Do I Need Pelvic Floor PT and Sexuality Counseling? By: Dr. Erin Dean, PT, DPT, CLT-LANA

How pelvic floor physical therapy helps during and after cancer treatment:

The pelvic floor is the group of muscles that run from your pubic bone to your tailbone, and they surround the urethra, penis, vagina and anus. They hold up your organs as you move, they keep urine and feces in and let them out at your will, they are a part of your core, and they play a big role in your sexual function.

In gynecological or colorectal cancers, chemotherapy can lead to pelvic floor weakness, causing urinary or fecal incontinence. It can also shut down your ovaries, causing medically induced menopause that leads to urinary urgency and changes in vulvar tissues and subsequent painful penetration. Radiation can cause urinary or fecal urgency and leakage and shortening of vaginal or rectal canals, which can lead to difficulties with bowel movements or intercourse. Surgeries for these cancers can also lead to any and all of these issues.

Pelvic floor physical therapy includes an initial examination of your pelvic floor and other systems that may be leading to your symptoms, then treats you as a whole person, including specific education and exercises to help you get back to or better than your pre-cancer self.

People with breast cancer experience pelvic floor issues too:

With breast cancer, patients may undergo surgery, chemo, radiation and hormone therapy. In addition to the pelvic floor issues due to chemo, people with hormone positive breast cancers usually take endocrine blockers (examples-Anastrozole and Letrozole), which can either force people into menopause or rid menopausal patients of the remaining estrogen in their fat tissue, causing renewed or worsened menopausal symptoms. The most common side effect is thinning and weakening of vulvar tissues, leading to painful penetration and subsequent loss of libido.

“Pelvic floor issues may also be worse for people in breast cancer treatment because they don’t know about them. A small study published in 2022 in the journal Support Cancer Care suggests that women in treatment for breast cancer aren’t being told about the possibility of pelvic floor dysfunction. According to the study’s author, the participants reported that if they knew they had an increased risk of developing pelvic floor problems after treatment, they would have been better prepared to manage the condition. ” (2)

Pelvic floor PT after prostate cancer treatment:

Prostate cancer surgery often causes urinary incontinence and can also cause sexual symptoms such as erectile difficulties. Pelvic floor PT can help the patient get back the coordination and strength necessary to keep incontinence to a minimum. We also educate on the use of a penis pump in conjunction with other therapies prescribed by your oncologist or urologist to help to keep the erectile tissue healthy, possibly even if nerves were damaged.

Pelvic floor PT and sexuality counseling combined:

Combining pelvic floor PT with sexuality counseling can not only address your pelvic floor weakness, incontinence and your pelvic or penetrative pain, but can also help you move from a place of surviving cancer treatment towards living your life again, fully, with vibrance and with a renewed sexuality. Sexuality counseling is helpful for all cancer patients no matter the gender or the cancer type. We talk about grieving the cancer first and sometimes work with mental health therapists on this piece. We then discuss how to spark intimacy, including discussing options for sex that may not center on penetration, how to improve sexual desire or remove barriers to having good sex again and ways to focus on pleasure and connection to yourself, your partner and the world around you.

For more information about pelvic floor PT and sexuality counseling initial examination and treatment:

https://www.youtube.com/watch?v=rNNkA9dM-tY

References:

1. Thomme GV. MD Anderson Cancer Center. MD Anderson Cancer Center. Published 2024. Accessed January 13, 2026. https://www.mdanderson.org/cancerwise/5-questions-about-pelvic-floor-physical-therapy-answered.h00-159694389.html

2. Surles T. Pelvic Floor Therapy: What It Is & How It Can Help After Breast Cancer Treatment. Breastcancer.org. Published 2024. https://www.breastcancer.org/treatment-side-effects/pelvic-floor-therapy

3. How Pelvic Floor Therapy Can Help During Cancer. Cancer.org. Published June 17, 2025. https://www.cancer.org/cancer/latest-news/how-pelvic-floor-therapy- can-help-during-cancer.html

About the author:

Erin Dean (she/her) is a doctor of physical therapy who is certified in pelvic health, lymphedema therapy and oncology rehabilitation. She is also certified as a sexuality counselor, assisting patients in returning to their vibrant, creative and sexual lives after cancer treatment. She has a background in yoga and seeks to treat the patient as a whole person, mind, body and all. Erin spent 10 years traveling, working, and volunteering in different countries before going back to school at 30 to get her doctorate in PT. She is an avid cyclist with a love of the outdoors, and she and her spouse have a five year old son.

Degrees/certifications:

  • Doctorate of Physical Therapy
    Texas State University

  • Bachelors of Arts in German
    University of Texas

  • CAPP Pelvic Health Certified Therapist
    American Physical Therapy Association

  • Certified Sexuality Counselor

  • Sexual Health Alliance

  • LANA Certified Lymphedema Therapist

  • Lymphology Association of North America (LANA)
    Klose Training

  • Oncology Rehab Therapist

  • Physiological Oncology Rehabilitation Institute (PORi)

  • 500-Hr Viniyoga Teacher
    Viniyoga Institute

Memberships and Accolades: 

American Association of Sexuality Educators, Counselors and Therapists (AASECT); American Physical Therapy Association-Oncology Section member and Academy of Pelvic Health member; Sexual Health Alliance

Participates in community and Texas-wide presentations/educational events:

Presenter at: Texas Oncology Foundation Survive and Thrive Conference 2024; Junior League of Austin 2025; Texas Oncology Foundation Survive and Thrive Virtual Experience 2024 and 2025; SafeSpacesYoga 2024; Viniyoga with Mirka 2024; CRIM 2019 and 2023

Angela Wicker-Ramos