One of the more widely used therapies that could significantly improve the quality of life of women who experience painful intercourse – pelvic floor physiotherapy – is currently largely unavailable in Montenegro.
This therapy is “still at an early stage of development and is not available within the public health system”, said the Chamber of Physiotherapists of Montenegro.
“Given the importance of pelvic floor therapy in treating urinary incontinence, painful intercourse, postnatal rehabilitation and menopause-related complaints, there is a need for it to be developed further and made more widely available within the health system.”
It said that the first training course in pelvic floor therapy was held this year.
Pelvic floor physiotherapy can be “particularly important” at stages of life marked by major hormonal and physiological change, such as pregnancy, the postnatal period and the menopause.
Nevena Miletic Djuric, a Belgrade-based physiotherapist specialising in the pelvic floor, said that along with these changes, the tissues, the muscles, the nervous system and the way the pelvic floor functions all change, leading not only to sexual problems but also to urinary and faecal incontinence and conditions such as prolapse.
It has also been used successfully for years to treat vaginismus – an involuntary muscle spasm that makes intercourse extremely painful – as well as chronic vulval pain [vulvodynia], dyspareunia [painful intercourse] and pelvic floor muscle tone disorders.
“The effects of the therapy are usually assessed after six to 12 weeks. It does not mean that that’s when we expect full recovery, but at that time we should be able to assess if there is a clear trend of improvement,” said Miletic Djuric.
Typically, the pain eases first, she said, followed by a gradual return of sexual function.
In many European countries, this type of therapy is available to patients within the public healthcare system.
Miletic Djuric cited the example of France: “Postnatal pelvic floor rehabilitation can be prescribed after childbirth and is covered 100 percent by public health insurance, within the set standard tariff. According to an analysis of the French national health data system, almost 639,000 women used pelvic floor rehabilitation in 2022.”
In Britain’s National Health Service, NHS, it is the first-line recommendation in postnatal care, and for problems with prolapse, pelvic pain and sexual dysfunction.
“For it to be accessible, there needs to be a sufficient number of properly trained specialists, as well as a clear pathway for women to receive an appropriate assessment and treatment”, Miletic Djuric said.
Another issue is Montenegro’s complete lack of sexologists – psychotherapists who deal with the psychological aspects of sexual problems.
“Sexual problems are a taboo subject in Montenegro, specialist training in sexology is not available in Montenegro, and there is certainly nothing of the kind within the public health system,” said psychotherapist Adriana Pejakovic.
According to Pejakovic, women say they are forced to go from one therapist to another, getting help only if they are “lucky” enough to find the right one.
“At the system level, there are counselling services on women’s reproductive health, but through my work I have noticed that there is no multidisciplinary approach to problems such as a lack of sexual satisfaction, painful intercourse, anorgasmia… And within psychotherapy practice, which is mostly private, there is no established practice for sexual problems with a psychogenic basis.”
Two gynaecologists with expertise in hormone therapy