditions affecting pelvic organs—including endometriosis. APTA Academy of Pelvic Health

You deserve providers who understand that women’s health and chronic pelvic pain can involve more than one system.

The Root Cause: Chronic Pain Can Create Chronic Protection

One of the most important things to understand about chronic pain is that the body adapts.

When pain continues, you may begin changing the way you move without realizing it.

Muscles may stay tense.

Breathing patterns may change.

Certain activities may become guarded.

Your nervous system may become more alert to sensations within the painful area.

For some women, the cycle may look something like this:

Step 1: Endometriosis contributes to pelvic irritation or pain

Step 2: The pelvic floor tightens protectively

Step 3: Persistent muscle tension creates additional discomfort

Step 4: Pain makes the nervous system increasingly protective

Step 5: The cycle becomes easier to trigger

This isn’t the exact progression for every woman.

But understanding the possibility of a pain-and-guarding cycle can help explain why symptoms may continue even when you’ve already tried treatments aimed at the endometriosis itself.

The goal isn’t temporary relief—it’s long-term strength, comfort, and function.

Action Steps if You’re Struggling With Chronic Pelvic Pain

1. Seek Specialized Care

Consider working with a pelvic floor physical therapist who understands endometriosis and chronic pelvic pain.

A pelvic health physical therapist can evaluate factors such as:

  • Pelvic floor muscle tension
  • Weakness
  • Coordination
  • Tender areas
  • Movement patterns
  • Breathing
  • Nerve involvement

Treatment should be individualized rather than based on one generic exercise plan. APTA Pelvic Health describes pelvic health physical therapy as a whole-person approach tailored to the patient’s symptoms, lifestyle, health history, and goals. APTA Academy of Pelvic Health

2. Pay Attention to Symptom Patterns

Notice:

  • When symptoms increase
  • Whether pain changes around your menstrual cycle
  • Which movements make symptoms worse
  • Whether intercourse or bowel movements trigger pain
  • Whether stress or fatigue changes your symptoms

Patterns can give your healthcare team valuable information.

3. Don’t Assume More Kegels Are the Answer

Pelvic floor dysfunction doesn’t automatically mean weakness.

If your muscles are already tight and guarding, repeatedly contracting them may not address the problem.

Some women need strengthening.

Others need relaxation and mobility.

Many need a combination of strategies.

4. Address the Whole System

Healing may involve more than treating one diagnosis.

Depending on your individual situation, care may involve:

  • Medical treatment for endometriosis
  • Pelvic floor physical therapy
  • Movement and exercise
  • Breathing and pressure management
  • Bowel and bladder support
  • Nervous system regulation
  • Pain education

Understanding your body creates confidence.

5. Keep Advocating for Yourself

If you feel dismissed, keep asking questions.

Look for providers who understand endometriosis, pelvic floor dysfunction, and chronic pelvic pain.

Your symptoms deserve thoughtful investigation.

You’re Not Alone

If you’ve been told that your pain doesn’t make sense, you’re not alone.

Many women with endometriosis feel frustrated when their symptoms don’t seem to match what providers can easily see.

But pain is complex.

The pelvis is complex.

Your pelvic floor, surrounding tissues, nervous system, bladder, bowel, reproductive organs, and movement patterns can all influence the way your body experiences pain.

Your body is not broken.

And your symptoms deserve more than another generic answer.

When we stop looking only at one structure and begin considering the entire system, we create more opportunities to understand what may actually be contributing to your pain.

Root-cause healing matters.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals:

Your Pelvic Floor’s Next Step Form

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Kegels for Pelvic Floor Problems: Why Squeezing Isn’t Always the Answer

For decades, women experiencing pelvic floor issues have been given the exact same piece of advice: “Just do your Kegels.” Whether you are dealing with bladder leaking when you sneeze or struggling to enjoy intimacy in marriage because of pain, the standard response is almost always to squeeze and hold.

But what happens when you do hundreds of repetitive pelvic floor exercises and nothing changes? Or worse, what if your symptoms actually feel like they are getting worse?

If you are struggling to enjoy intimacy because it is painful, or if you feel isolated by embarrassing leaks, I hear you, and you are not alone. It is deeply frustrating when you want to feel connected to your spouse and proud of your body, but physical discomfort gets in the way.

Understanding your body creates confidence. The truth is, Kegels aren’t the right solution for every pelvic floor problem, and most women were never taught how these muscles actually work.

Let’s look at the root cause of these symptoms and why it may be time to move beyond the Kegel.

The Problem With the “Just Squeeze” Approach

To understand why standard pelvic floor exercises sometimes fall short, think about any other muscle in your body.

If you had a tight, overworked, knotted muscle in your neck or shoulder, you wouldn’t necessarily fix it by doing repetitive shrugs and squeezing it tighter. Depending on the problem, you might need to work on relaxation, mobility, coordination, and eventually strength.

Your pelvic floor is similar.

Some women experiencing incontinence or painful sex have weak pelvic floor muscles. Others have muscles that are chronically tight, guarded, or hypertonic—meaning they have difficulty fully relaxing.

