Every fortnight for four months, Francesca Linstead religiously attended appointments at the Chelsea and Westminster Hospital for a massage paid for by the NHS.
A special physiotherapist at the West London unit was assigned to her, spending the 45-minute appointments trying to source and relieve her pain.
You might assume Francesca, a 55-year-old radio producer from Teddington, South-West London, was suffering from a bad back or a frozen shoulder.
Not quite. For Francesca is one of a growing number of professional women undergoing physiotherapy, not to fix an injury, but to cure stress-related tension in a far more intimate place.
It’s well known that women today are facing more stress than ever before, thanks to demanding jobs, longer hours and the twin toils of caring for older parents and raising children.
An increasing number of women are avoiding sex because of damage to their pelvis. Laura Burton (pictured), 33, was unable to have sex after the birth of her son Joshua
But it appears that the strains of modern life are now taking their toll on women’s bodies in a rather unexpected way.
Rather than store anxiety in their necks and backs, women like Francesca are developing a tendency to tense the muscles in their pelvis So knotted do these muscles become that these women are sometimes left unable to make love.
We’ve long known that the mental impact of tension can destroy the libido — but few people are aware that women’s high stress levels can so painfully damage the physical side of lovemaking, too.
Yet the pain suffered in the pelvic area can be just as agonising as a stress-induced migraine or a bad back.
It can have severe emotional consequences, too, says woman’s health physiotherapist, Katie Mann, who sees up to 400 women a year at a clinic at the Southport and Ormskirk Hospital NHS Trust.
‘For many, the physiotherapy saves relationships,’ she says. ‘It’s not just that making love goes out of the window — intimacy does, too, because women become afraid of having a cuddle in case it’s expected that sex will follow.’
Yet it’s only in the past few years that experts have made the link between stress and pelvic pain. Until recently, the UK has lagged behind other countries where women see their gynaecologists as routinely as the dentist, and not just after they have had children.
Physiotherapist, Katie Mann sees up to 400 women a year to offer treatment for the stress caused to the pelvis (stock image)
Proponents of NHS-funded physiotherapy say it can negate the need for later surgery. Incontinence, often another side-effect of vaginal tension, is one of the main reasons that older women are placed in state-funded care rather than being able to stay in their own homes.
Encouraging women to take action before it’s too late, they say, could save the NHS millions of pounds, as well as rescuing women from a life of severe pain and embarrassment.
Physiotherapy specialist Katie says: ‘I think it’s about British reserve. In this country, we don’t like to talk about such personal things. Women are also expected to be stoic and not trouble others with problems of a gynaecological nature.’
American doctors David Wise and Rodney Anderson, who co-wrote the book A Headache In The Pelvis, explain that tension manifests itself in the pelvic area because it is made up of a dense muscular network, which holds up the core of the body and protects organs such as the uterus, bladder and bowel.
Laura Burton revealed the damage to her pelvis began to affect intimacy with her husband
Under stress, the muscles get taut and tight, cutting off the supply of blood and oxygen. Lactic acid builds up, and nerves get irritated, causing pain that radiates into the entire pelvic region.
It can be so severe that riding a bike, sitting for long periods or simply walking is excruciating.
Other effects of pelvic stress include constipation and recurring urine infections such as cystitis, according to the Expert Review of Obstetrics & Gynaecology.
It’s down to personality and how susceptible a woman is to anxiety whether she will carry her tension in her pelvis, says Katie Mann.
‘Tension can get to any muscle. Some women carry it in their neck and shoulders. Others will get migraines or irritable bowel syndrome (IBS). Some will find it affecting their pelvic floors.’
For some patients, treatment is vital because the physical effects are having an impact on their working life as well as their love life.
The fact that such tension can create bladder control problems is particularly debilitating for career high-fliers.
‘Imagine being a female judge,’ Katie says. ‘You have gone through your barrister’s training, taken silk and then, all of a sudden, you have to stop to keep running to the loo. Or say you are a female surgeon in the middle of an operation. You can’t just keep stopping the proceedings.’
