To the Lady with Vaginal Adhesions…

Sometimes I’m wrong.  I’m cool with that.

But, sometimes I’m wrong on the Internet.  Guess what.  I’m also cool with that.  But, I do think I need to correct my wrong…on the Internet.

A while back, a blog reader commented with a question about vaginal adhesions.   She was diagnosed with adhesions and was told that this is why she has painful sex.  The reader wanted to know what I thought of adhesions.  This is how I responded:

“So, honestly, what is a vaginal adhesion? Did you ask your therapist or bodyworker that? I just think that might be a semantics thing. I never tell my patients they have a vaginal adhesion. I tell them they have scar tissue if they have scar tissue, I say they have trigger points if they have trigger points and I say they have a contracture (really shortened, tight muscle that needs to be manually lengthened) if I think they have a contracture. Those are my honest thoughts. I don’t think a vaginal adhesion is mythological like a unicorn, but I do think it’s just a semantics issue. Of the things above that I listed, I think that internal vaginal pelvic floor physical therapy with a therapist’s finger doing the work is probably the best option – knowing what little I know about your specific case.”

Well, guess what?  I was right and I was wrong.

I was correct in saying that vaginal adhesions are not mythological.  But, I probably wasn’t completely correct in saying that a diagnosis of vaginal adhesions is just a “semantics” issue.

What I have since learned is that vaginal adhesions are as real as the pimples on your shoulder and as real as that $300 utility bill.  They don’t always appear and a therapist can go years without seeing one, some, I dare say can go a career without ever seeing a vaginal adhesion, but they are out there.  Mark my words.  They are out there.

I have had three patients with vaginal adhesions now – all of whom I met after this anonymous blog commenter wrote to me.  All the while I thought of her…the anonymous poster.

You:  a woman reading my blog who was told you have vaginal adhesions

Me:  the blog writer who jokes about it all

If you are out there, give me a sign that you read this.  A comment.  An email.  A disparaging word.  Anything.  Just let me know you found me again.

Okay, so vaginal adhesions might be a semantics issue to some people who have never worked with adhesions, but for those of you who actually do have adhesions, you must know that they should be destroyed.

I learned this the scary/fun way.  I had a patient whose vaginal canal was full of adhesions.  It was frustrating because my finger was blocked every which way I decided to go.  It was like a cobweb of road blocks.  And, by the way, cobweb truly is the best way to describe adhesions.  It is a webbing of very thin vascularized tissue.  I could only insert my finger just past the bed of my fingernail.  What’s worse was, the woman wasn’t getting any better.  My futile efforts to force the finger into the furthest unknown were fruitless.  I don’t do well with fruitless treatments.  I don’t know if I was frustrated and treated with more force or if the hand of God just guided my own, but there came a treatment where when I removed my finger from the patient’s vaginal canal, there…was…blood.

No one ever told me there will be blood.

And there it was.  Blood.

What did my neurotic ass do?

Freak the fuck out.  That’s what I did.

There were apologies, questions, swearing that I’d let the doctor know right away, heart palpitations, IBS’ing all over the place, fear, tears and sweat.  You don’t make a patient bleed.  That’s an unspoken pelvic floor therapy rule.

I told the patient that there was blood on my glove.  I told her that that had never happened before.  I told her that perhaps she wasn’t getting enough estrogen into her vaginal canal (and truly, she wasn’t).  She was fine though.  She was cool as a cucumber, just chillin’ there watching me lose it.  This did make me feel better somehow.

So I call the doctor and the doctor is pleased with the bleed.  She says that the patient has tons of vaginal adhesions and I broke some and I needed to keep doing that until they were all gone.

You have no clue how relieved I was.  And then I just got excited.  Like, too excited.

This, for me, shifted things.  I learned that vaginal adhesions don’t hurt when you break them, they just bleed because they have vasculature.  They can reform again.  I learned that depending on where the vaginal adhesions are attaching, they can cause pelvic pain.  I also learned that 10% of women develop vaginal adhesions after mesh placement.  Others develop vaginal adhesions because of vulvovaginal atrophy over time or because of medical treatments.

I learned that adhesions are out there and you can stop them.

This is now one of my favorite topics to discuss with patients, doctors, students, my husband, neighbors, the mail man, my son, my friends, the food, my pillow, my mirror, my fingers.  I just love it.

If you have any questions or comments, please leave them anonymously in the comment section below or email me at [email protected] If you are a therapist and you’d like to subscribe to Alcove Education’s emails, just email me.

14 thoughts on “To the Lady with Vaginal Adhesions…”

  1. I am a pelvic floor PT. I am interested in Alcove Education emails. Yeah adhesions are real as are restrictions and scar tissue and trigger point …. all respond well with some manual therapy. Do you know the work of Jean Paul Barral DO, PT? (to quote you – game changer). Thanks. Suz PT, DPT

  2. I am a pelvic floor PT. I am interested in Alcove Education emails. Yeah adhesions are real as are restrictions and scar tissue and trigger point …. all respond well with some manual therapy. Do you know the work of Jean Paul Barral DO, PT? (to quote you – game changer). Thanks. Suz PT, DPT

    1. Hi Susan,

      You’ve now been added to the list.

      I learn every day. I do know about Barral and I’ve gone the Ramona Horton route to learn more. I took a level 1 Barral course and the teaching methods weren’t my cup of tea. I do use visceral work in my practice, especially for the bladder.

