When it comes to pelvic floor physical therapists, we are all well versed in discussing and treating dyspareunia. Also known as painful intercourse.

However, what I want to discuss today is the physical inability to have intercourse, due to orthopedic issues.

I’ve said it before, and I’ll say it again. To be a good pelvic floor PT, you first have to be a good orthopedic PT.

There are lots of injuries that interfere with one’s ability to have a healthy sex life; like “bad knees”, hip injuries, back pain, or a rotator cuff tear, etc.

This was first brought to my attention 7-8 years ago, when I had a 75 year old woman referred to me due to painful intercourse. Prior to meeting her, I had made the assumption that it would likely be atrophic vaginismus. However, upon meeting her and discussing why she was coming to PT, I learned it was because she was limited in her ability to have sex with her husband due to a “bad knee”. She told me that her husband had a surgically fused spine so during sex she always had to be on top, but her knee was making it harder and harder to do so.

I remember being so surprised that this was the reason she was coming in for, but then she said: “I might be old, but I’m not dead, and we still want a healthy sex life.” And that was my first lesson that intimacy doesn’t have to end as we age; and that everyone young and old should be able to enjoy it to the best of their ability.

So we jumped into a full orthopedic evaluation of her knee, finding that she was significantly lacking in range of motion and hip strength. Happily, after 6-8 weeks of PT, she was able to make gains in all of these departments, and reported that she was back to having comfortable intercourse again with her husband. He sent along his thanks.

But this got me thinking, in the medical community so much is invested in things like erectile dysfunction, but there hasn’t been much or any research into functional inability to have intercourse. I purpose that these numbers are pretty high, and greatly decrease people’s quality of life. There is something caused “functional incontinence”, which is where someone’s disability prevents them from being able to make it the bathroom in time. This could be short term like a broken leg or longer term, like being wheelchair bound. This seems very much on par to the topic we are discussing now. Basically, someone’s orthopedic issues are standing in the way of sexual function; but it doesn’t need to be that way.

Sexual intercourse is a major part of someone’s quality of life — so don’t let an injury prevent you from pursuing this.

If you want to see a PT for your orthopedic issues, be prepared to answer questions like: What positions do you and your partner like to use? How long do you need to be able to do it for? What is stopping you from being able to have intercourse? PT’s are very goal oriented, and knowing these answers will help cater the exercises to your needs.

Let’s take the embarrassment out of discussing sexual health; and help people live their best life.