Pelvic Floor Physical Therapy

Pelvic floor physical therapy (PFPT) is hands-on rehabilitation for the muscles that support the pelvis. It helps with long-term pelvic pain, pain during intercourse (dyspareunia), bladder and bowel problems, and recovery after surgery or birth. A pelvic floor therapist checks whether these muscles are too tight or too weak. The therapist also looks for trigger points, which are tender areas in the muscle. The exam also looks for stiff scar tissue and for muscles that do not work well together. This care treats the muscle side of problems that often have hormonal or gynecologic causes as well.¹

Many women with endometriosis or chronic pelvic pain also have pelvic floor problems. Adhesions (bands of scar tissue), inflamed lesions, and bracing against pain can all change how these muscles work. One randomized trial enrolled 34 women with deep endometriosis and pain at the vaginal opening during intercourse. None had given birth. Half received five therapy sessions, and the rest received no treatment. Thirty women were checked again at four months. On ultrasound, the pelvic floor muscles of the treated group relaxed more. Their pain during intercourse and their pelvic pain also improved more than in the untreated group.² A second report from the same women looked at bladder, bowel, and sexual function. The two groups did not differ on these measures. The treated group did show a trend toward less constipation.³ In this trial, therapy relaxed the pelvic floor and eased pain, while bladder, bowel, and sexual function stayed about the same. A 2025 review that pooled many studies found that physical rehabilitation lowers the symptom burden of endometriosis and adenomyosis.⁴

PFPT works alongside a full gynecologic evaluation and does not replace it. Surgery removes the disease itself. PFPT treats the effects on muscles and nerves that the disease leaves behind. After excision, many patients still brace their pelvic muscles or have stiff scar tissue. Pelvic floor therapy can help release both. The same is true after adhesiolysis or other pelvic repair surgery.

Common reasons to see a pelvic floor therapist include pelvic pain with a muscle component, pain during intercourse, postpartum recovery, and bladder or bowel problems. A visit usually includes an internal and external examination. The therapist checks muscle tension, trigger points, and how the muscles move and work together.