Cleveland Clinic explains that pelvic floor muscles can be either too weak or too tight. Weakness may contribute to urinary incontinence, while overly tight muscles may contribute to pelvic pain, difficulty urinating or having bowel movements, and painful sex. Cleveland Clinic

When a muscle remains constantly tense, it may have difficulty relaxing and coordinating appropriately when your body needs it.

That’s why simply adding more contractions isn’t always the answer.

Myth-Busting: Setting the Record Straight on Pelvic Exercises

Myth 1: Painful intimacy after having kids is just normal friction

While tissues need time to heal after childbirth, ongoing pain during intimacy can have several causes.

Pelvic floor tension may be one of them.

Painful sex can also involve vaginal dryness, scar tissue, hormonal changes, endometriosis, infection, injury, or other pelvic health conditions.

Cleveland Clinic notes that pelvic floor dysfunction is one possible cause of painful intercourse and that treatment depends on identifying the underlying reason for the pain. Cleveland Clinic

Myth 2: Squeezing tighter always fixes a leak

Not necessarily.

Some women with leaking do need more pelvic floor strength.

But others may have problems with timing, coordination, pressure management, or the ability to fully relax between contractions.

If your pelvic floor is already holding significant tension, simply adding more squeezing may not address what your body actually needs.

Myth 3: You can solve every pelvic floor problem with an app or tracker

Pelvic floor function involves much more than repetitive muscle contractions.

Your symptoms may also be influenced by:

  • Breathing
  • Core function
  • Posture
  • Hip strength
  • Movement patterns
  • Pressure management
  • Nervous system tension

This is about more than symptom management.

Root-cause healing matters.

The Root Cause of Pain and Leaking

To understand why symptoms continue, we have to look at how your pelvic floor functions at rest and during movement.

Pelvic floor dysfunction may involve an inability to fully relax, poor coordination, weakness, or a combination of factors.

Pregnancy, childbirth, chronic stress, pain, posture, and daily movement patterns can all influence how these muscles behave.

For some women, the nervous system develops a protective pattern that causes the pelvic floor to remain tense.

An overactive pelvic floor may then struggle to coordinate efficiently during activities that suddenly increase pressure, such as:

  • Coughing
  • Sneezing
  • Running
  • Jumping
  • Lifting

At the same time, muscles that don’t relax appropriately may make penetration, pelvic exams, or tampon insertion uncomfortable.

Cleveland Clinic describes pelvic floor dysfunction as a problem with correctly relaxing and coordinating the pelvic floor muscles. Symptoms can include urinary leakage and pain during intercourse. Cleveland Clinic

Your body is not broken.

It may simply need something more individualized than another generic set of Kegels.

Action Steps to Lengthen and Release Your Pelvic Floor

If you suspect your pelvic floor is holding excess tension, shifting some of your attention from contraction toward relaxation and awareness may be helpful.

1. Perform a Conscious Body Scan

Several times throughout the day, check in with your body.

Ask yourself:

  • Am I clenching my glutes?
  • Am I sucking in my stomach?
  • Am I holding my breath?
  • Is my jaw clenched?
  • Am I carrying tension through my hips?

Let your shoulders soften.

Unclench your jaw.

Allow your abdomen to relax.

You don’t need to consciously force your pelvic floor downward. Simply begin noticing how much tension you’re carrying.

2. Try a Comfortable Pelvic Floor Relaxation Position

A position such as Happy Baby may feel comfortable for some women.

Lie on your back and bring your knees toward your chest. If comfortable, hold behind your thighs, around your ankles, or at your feet while allowing your knees to gently widen.

Then breathe.

The position should feel supportive—not painful or aggressive.

If Happy Baby isn’t comfortable for your body, choose another relaxed position instead.

3. Visualize the Release

As you inhale, imagine your pelvic floor gently softening and widening.

Some women like to picture:

  • A flower opening
  • A hammock gently lowering
  • A trampoline softening downward

The goal is not to push.

It is to develop awareness of what relaxation feels like.

4. Don’t Assume You Need More Kegels

If you’ve been doing Kegels consistently and your leaking, tightness, or painful intimacy isn’t improving, don’t assume the answer is simply more repetitions.

Your pelvic floor may need:

  • Strength
  • Relaxation
  • Coordination
  • Better pressure management
  • A combination of these

That is exactly why individualized assessment matters.

5. Get a Pelvic Floor Assessment

A pelvic floor physical therapist can evaluate whether your symptoms are primarily related to weakness, tension, poor coordination, breathing, pressure management, scar tissue, or another pelvic health concern.

That gives you a strategy based on your body rather than a generic exercise plan.

You Deserve Pleasurable Intimacy and Confidence

Your marriage, your physical comfort, and your pleasure are important pieces of your overall wellness.

You do not have to live with painful intimacy or organize your life around leaking.

But the solution isn’t automatically more Kegels.

Sometimes strengthening is needed.

Sometimes relaxation is needed.

Sometimes your pelvic floor needs to relearn how to coordinate with your breathing, core, and movement.

The goal isn’t temporary relief—it’s long-term strength and freedom in your own body.

By understanding what your pelvic floor actually needs instead of automatically squeezing harder, you can begin building a healthier and more functional relationship with these muscles.

Most women were never taught this.

Understanding your body creates confidence.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for personalized guidance based on your symptoms and goals:

Your Pelvic Floor’s Next Step Form

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