A Research-Oriented Infographic for Sex Therapists
Sex therapists and pelvic health specialists share a common goal: enhancing quality of life. While psychosexual approaches are vital, the neuromusculoskeletal system plays a crucial role in sexual comfort, function, and overall well-being. This guide explores Pelvic Floor Dry Needling (PF-DN) as an evidence-based modality to consider in collaborative care.
Pelvic floor dysfunction, often presenting as pain or hypertonicity, significantly impacts sexual health. Conditions like dyspareunia, GPPPD, and chronic pelvic pain can create substantial barriers to intimacy and sexual satisfaction. Addressing these physical components is often a crucial step in a client’s journey towards improved sexual well-being.
Many individuals experience pain that interferes with sexual function. Myofascial restrictions and trigger points in the pelvic floor are frequent contributors.
Pelvic pain can lead to fear-avoidance of intimacy, decreased libido, and significant distress, impacting both individuals and relationships.
Pelvic Floor Dry Needling (PF-DN) is an invasive procedure where a trained clinician inserts a thin filiform needle into myofascial trigger points (MTrPs), muscles, and connective tissues in the pelvic region. Its application is often guided by Western neurophysiological and anatomical principles to manage neuromusculoskeletal pain and movement impairments.
Elicits a Local Twitch Response (LTR) to reduce muscle contraction, improve local blood flow, and restore normal muscle fiber function. (Refs 1,2)
Influences pain pathways via segmental inhibition (gate control) and activation of descending inhibitory systems, potentially releasing endogenous opioids. (Refs 1,2)
May downregulate an overactive nervous system by reducing peripheral pain signals, crucial in chronic pain states. (Ref 3)
Many individuals seeking sex therapy experience physical discomfort or pain stemming from pelvic floor muscle dysfunction. Addressing these somatic components can be a pivotal part of their journey to improved sexual health and function.
The body can hold emotional stress and trauma within its tissues, particularly in the pelvic region. Chronic muscle guarding often reflects underlying emotional states.
While PF-DN primarily targets physical dysfunction, releasing long-held muscular tension can sometimes facilitate an emotional release or create an opening for deeper emotional processing. This potential secondary effect can complement psychotherapeutic work, especially for clients with trauma histories or significant anxiety about intimacy. (Ref 13)
A growing body of research indicates the effectiveness of dry needling for pelvic pain conditions that commonly impact sexual health. While more research specifically measuring sexual function outcomes is ongoing, the evidence for pain reduction and improved function is promising.
Gaubeca-Gilarranz et al (2024) found DN significantly improved pain, catastrophizing, and central sensitization scores in women with CPP. (Ref 3)
Jhun et al (2012) reported a case of 20-year vulvodynia resolving after 2 DN sessions, with sustained results. (Ref 7)
Ziaeifar et al (2019) showed DN improved pain and disability in patients with chronic pelvic pain and myofascial dysfunction. (Ref 8)
Brennan et al (2017) found moderate evidence for physical therapy targeting pelvic floor muscles (including trigger point therapy) in GPPPD. PF-DN, by a trained clinician, may enhance outcomes for persistent trigger points. (Ref 11)
Systematic reviews also support DN for general musculoskeletal pain (Refs 9,10).
Effective collaboration between sex therapists and pelvic health practitioners (including pelvic floor physical therapists and clinicians trained in PF-DN) is key to providing holistic, client-centered care.
Client Readiness & Autonomy: Decisions must be client-led. Provide information, not persuasion. Discuss comfort levels and anxieties.
Practitioner Selection: Seek pelvic health practitioners explicitly trauma-informed in their approach (safety, consent, choice, attunement).
Pacing & Preparation: Help clients prepare, develop coping strategies, and advocate for their needs. Treatment should be client-paced.
Preventing Re-traumatization: Prioritize the client’s felt sense of safety. Open, consented communication is vital.
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Potential unaddressed physical factors contributing to sexual difficulties are noted.
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2.
Discuss potential benefits of pelvic health assessment (e.g., by pelvic floor PT). Mention interventions like PF-DN by trained clinicians as possibilities if indicated post-assessment. Emphasis on client choice and trauma-informed approach.
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3.
Client expresses interest. The sex therapist provides resources/referrals with the client’s consent for information sharing.
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4.
By a qualified practitioner (e.g., pelvic PT), with ongoing consent and sensitivity.
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5.
Assessing practitioner discusses findings and options (e.g., manual therapy, exercise). If PF-DN is indicated, a clinician trained in the technique discusses it. Client makes an informed decision.
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6.
Sex therapist supports client. Consented inter-practitioner communication occurs regarding progress and relevant factors.
Addresses the “bio” in biopsychosocial, acknowledging physical pain’s link to psychosexual well-being.
Aligns with practitioners using evidence-based interventions, including PF-DN, where supported by research.
Offers clients tangible strategies for physical symptoms, reducing hopelessness associated with chronic sexual pain.
Addressing physical barriers can enhance client engagement and outcomes in psychosexual therapy.
Pelvic Floor Dry Needling, delivered by trained and licensed clinicians within a comprehensive treatment plan, offers a valuable evidence-supported option for addressing myofascial pain critical to sexual health.
Sex therapists are pivotal in identifying when referrals for pelvic health assessment (which may lead to exploring PF-DN) are beneficial. This interdisciplinary, trauma-informed, and client-centered collaboration can significantly improve outcomes and enhance sexual well-being.
