Pelvic Floor Issues

In last week’s article we spoke with many women about their difficulties navigating their sex lives while undergoing cancer treatments. This week we wanted to share what we learned about what options women have when sex is difficult, painful, or even unthinkable.

Part of the problem women face in their sex lives is dryness due to chemotherapy.  Chemo stops the production of estrogen, which can lead to vaginal dryness and vaginal atrophy (the thinning of the vagina), which can make sex uncomfortable at best, and more often than not, painful. Coconut oil is recommended as a lubricant because of its natural ingredients. Some women try topical estrogen cream, but this is not recommended for women who have hormone related cancers. Be sure to talk to your doctor about what could work for you.

We spoke with Nichole Samms, a doctor of physical therapy with Outpatient Rehabilitation Services at MD Anderson Cancer Center in Houston, who helps patients with pelvic floor issues. Pelvic floor physical therapy involves the pelvic floor muscle group, which is responsible for a variety of functions. These muscles support the pelvic organs, assist in bowel and bladder control, and contribute to sexual arousal and orgasm. We asked her what patients struggling with sexual activity should know, and where they can go for help.

“Pelvic floor physical therapy is available,” she told us, “but physicians aren’t always aware that it is. We’re working to make sure that physicians are aware these services exist so they can direct their patients to us. It’s not just kegels, and we treat males and females.” While most rehab facilities are aware of pelvic floor centers and refer their patients to a therapist, finding someone in your area can be difficult. Dr. Samms has patients that come from all areas of the country, many of them driving hours to see her. One of her patients has a 19 hour commute to her office.

I asked Dr. Samms what she hopes patients understand about the sexual challenges they face. We discussed what she calls Readiness for Change.  “If a woman undergoing treatment,” she explained, “It’s possible she wants to get through treatment before she’s ready to pick up the pieces. It’s really important she not be pressured into being sexually active until she really feels ready. I’ve had some patients though who have a really supportive partner, and they were ready to dive right in.” I asked if she welcomed couples to her practice. “Partners are welcome to come and learn techniques so they can help the patient,” she said. “Our goal is to get the patient independent of us. If their partner learns the techniques we are using, they can assist in the recovery. Some women don’t want their partner to see them in a clinical setting and prefer to come alone. For others, the partner may not feel comfortable being there. But for those who are open to it, the more they can come to together, the better.”

Dr. Samms said she finds that her patients are each other’s biggest advocates, because they spread the word about their experiences with pelvic floor therapy. While much of her work can help patients regain a normal sex life, she pointed out that her practice doesn’t just treat cancer patients for sexual health. “Sometimes after several rounds of chemo, a patient realizes they pee every time they laugh,” she said. “We want patients to know we can help with that too.”

I asked her what else patients can look for if they don’t have a pelvic floor center near them. “Occupational therapy is a great resource,” she said. “It can help with sexual positioning and body image. It’s not a replacement for pelvic floor therapy, but there are some occupational therapists who are familiar with what we do, and they can be a good supplement for pelvic floor therapy.”

She also said not to underestimate seeing a certified sex counselors. “They have fantastic ideas on how to help couples can build intimacy in new ways,” she said. “Patients and their partners can really benefit from sessions with a sex counselor.”


Tara Langdale, VuVa TechTara Langdale is the president of VuVaTech LLC. She has dedicated her life to helping women with pelvic pain. “I created this company because I have Vulvodynia, a condition that causes unknown nerve pain in the vaginal opening and stabbing pain during intercourse,” she told us. “When I needed help, I really wasn’t given any resources to help me. Creating pelvic pain awareness after cancer is important so I will keep spreading the world as much as I can.”

VuVaTech offers magnetic vaginal dilators for women who have pain during intercourse.  Neodymium Magnets are within each dilator that increase blood flow and relieve sexual discomfort while soft tissue lengthens, relaxing muscles and ligaments. As the tissue relaxes, the Neodymium magnets increase blood flow to the painful area, calming nerves. VuVa™ Dilators are the only patented dilators available with Neodymium magnets. Tara Langdale’s company not only helps you choose dilator sizes, they can help you find a pelvic floor physical therapist in your area.

I asked Tara Langdale what message she has for couples who are struggling to stay sexually active when the woman is suffering from pelvic floor pain. “There are many other ways to show intimacy besides having penetrative intercourse during pelvic floor therapy,” she said. “You really need to see a pelvic floor physical therapist in conjunction with your physician. I think partners need to really understand how much intercourse is painful and that women with pelvic pain want to have intercourse, but it truly does hurt. Taking the time to use dilators before intercourse to truly relax the muscles allows for easier penetration.”VaVu Tech

For more information on vaginal dilators, visit

If you are looking for a therapist to help with pelvic floor issues, check first with your medical team to see if there is a pelvic floor rehab center or a Sex and Intimacy Clinic already available to you. If not, here are two organizations Dr. Samms recommends:

Herman and Wallace Pelvic Rehabilitation Institute, where a patient can look up therapists in their area

American Physical Therapy Association

Other resources:

American Association of Sex Educators, Counselors,  Therapists
American Cancer Society

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