For Francesca, sex became so torturous that intercourse with her long-term partner was impossible for two years.
The effect on her confidence was so profound that she found it increasingly difficult to keep up the confident veneer she needed for her job in radio. Eventually, she was referred to an NHS Woman’s Health Physiotherapist.
After some discussion, Francesca traced her problems to the stress she had suffered while setting up her own production company and working 14-hour days.
‘My work stress contributed to gradual tightening that made sex unbearable,’ she says.
‘Once sex started to hurt, the problems quickly got worse. The more discomfort I anticipated during sex, the more I tightened my muscles as I braced myself. That caused more knotting.
She revealed that she had to carry a spare plastic bag for wet clothes as the damage began to affect control of her blader
‘I was too embarrassed to say anything to my partner and the pain became my best-kept secret. I started to feel as though I had a permanent disability no one could see.’
When she was first referred for treatment, Francesca freely admits she was dubious — not to mention very embarrassed.
‘It sounded so off the wall that you could have tension in that area. I was uncomfortable with the thought of being massaged by a woman in such an intimate place but my embarrassment was eased by the fact the sessions were thoroughly business-like.’
When she had sex again, Francesca says she was tentative. But the treatment had worked. ‘I felt a little discomfort but I did the exercises I had been taught and felt the pain drop away,’ she says.
‘Between appointments, I had regular homework to do — three sets of ten exercises in which I had to tense and then relax my pelvic floor muscles. I also had to visualise my hips widening and making space in that area.
‘I could do them anywhere — lying in bed, walking around or even waiting at a bus stop.
Francesca is so relieved that she was referred for treatment but for many women, the pain they endure remains an unspoken taboo, something perceived as shameful. They may not even be aware of the fact that the physical pain they are experiencing during love making is linked to the levels of stress they are dealing with.
Many women who suffer from pelvic floor damage are high-flyers aged between 25 and 55
Treatment, however, is improving all the time, as women’s health physiotherapist Christien Bird, who treats a range of professional women at the White Hart private practice in Barnes, South-West London, testifies. She is one of more than 700 women’s health physios who are able to offer help with pelvic floor problems caused by stress, as well as by childbirth.
First, Christien scans patients’ pelvises to show them how unconsciously tensing up the complex network of ligaments in this area may be squeezing their internal organs, such as their bladder, bowel and birth canals, so that they don’t work properly.
Then, in a darkened room, in sessions lasting up to an hour, Christien helps relieve any areas of tension through specialised internal massage. She also gives them a range of daily exercises to practise to help them learn to relax their muscles once again.
Many patients are high-flyers, aged between 25 and 55. ‘The more letters they have after their name, the more likely we are to see them,’ says Christien.
‘They tend to be the women who are always busy, thinking ahead, real doers, who are successful and career-orientated. In the same way as eating disorders are more common in this type of woman, so are these kind of pelvic problems.’
One successful woman who says the treatment saved her sex life is cellist Anna Martin.
Laura Burton was prescribed ten minutes of exercise a night with a pelvic toner by her GP to strengthen its muscles
As a professional musician in a competitive industry, she not only had to deal with the stress of auditions and live performance, but was growing increasingly tense from the worry of organising her wedding.
Eventually, she built up so much stress in her pelvic area, she was physically unable to make love to her fiancé.
Anna, 30, from St Albans, Herts, says: ‘About a year before my big day, I started to feel a tightness in my pelvis and burning whenever I went to the loo.
‘It got so bad it became impossible to sit down for long. Sex was out of the question. At times my pain levels were nine out of ten.’
Her doctor investigated but found no evidence of abnormality — and somewhat tactlessly advised she should ‘go home and have a glass of wine’.
