Like many, Lindsay Joy was not raised to talk about sex openly. When she began having pain during sex, she was unsure about discussing her symptoms with a doctor.
“I felt horrified and embarrassed to talk about my pain, and I feared this might be my reality moving forward,” Lindsay says. “At first, I didn’t know who to turn to. I wondered if this was something that just came with weight gain or age, especially as I entered my 30s.”
Donna Marinelli, nurse practitioner with Atrium Health Women’s Care One Health OB/GYN, referred Lindsay to Atrium Health Women's Care Sexual Health for a consultation.
“Based on Lindsay’s symptoms and history, I knew she needed a multidisciplinary approach, including pelvic floor physical therapy,” Marinelli says. “I have referred patients to our sexual health clinic on many occasions and have always had positive feedback. I am so grateful we have this wonderful care option available to the women of our community.”
Rachel Murray, nurse practitioner, and Erika Warren, doctor of physical therapy and a pelvic health physical therapist, who both practice at Atrium Health Women's Care Sexual Health, assessed Lindsay’s condition during her exam. Within minutes, Warren noticed Lindsay’s pelvic floor muscles were extremely tight. Warren and Murray developed a treatment plan, which included a personalized blend of pelvic floor physical therapy, hormones and natural interventions.
Lindsay was thrilled to have a solid assessment of her condition and a clear treatment path. It made her feel like she could “skip down the hallway” with excitement.
Lindsay recalls how she felt at every appointment: “I always felt heard, seen and validated. I never felt embarrassment or shame. I felt celebrated when I started feeling better.”
Multiple medical issues
In addition to her pelvic pain, 30-year-old Lindsay was having lower back pain. Due to Hashimoto’s disease, an autoimmune condition that affects the thyroid, Lindsay had gained about 60 pounds. This was surprising since she maintains an active lifestyle, including nannying three children. She thought the back and pelvic pain was a direct result of the weight gain.
Murray diagnosed Lindsay with clitoral phimosis, a condition where the skin covering the clitoris adheres to the clitoris, potentially impacting sensation.
“I started her on a cream that combines estrogen and testosterone to improve the tissue’s health and sensitivity, along with physical therapy,” Murray explains. “We also explored ways to address her low libido, including sensate focus, which encourages couples to connect through touch, and mindfulness.”
Exercises for spine and pelvis
During Lindsay’s first physical therapy appointment, Warren had Lindsay stand up, bend over and touch her toes. Then, she had Lindsay put her hands on her hips and lean back. Observing her movements, Warren noted that the bottom two to three vertebrae in Lindsay’s spine were less mobile than expected.
Warren identified that Lindsay had an anterior pelvic tilt, also known as lower crossed syndrome – an imbalance of muscle strength between the front and back of her pelvis. This forward tilt of the pelvis restricted spinal movement during forward and backward bends. Additionally, the pelvic tilt caused Lindsay’s pelvic floor muscles to tighten. While Lindsay could contract these muscles, she was unable to relax or lengthen them.
During physical therapy, Warren also pointed out issues with Lindsay’s posture. Since she was sitting incorrectly, Lindsay was frequently overextending her spine.
Warren used internal massage to help stretch and loosen Lindsay’s pelvic floor muscles. She also prescribed a personalized routine of exercises, including pelvic floor stretches and back stretches, to help her build strength and increase flexibility.
Celebrating small wins and measuring progress
Lindsay’s physical therapy spanned about seven months and included numerous ups and downs. It took about 14 weeks for Lindsay to start experiencing pain relief in her pelvic floor and back. Lindsay and her partner incorporated maneuvers she learned in physical therapy into their sex life, working to stretch and align her pelvis in specific ways.
As a physical therapist, Warren helps her patients keep their eyes fixed on the bigger picture and teaches them how to measure progress effectively. With pelvic floor muscle issues, for example, she can often identify subtle improvements in the quality of the contraction, which patients may not recognize.
“It can take time to see pain improve,” Warren explains. “Rehabilitation rarely follows a straight path from injury to recovery. That’s why it’s so important to celebrate even the smallest signs of progress.”
For Lindsay, back pain and posture improvements came faster than pelvic floor recovery. Warren focused on celebrating these early wins.
“Walking into physical therapy always felt great,” says Lindsay. “I was eager to share my challenges and progress. I never hesitated to ask questions or seek advice. Looking back, I’m incredibly proud of the work I’ve done.”
Multidisciplinary approach to women’s care
According to Warren, many OB-GYNs may not realize that clinics dedicated to sexual health are available for patient referrals.
“Your sexual health is influenced by various factors, including muscular, hormonal and neurological,” says Warren. “It takes time to navigate through all these complexities. At our clinic, we have the expertise and time needed to thoroughly address each aspect, accelerating the process for our patients and enabling a deeper, more effective evaluation.”
“It’s rare to have a physical therapist, a nurse practitioner and a medical doctor all in one office,” Warren continues. “This multidisciplinary collaboration ensures patients with sexual health concerns receive well-rounded care and feel better faster.”
Warren and her colleagues use quick, seamless communication tools to coordinate care. This allows them to schedule concurrent appointments, like an OB-GYN visit and a physical therapy session on the same day, saving patients extra trips.
Regaining control and confidence
Lindsay couldn’t be happier with her experience at Atrium Health Women's Care Sexual Health. She felt the staff truly listened to her and advocated for her, ensuring she never felt out of place or that her concerns were unimportant. Because of this, she will “sing their praises forever.”
And her everyday life has changed significantly now that she knows where her pain is coming from.
“I’ve learned the importance of being in tune with my body and muscles,” notes Lindsay. “Even when I’m just sitting, I’m more aware of my posture and how it makes me feel. If my back starts to hurt, I know how to fix it using a variety of stretches.”
Lindsay is relieved that sex feels normal again and that her sex drive is intact.
“It’s great to be excited about sex again and not be horrified that something is going to hurt,” she explains. “On top of that, I thought my sex drive had tanked. Turns out, I’m fine – she’s back for good!”
Lindsay’s health journey has also changed her outlook on the human body.
“Women are amazing,” she says, “We shouldn’t hide or feel ashamed about our pain. Our feelings are valid and usually indicate underlying issues. I’m excited to be more open and talk about things that might initially seem scary.”
A safe space for women
For Warren, one of the most rewarding parts of pelvic health physical therapy is helping women overcome challenges they’ve often suffered with in silence for years.
“Helping women improve their physical and emotional well-being, especially in areas like relationships and intimacy, has such a profound impact on their quality of life,” Warren explains. “It’s incredibly fun and fulfilling work."
Warren calls Atrium Health Women's Care Sexual Health a “safe space” for women.
“We’re deeply mindful that many of our patients have experienced trauma, whether from personal relationships or previous health care systems,” Warren notes. “We’ve worked hard to create an environment where you feel comfortable and supported. We’ll work with you to understand what’s going on, including what’s normal and what’s not.”
Lindsay is very open about telling friends – and even strangers – about the benefits of sexual health.
“There are specific doctors out there who can help,” Lindsay says. “Let’s break the stigma. We should talk about how we feel and what is and isn’t working for us.”
If you have questions or concerns about sexual health, Atrium Health Women's Care Sexual Health is the place to find answers.
