The Role of Psychological Skills in Pelvic Health Physical Therapy
The Role of Psychological Skills in Pelvic Health Physical Therapy
Pelvic health physical therapists are often amongst the first professionals patients consult for pelvic floor concerns, which can significantly affect sexual functioning and intimacy. While the focus of training traditionally emphasizes anatomy, physiology, and rehabilitation, patients rarely present with physical symptoms alone. Their experiences are shaped by psychological, relational, and cultural factors, all of which profoundly affect outcomes in physical therapy.
Why Psychological Skills Matter in PT Practice
Evidence consistently shows that sexual dysfunction, pelvic pain, and related conditions are not purely biomedical issues. They are mediated by anxiety, avoidance, shame, trauma histories, cultural scripts, and interpersonal dynamics. For example, fear-avoidance behaviors may exacerbate pelvic floor dysfunction in the same way they perpetuate musculoskeletal pain. Similarly, trauma responses such as dissociation or hypervigilance can be triggered in a physical therapy setting, complicating examination and treatment.
Physical therapists are not expected to act as psychotherapists. However, they are often in close therapeutic contact with patients at vulnerable moments, making it essential to have basic counseling and communication skills. Skills such as active listening, empathy, appropriate inquiry about intimacy, and confidence in making referrals are not supplemental—they are necessary for effective, patient-centered care.
The Role of Relational Dynamics
Sexual functioning does not occur in a vacuum; it is embedded in the context of intimate relationships. Relational dynamics such as communication styles, conflict patterns, attachment needs, and power imbalances all influence how individuals experience their bodies and their sexuality.
For example, a patient with pelvic pain may struggle not only with their own distress but also with their partner’s frustration, avoidance, or misunderstanding. Similarly, a lack of emotional safety within the couple may make it more difficult to sustain sexual desire, even when physical symptoms are addressed. These dynamics directly affect treatment outcomes: a patient may disengage from therapy, underreport symptoms, or avoid exercises that provoke vulnerability if their relational environment feels unsafe or unsupported.
For pelvic health physical therapists, awareness of these patterns is essential. While the PT is not providing couples therapy, understanding how intimacy and relational stressors interact with pelvic health allows for more accurate assessment, more effective communication, and more compassionate care. It also informs when a referral to a mental health or couples therapy professional is warranted, ensuring patients receive holistic, integrated support.
Integrating a Psychologically Informed Approach
Incorporating psychologically informed practice does not mean overstepping scope. It means understanding that the body cannot be separated from lived experiences, relationships, and culture. A PT who can recognize when distress is relational, cultural, or trauma-related is better equipped to support their patient and coordinate with other professionals. The result is improved adherence, better outcomes, and a more compassionate standard of care.
A New Course to Bridge the Gap
To support clinicians in this area, I developed the course “Psychologically Informed Sexual Counseling for Pelvic Health Physical Therapists: Addressing Couple Relationships, Sexual Trauma, and Culture.” Offered through APTA Pelvic Health, this online on-demand course covers:
- Foundations of counseling and communication skills
- The PT’s role in sexual counseling and appropriate scope
- Couples’ dynamics and relational factors affecting sexual health
- Sexuality across the lifecycle, including pregnancy, postpartum, menopause, and aging
- Intimacy, passion, and desire in long-term relationships
- Trauma-informed care and its impact on sexual health
- Cultural and religious considerations in patient care
- How and when to make referrals, and how to collaborate with mental health professionals
Conclusion
As the field of pelvic health continues to evolve, PTs must expand their skill set. Developing a psychologically informed lens enhances clinical care and ensures patients feel seen as whole people. This course provides a structured, evidence-based way to gain those skills and bring them into everyday practice.
About Talli Yehuda Rosenbaum, MSc
Talli Yehuda Rosenbaum is an individual and couple therapist and is certified as a sex therapist and sex therapy supervisor by The International Association of Psychosexual Therapists (IAPST) as well as the Israeli Society for Sex Therapy (ISST). She cohosts the Intimate Judaism podcast and is co-author of the book “I am For My Beloved: A Guide to Enhanced Intimacy for Married Couples.” and co-edited the Springer textbook entitled “The Overactive Pelvic Floor.”She has authored over 40 journal articles and several book chapters on trauma and sexuality, sexual pain disorders, and sexuality and Judaism and is an associate editor of the Sexual Medicine Reviews. Talli earned a Masters in Clinical Sociology and Counseling and a certificate in Mental Health Studies from the University of North Texas in Neve Yerushalayim. She holds a bachelors degree in Physical Therapy from Northwestern University. Before re-training as a psychotherapist, she treated patients as a physical therapist for 25 years. In addition to maintaining an active private practice, Talli is the academic advisor for Yahel: The Center for Jewish Intimacy. Talli frequently lectures both in Israel and abroad, to lay as well as professional audiences.