But determined to fulfil her dream of starting a family, Anna searched the internet and found out about the specialised physiotherapy. ‘Like everyone else, I had assumed a physio was someone who released frozen shoulders,’ says Anna.
She says although speaking about her pelvic damage was embarrassing she wanted other women to know that there is help available
‘When I was finally examined, I was told my vaginal muscles were like rock and my pelvic floor muscles had tightened completely because I was holding on to so much stress, which had caused them to go into spasm. She explained that while many people hold tension in their necks and shoulders, others will feel it in their pelvic floor and hold the muscles up high all the time.
‘It hadn’t helped that as a professional musician I was in a competitive industry, so I was under work-related stress.
‘The way I sat to play the cello was making the problem worse because it was depriving the muscles of blood and oxygen.’
Often a key part of the treatment is for women to be trained how to relax and use their muscles differently. Physiotherapist Christien says: ‘When women see their internal anatomy on the scan, they understand that it’s something they can change. It’s no different to any other motor skill, such as learning to drive a car.
‘With plenty of repetition of the exercises, it’s as though they learned to change gear without thinking about it.
‘Some of the causes may be psychological but the pain is real. It’s a hidden disability. As it’s also about the mind, we ask patients to think about lifestyle changes, and try meditation and cognitive behavioural therapy (CBT) to address the underlying issues.’
For some women an absence of sex before seeking help for their pelvis put a strain on their relationship (stock image)
Laura Burton, 33, a supermarket manager and new mum from Bearsted, Kent, says worrying about the physical pain she experienced — not to mention the debilitating side-effects, which for her included incontinence — helped turned the problem into a vicious circle until she found out she could get help. She first experienced pelvic tension after a traumatic birth — a complex forceps delivery. The nerve damage meant that her pelvic floor muscles no longer worked properly to keep the neck of her bladder closed.
‘Not being able to control my bladder made me so nervous I didn’t want to go out. If people spotted my incontinence pads in my handbag, I pretended they were extra large sanitary towels.
‘I also kept a spare plastic bag for my wet clothes — I called it “my carrier bag of shame”. I thought: “I’m meant to be carrying a spare change of clothes for my baby, not for myself!”
‘Worst of all, it hit my confidence so much I didn’t want to be intimate with my husband, Martin, so it was affecting our marriage, too. The psychological worry made me tense up even more.
‘In desperation, I went to see my GP who was very sympathetic and referred me to a women’s physiotherapist. She prescribed ten minutes of exercise a night with a pelvic toner, which sends electrical impulses into the muscles of the pelvic floor to make them stronger.
‘When she told me, I immediately thought: “How is this going to work?” I had always assumed a physio was someone who helped you if you had a bad back.’
Laura believes the same way muscles can be toned on the outside is the say way that they can be on the inside (stock image)
There were some raised eyebrows among Emma’s family and friends when she told them about her treatment.
‘Even my mum said: “Sorry, where exactly are you having physio again?” But it’s been so life-transforming for me.
‘Although it’s embarrassing, I wanted to talk about this to let other women know they don’t have to put up with urinary incontinence, which was one of the side-effects I was dealing with, and the problems that go with it.
‘I have spoken to older ladies who tell me they are worried every time they sneeze.’
‘Yet most don’t know there are women’s physiotherapists who can help them get back in shape enough to conquer the problem.
‘My story shows that if you tone up your muscles on the outside, you can tone them on the inside.
‘Looking back, I’m so glad I did something about it rather than suffering in silence — or allowing my marriage to suffer.’
Sadly, for Francesca, although the physiotherapy was a ‘lifeline’, her ten-year relationship didn’t survive the absence of sex.
‘The intimacy had already gone, but I’m still lucky to have a second chance at a sex life,’ she says.
‘So many doctors still don’t seem to know that this approach even exists.
‘Think of all the other women out there who have to abandon making love and see their relationships disintegrate as a result — and all because they don’t realise that stress is affecting them in such an intimate way — or that there’s a cure.’
Some names have been changed.