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Painful gynecological exams and uncomfortable sexual intercourse: Could excessive tension in the pelvic floor be to blame?

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Many women experience a situation at some point in their lives where they are surprised by pain during a gynecological exam or discomfort during sexual intercourse. If all medical test results are normal but the problems persist, the cause may lie elsewhere—for example, in excessive tension in the pelvic floor muscles.

A Tense Pelvic Floor – A Hidden Cause of Pain

How does excessive voltage occur?

Increased tone (tension) in the pelvic floor may result from:

  • Long-term stress and mental exhaustion,

  • extreme physical exertion,

  • urinary tract infection or vaginal infection,

  • surgical procedures in the pelvic, abdominal, or hip joint regions,

  • painful or traumatic experiences.

“These are all factors that can lead to a reflexive increase in pelvic floor muscle tension,” explains intimate physical therapist Katarína Hanuliaková, MSc, from the IntimFyzio.

What are the symptoms of increased pelvic floor tension?

Typical symptoms include:

  • Pain during a gynecological exam,

  • uncomfortable or even painful sensations during sexual intercourse,

  • a feeling of pressure or tightness in the lower abdomen,

  • frequent urge to urinate or a feeling of incomplete emptying,

  • digestive problems and frequent constipation

  • inability to relax

There is a solution—pelvic floor physical therapy

Targeted gynecological physical therapy can restore proper function to the pelvic floor muscles and relieve excessive tension in them. It is a noninvasive and effective method that helps the body regain its balance.

What does normotonia mean?

Normotonia is a condition in which the pelvic floor muscles are appropriately toned—neither too loose nor too tight. It is precisely in this state—normotonia—that the pelvic floor can effectively perform its functions:

  • Support the pelvic organs,

  • help promote proper bowel movements,

  • to help with proper breathing,

  • enable pain-free sexual intercourse, and even make it possible to reach orgasm.

“The goal of physical therapy is to restore this normotonia and help women feel good in their own bodies again,” adds intimate physical therapist Katarína Hanuliaková.

Don't put off solving problems

If you’ve experienced a painful gynecological exam or feel discomfort during sexual intercourse, don’t ignore it. Even if the test results show nothing wrong, your body is sending you a signal that it needs your attention. The right step is to see a physical therapist who specializes in the pelvic floor. Just a few sessions together can significantly improve your quality of life.

Your intimate health deserves your attention

Painful sexual intercourse or a gynecological exam isn’t normal just because the test results look good. If you’re experiencing discomfort, look for the cause and a solution.

At the IntimFyzio Center, we’ll help you restore your balance and comfort.

Schedule an appointment – click here

Learn more about pelvic floor physical therapy— click here

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The body does not need to be fixed. It needs to be understood.

I am a woman, wife, mother and physiotherapist. Over the years of practice, I have realised that health does not come only from eliminating symptoms or solving a specific problem. Real change comes when a person begins to better understand themselves, their body, and the way they live their life.

It was this idea that led me to create the space you know today as ToBe – a place where different areas of expertise, perspectives, and approaches to health are interconnected. A place that does not see a person only through a diagnosis or individual symptoms, but as a unique whole.

My professional journey began in physiotherapy and the musculoskeletal system. Over time, clients and their stories gradually led me deeper – from working with the body through the pelvic floor to understanding the meaning of emotions, the psyche, and the functioning of the nervous system. Today, I see the body as the bearer of a person’s story, and therapy as a space where we can get to know that story, understand it, and support its natural process of change.

How I work

Years of practice have taught me to slow down. To listen more. To place less emphasis on performance, results, or quick change.

In therapy, I strive to create a safe space where clients can become more aware of their bodies, their needs, and the connections between what they are experiencing and what is happening on a physical level. I don’t focus only on symptoms; I also look for their possible causes and the context in which they arise.

Over the years, I have become increasingly aware of how closely the body, mind, and nervous system are connected. This is why I naturally integrate a psychosomatic perspective and the principles of nervous system regulation into my work – gently, clearly, and always with respect for where each client is in their own process.

I believe the body has a remarkable capacity for healing and renewal. Sometimes it doesn’t need more pressure — it needs understanding, a sense of safety, and the right conditions to begin functioning in a different way.

What I can help you with

In my practice, I specialise mainly in:

  • urogynecological physiotherapy
  • pelvic floor dysfunction
  • incontinence
  • painful conditions after childbirth
  • preparation for childbirth and postpartum recovery
  • painful menstruation
  • pain during sexual intercourse
  • functional disorders of the musculoskeletal system
  • chronic pain without an organic cause
  • unintegrated scars
  • psychosomatic connections of health problems
  • regulation of the nervous system

Methods and approaches I use

In my work, I connect physiotherapy with knowledge from psychosomatics, work with the nervous system, and a holistic therapeutic approach. I mainly use:

  • urogynecological physiotherapy
  • pelvic floor therapy
  • diagnosis and therapy of functional disorders of the musculoskeletal system
  • visceral manipulation
  • osteopathic principles
  • craniosacral therapy
  • psychosomatic approach in physiotherapy
  • principles of nervous system regulation
  • knowledge from Somatic Experiencing® training

In therapy, I combine professional knowledge with a sensitive perception of the person and their story. My goal is not only to relieve the problem, but to support the client in better understanding themselves and their body.

ToBe – the concept

ToBe grew naturally out of the original IntimFyzio centre. Over time, I increasingly felt the need to bring different areas of expertise together and create a place where a person does not have to be divided into separate parts.

Today, ToBe is a multidisciplinary space where physiotherapy, psychology, psychotherapy, women’s health, traditional Chinese medicine, work with the nervous system, and other approaches come together – united by a common idea: to see a person in their entirety and create the conditions for health, growth, and a deeper connection with oneself.

Education and professional development

I studied physiotherapy at the Faculty of Medicine of Comenius University in Bratislava, and completed my master’s degree at the University of Brighton in the United Kingdom.

I have completed a specialisation in functional and structural disorders of the musculoskeletal system at the Slovak Medical University in Bratislava. I hold a licence for independent medical practice and am a member of the Slovak Chamber of Physiotherapists.

Training that has significantly shaped my therapeutic approach

  • Somatic Experiencing® (currently in training, Lilian Troost)
  • Psychosomatic approach in physiotherapy (CKP Edu, Prague)
  • Visceral manipulation and osteopathic approach (Inge Schuermans, MSc)
  • Birth trauma in physiotherapy and self-regulation tools in client practice (Mgr. Radka Tomášková)
  • Holistic approach to scar and pelvic floor therapy (PhDr. Michaela Prokešová, PhD.)
  • Traditional care for women and mothers (Angelina Miranda Martinez)
  • Osteopathic approach in pregnancy and gynaecological dysfunctions (Inge Schuermans, Jory Paul)
  • Ludmila Mojžišová method (Mgr. Jana Jedličková)
  • Physiotherapy of pelvic floor dysfunction and urinary incontinence (Prof. Magdaléna Hágovská, Mgr. Zuzana Woleková)
  • Craniosacral therapy (Mgr. Helena Toušková, Upledger Institute)
  • Certified DNS Therapist Diploma (Prof. Pavel Kolář)
  • Diagnosis and Therapy of Functional Disorders of the Musculoskeletal System (Eva Janíková)
  • Stott Pilates (Jitka Kadish)

I believe health is not a goal to be achieved. It is a relationship we build with ourselves, our bodies, and our lives – and it is a journey I love to accompany my clients on.