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Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve was written by Heather Jeffcoat, DPT, a physical therapist with countless successes in treating pain of this type. Women with vaginismus, overactive pelvic floor, painful intercourse, vulvodynia, vulvar vestibulitis, vestibulodynia, dyspareunia, interstitial cystitis have all benefited from her unique program. Heather uses her orthopaedic background to approach treatment of these muscles like they are....muscles! She utilizes a self-treatment tool called a dilator to provide massage and other muscle relaxation and stretching techniques in a gentle fashion to return a women's muscles back to a resting, rather than guarded, state.

Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve

What Others are Saying About "Sex Without Pain ":

I have seen Heather's treatment program work time and time again with my patients. Her unique approach to treating women with painful intercourse through a combination of hands on skills, patient education and the thorough home program outlined in this book has surpassed the results of her peers. Her techniques and expertise have been an invaluable resource to my practice."

- Kerri Parks, MD (Associate Professor Ob/Gyn USC Keck School of Medicine)


I will use it frequently for clients who cannot afford pelvic floor PT or for those who cannot find pelvic floor PT any where near them! I have so needed this resource. The clarity of each step and the drawings are so helpful - I don't know of any other resource that will be as effective for self-help."

- Joyce Penner, RN, MN (Sexual Therapist, Educator and Co-author of The Gift of Sex, Restoring the Pleasure and numerous other publications)


Sex Without Pain is an essential book for any woman suffering with pelvic or sexual pain. Heather's approach is simple and clear. She empowers the woman and her partner with the resources needed to lead a healthy and pain free sex life. A great read for patients and professionals alike."

- Jennifer Briggs, DPT (Women's Health Physical Therapist, Pennsylvania)


• To order "Sex Without Pain" in paperback from Amazon for $24.99, click here.

• To order an electronic read-only non-printable PDF copy of the book for instant download at $19.99, use the button below:

• To schedule an appointment at one of the Femina PT offices, click here.

• For a list of other trusted health care providers, click here.

Photo by Luis Quintero on Unsplash
Photo by Luis Quintero on Unsplash

Many people start like to start the new year off with exercise regimens and plans to lose weight.

Unfortunately, often times women who start exercise programs to lose weight also lose their ability to control of their bladders and experience urine leakage during physical activity, otherwise known as stress urinary incontinence (SUI).

So what makes certain exercises more leak-prone? Which exercises put less stress on your pelvic floor? Read on to find out.

Why would exercise make you leak?

One leading hypothesis for what causes stress urinary incontinence is that sudden increases in abdominal pressure can put stress on the pelvic floor muscles, reducing the muscles’ “elastic recoil” which a muscle’s ability to rebound after a sudden stretch, which can cause weakness and reduced performance. As we’ve talked before in our blog series about pelvic organ prolapse, when the pressure in the tummy is stronger than the supporting muscles, tissues and tendons, things tend to travel south. If you are doing high-intensity activities like sprinting, jumping, lifting, and crossfit, you may be increasing your abdominal pressure without enough pelvic floor support to help your organs from shifting.

High Impact Exercises and Increased Prevalence of SUI

In general, higher impact sports, such as basketball, volleyball, and tennis have a higher prevalence of urinary incontinence vs. lower impact sports such as swimming and pilates (de Mattos Lourenco, et al., 2018). A recent article by Yang et al. (2019) found that SUI prevalence is higher in women who participate in CrossFit vs. aerobics. Certain sudden movements, including jumping and sprinting, tend to cause more leakage than slower, steadily paced movements.

The following is a list of exercises found to have higher prevalence of SUI in study participants from both the Mattos Lourenco and Yang studies:

High Impact Exercises That Cause More Leakage:

  • Jumping rope and “double-unders”
  • Box jumps
  • Squats with weights
  • Trampoline jumping
  • Thrusters
  • Basketball
  • Football
  • Gymnastics
  • Tennis
  • Hockey
  • Judo
  • Running
  • Softball

Low impact activities with reduced pressure on the pelvic floor

  • Bodyweight training
  • Walking
  • Water aerobics
  • Roller blading
  • Cycling
  • Hiking
  • Pilates
  • Swimming

What You Can Do

Don't be afraid to exercise, the key is to pick the right exercises that don’t cause you leakage. Choose exercises that off the “just right challenge” to your body.

Participate in lower impact activities if you are leaking

Low impact activities have less prevalence of urinary incontinence. Activities like weighlifting, cycling, hiking, pilates, yoga, and swimming are examples of low impact activities. If you are in an aerobics class that requires a lot of jumping, modify the movement to stay stationary on the ground: an example would be instead of jumping jacks, you could do squats or alternate bringing one leg out at a time.

Strengthen Your Pelvic Floor

Are you doing low impact activities and still leaking? You might need to strengthen your pelvic floor. Don't know how? Check out the Femina blog for articles about kegels.

Still confused? Come see us! The pelvic floor therapists at Femina PT are ready to help, make an appointment today.

Exhale with Movement

One common cause of incontinence and increased intra-abdominal pressure is holding your breath. Breathe when you move! Avoid exercises that make you bear down and DO NOT hold your breath while exercising.

Try exhaling with the following activities:

  • Exhale with exertion during exercise. Examples: when you bring a hand weight up into a bicep curl, exhale. When you push up from a squat, exhale.
  • Exhale while lifting (weights, baby, groceries)
  • Exhale while pushing anything (luggage, strollers, trash can, shoveling)
  • Exhale while you are bending over during exercise (stretching)
  • Exhale while reaching overhead (pull-ups, weight lifting)

Steady Breath While you Exercise

Practice a steady breath throughout your entire exercise session. This will help regulate your abdominal pressure and the pressure placed on your bladder.

Some Tips:

  • Relax shoulders and upper chest
  • Breathe in slowly to fill the lungs fully
  • Breathe out slowly through the mouth or nose
  • If you are feeling winded, bring your heart rate back down until you can breathe easily again

Use a pelvic brace and do your pelvic floor exercises daily.

Don’t know what I’m talking about? Find a pelvic floor therapist to help you. Pelvic floor therapists are trained to fully assess what is going on in your body in order to fully understand what is contributing to any urinary incontinence.

Resources

De Mattos Lourenco, Matsuok, Baracat, Haddad. 2018. Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal 29 (12):1757-1763.

Yang, J, Cheng, JW, Wagner, H, et al. The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurourology and Urodynamics . 2019; 38: 749– 756. https://doi.org/10.1002/nau.23912

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What Our Patients Have to Say

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Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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