      Sara

  3. A main cause (the main cause?) of vaginal — and labial — adhesions is Lichens sclerosus and Lichens planus, auto-immune skin disorders. I was dx’d with LP and know about adhesions first-hand, since at one point one side of my inner labia fused into the outer. It “unstuck” with topical estradiol and testosterone use, but I always keep an eye on things, since LP is wily and the fusing can happen pretty quickly. Among the on-line LS and LP group populations, adhesions/fusion is very, very common. In some cases, such as the one you’ve described, the opening of the vagina can become sealed and/or the clitoral hood adhere and trap the clitoris. Pretty scary. I’m kind of surprised that you weren’t familiar with this whole issue earlier and hadn’t encountered it before. . .but glad you are now and writing about it. And I share your hope that the anonymous woman sees this post!

    1. Hi Indra,

      I’m certainly familiar with vulvar atrophy that can happen at the labias and the clitoris and at the vaginal opening. The resorption that happens at the labias and the clitoral phimosis and resorption is extremely common and does well with physical therapy and topical use. However, vaginal adhesions are different, though they can happen with LS and LP and atrophy and mesh placement. Sealing of the vaginal opening is different from vaginal adhesions. I’m talking about the cobwebbing inside the vaginal canal. All the outer changes are very common. I’m extremely glad you commented, but I don’t want anyone to think I’m advocating for tearing labial or clitoral resorption. This is considered “architectural” changes that can absolutely be reversed, but therapists should not be tearing at this and causing or expecting bleeding. Thank you so much for your comment. Is what I’m trying to discern making any sense?

      Sara

      1. Sara,

        Thanks for the clarification! I hadn’t realized that the vascularized tissue that you’re describing as vaginal adhesions even existed and are a completely separate issue from what I’ve experienced externally as “adhesions.” Live and learn. Now I want to do some exploring and see if the walls of my very easily irritated vaginal walls are cobwebby to the touch. . . .

  4. Hi Sara,
    Are vaginal adhesions increasing in diagnosis (ie a more accepted diagnosis)? Do they get misdiagnosed as something else in your experience(LS, LP, etc?

    I am not sure I have felt this…is the cobweb parallel to vaginal canal or perpendicular?
    Thanks for your humor,
    AnnaKate Moore, PT, DPT

    1. Hi annakate,

      I don’t see vaginal adhesions as a diagnosis, but others might. The cobweb is inside the vaginal canal and it goes in all different directions like a matrix. You cannot see vaginal adhesions from the outside of the vagina.

      Sara

  5. Great post. I am a pelvic floor PT and in my first year of practicing I had a woman post about 6 months TOT procedure where I had blood on my glove and it made me very hesitant to continue with internal work. Makes me rethink it a little differently.

    1. Hi Andrea,

      I totally understand where you are coming from. Hopefully the article was helpful and empowering for you and the patient.

      Sara

  6. Hi Sara I was so glad I came across your post on pelvic adhesions. I have been in severe pain for 6 yrs. I have pain in my pelvic, groin , tailbone and low sacrum area. It’s all on the left side. I have told doctors that it’s not the same on the left side of that muscle in my vagina. I have room for a finger on the right and on the the left there is no room at all. I feel some cobwebs like u described. It feels totally adhesed to the vaginal wall. Not sure I using the right words. I am desperate for help. I have had exams but they do it quickly and do not feel the sides. They say it’s fine but it’s not. I don’t know what to do. I have been on opioids but get immune so they have not been helping. I want off of them but I can’t get anyone to believe me. They would rather act like I’m crazy and addicted to drugs and that’s the problem. I have been off the drugs twice and the pain is still there so I end up back on them. I can’t walk long or sit long cause the pain gets unbearable. I have no life. Everyday is only pain, depression, and loneliness. I’m in Kansas and need someone with your knowledge. I need your help. Please will u help me ?

  7. Sara, I have been in severe pain for 6 yrs. I have never had a gynecologist examine me thoroughly. I tell them what I feel but they don’t believe me because they don’t examine me or feel in the vagina like u do in your pt patients. My cobwebs are thick and the muscle in their is adhesed to the left and the other side here is enough room for a finger. I cannot get them to believe me and I can’t live like this. I can’t sit or walk long without severe pain. I have no life. I suffer day in and out. Have to take ativan to get sleep. I can’t stay asleep long. Please write to me and help me if u can. Sincerely, Jayne

    1. Sara , I have been in severe pain for 6 years. If u see this can u please answer ? I would appreciate it. I can not get any doctors here in Kansas to help me. They don’t believe me or examine me thoroughly. I have thick adhesions on the left side of the muscle running through my vagina. That muscle is stuck to the side. I can hardly go on like this. I need help with this pain. It’s too hard too endure. Please help me somehow. Sincerely, Jayne

      1. Sara , I keep having trouble posting this. Trying one more time. I have been in severe pain for 6 yrs. I do not get pelvic exams like the way u do it when u work w pelvic pain patients. My adhesions are thick and keep the muscle in the vagina stuck to the side. I can’t get any doctor to believe what I feel Can u please help in someway please? Have no life I can’t walk long or sit long. Laying down doesn’t help like it used to. I can’t take this pain much longer. It’s horrific I would appreciate your knowledge and if u respond so very much. Sincerely, Jayne

Leave a Reply

Your email address will not be published.