A history of sexual violence is associated with significant physical and psychological sequelae, including sexual pain and dysfunction (1). Pelvic floor physical therapy is commonly used to treat sexual pain (2); however, its application in women with a history of sexual trauma requires particular sensitivity, as therapeutic procedures may involve intimate contact and potentially trigger distress.
Understanding patient experiences is essential to guide trauma-informed care and optimize treatment outcomes (3). Therefore, the aim of this study was to explore the experiences of women with a history of sexual violence undergoing pelvic floor physical therapy for sexual pain.

This qualitative study used semi-structured interviews to explore the perceptions of women with a history of sexual violence who underwent pelvic floor physical therapy for sexual pain. Treatment included pelvic floor muscle (PFM) stretching and the use of vaginal dilators.
Interviews were conducted individually, audio-recorded and transcribed in full. Data were analyzed using qualitative content analysis with systematic coding and categorization to identify recurrent themes related to treatment experiences. A trauma-informed approach was incorporated, including explicit consent before each intervention, patient-controlled pacing, permission to pause or stop at any time, continuous verbal communication before and during touch and emphasis on safety, predictability and validation of patients’ experiences.

Ten women participated (mean age 30.3 ± 4.2 years). Five main themes were identified: (i) pain invalidation, (ii) therapeutic rapport, (iii) sexual education and body awareness, (iv) experiences with perineal massage, and (v) experiences with vaginal dilators.
Participants reported prior experiences of pain minimization and lack of validation. Establishing trust with the therapist emerged as a central factor for engagement in treatment. Sexual education and increased body awareness were perceived as empowering and contributed to greater self-efficacy.
PFM stretching and vaginal dilator use were initially associated with discomfort and emotional vulnerability; however, when delivered within a trauma-informed framework, these interventions were progressively accepted and contributed to improved confidence and reduced fear related to vaginal penetration.

Pelvic floor physical therapy in women with a history of sexual violence is a complex and highly individualized process, influenced by prior trauma and patient–therapist interaction. Although therapeutic interventions may initially evoke discomfort or emotional distress, a trauma-informed approach appears to facilitate engagement, enhance perceived safety and mitigate negative experiences. These findings highlight the importance of therapeutic rapport and patient-centered communication in optimizing treatment outcomes.

Pelvic floor physical therapy for sexual painin women with a history of sexual violence requires a trauma-informed approach. Therapeutic rapport, validation and gradual exposure to interventions are key elements to promote safety, engagement and positive treatment experiences. These findings reinforce the need to integrate trauma-informed principles into pelvic floor clinical practice.

Tetik S, Alkar ÖY. Vaginismus, dyspareunia, and abuse history: a systematic review and meta-analysis. J Sex Med. 2021;18(9):1555–1570.
Morin M, Dumoulin C, Bergeron S, et al. Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial. Am J Obstet Gynecol. 2021;224(1):189.e1–189.e12.
Stirling J, Chalmers KJ, Chipchase L. The role of the physiotherapist in treating survivors of sexual assault. J Physiother. 2021;67(1):1–2.