Five Activities to Use Prior to Vaginal Penetration

Dee Hartmann is a graduate of Northwestern University Medical School of Physical Therapy, Chicago, Illinois, as well as St Ambrose University, Davenport, Iowa, where she received her DPT. Practicing physical therapy for over 36 years, Dee is an internationally recognized author, teacher, and speaker on the treatment of chronic pelvic pain. For the last 22 years she has devoted the majority of her practice to the treatment of women with chronic vulvar pain, sexual dysfunction, chronic pelvic pain, and bowel and bladder disorders. As an active member of the APTA’s Section on Women’s Health, she is originating chairman of the Task Force responsible for the creation of the Certificate of Achievement for Pelvic Physical Therapy (CAPP) and served on the Vulvar Pain Task Force. She is a fellow and past member of the Executive Counsel of the International Society for the Study of Vulvovaginal Disease (ISSVD) and was a counselor for the North American Chapter of the ISSVD; a current associate editor for the Journal of Sexual Medicine; a current member and past board member of the International Pelvic Pain Society (IPPS); a current member and past board member of the National Vulvodynia Association (NVA); and is a member of the International Society for the Study of Women’s Sexual Health (ISSWSH). Dee is happily married to the love of her life and is the mother of 5 wonderful grown children.

~All completed while laying down~
Instructions used in conjunction with video viewing



~All completed while laying down~
Instructions used in conjunction with video viewing



1. Deep diaphragmatic breathing
a. With your hands on each side of your lower ribcage, take a deep breath and focus on bringing air all the way down to your hands. Feel your ribs expand as you breathe in.
b. Don’t focus on guiding the breath to the upper ribcage or abdomen. Only your ribs should expand—not your chest or belly.
c. As you breathe deeply, you will begin to relax which will encourage your pelvic floor muscles to re-lax. Feel your breath all the way down into your pelvis.
d. After you breathe in, hold the breath for a count of 5 then breathe all the air out. Repeat 5 times.


2. Stretch your lower abdomen (Use caution if you have IUD)
a. Place the palms of both hands in the middle of your abdomen, just below your belly button.
b. Scoop in and lift up on your belly with your fingers, like you are trying to pull your belly button up and out. It should not hurt! If you have an IUD, be gentle.
c. You are stretching tissues all the way down into your pelvis, encouraging the urethra (carries the urine out), the bladder (holds the urine), and the pelvic floor muscles to let go.
d. Scoop in and hold for a count of 10. Repeat 3 times.

3. Stretch both hips
a. Pull your right knee up toward your left shoulder. Hold it there for a count of 20.
b. Repeat with your left knee to your right shoulder and hold for a count of 20.
c. As you do this, you stretch hip muscles that lie very close to the muscles on the inside of the pelvis. This stretching encourages all the pelvic floor muscles to relax.
d. Repeat each knee stretch 3 times, alternating sides after each stretch.


4. Active bridging
While lying on your back, lift your knees up toward the ceiling while placing both feet flat on the bed. Let your knees and feet be apart.
Squeeze your buttocks while lifting your hips up toward the ceiling, making your body straight from
your knees to your shoulders. Your weight is balanced between your shoulders and your feet.
To make the bridge, you are using muscles in your hips and low back. When you let yourself go back down, the hip and low back muscles relax. The muscles inside the pelvis tend to squeeze and relax as well.
Lift and hold 3-4 times for a count of 10 with each hold.

5. Pelvic Floor Muscle Contract and Relax
a. Tighten and hold inside like you are trying to hold back urine or gas. Let go all the way. You should feel both the squeeze and the release. Do this several times until you feel the movement inside.
b. Pelvic floor exercises (doing the 5-count hold and the quick squeezes = 1 set)
1) 5-count hold: Once you can feel the muscles move, squeeze and hold for a count of 5. Re-lease all the way and feel the inside relax.
2) Quick squeezes: Then, perform 5 quick squeezes, starting small and getting larger, like climbing a ladder. Release and again feel the inside relax.
c. Repeat each set 3 times, feeling the muscles squeeze and relax more each time.

***If you are having trouble or pain while performing this exercise, go back and repeat the first 4 activities before trying again.
Women who experience chronic vulvar pain often hold tension throughout their bodies. In addition, they often have anxiety about being touched, causing even more stress, which can create a vicious cycle of pain and holding. The activities described are meant to help you to decease overall tension, to reduce anxiety, and to help you begin to lessen pain before any type of vaginal penetration. The activities can be performed before and after vaginal penetration (like inserting tampon, during a gynecological exam, or having sex).

Try to perform all 5 of these activities as soon as you wake up and before you go to sleep. It is common for women who experience pain and anxiety to breathe in their upper chest. Try to use the deep breathing pattern throughout your day. Make this your new way of breathing.

These activities in and of themselves do not constitute a complete physical therapy program and are not designed to be the only thing you do to help your problem. Hopefully, you can also begin an active physical therapy treatment program with a women’s health physical therapist to help you continue to make progress.
Please discuss this with your doctor.

Don't forget to add a bit of pleasure to every day!


Dee Hartmann, PT, DPT
Dee Hartmann Physical Therapy
Co-author, The Pleasure Prescription: A Surprising Approach to Healing Sexual Pain - Buy Here on Amazon
Co-founder, Center for Genital Health and Education Inc (
Co-founder, VulvaLove Inc (