Gynaecological massage, often called pelvic floor massage, is a modality that is more medical, involving a deep knowledge of the female anatomy and a good understanding of genital pathologies.
Traditional gynaecological massage was commonly practiced until approximately 1920 by gynecologists. Most gynaecologists have moved to surgery and drug-based approaches since, leaving the practice abandoned for most of the 20th century. Pelvic floor physiotherapists and kinesiotherapists have brought the practice back to life in the last 2 decades, with a few new techniques. It is used to heal a number of issues, such as incontinence, constipation, pelvic organ prolapses, pelvic floor dysfunction, scar reduction, and to some degree, pudendal neuralgia. It usually requires months to years of treatment, and the results are sometimes disappointing.
My approach of gynaecological massage is a whole-body approach that involves trauma release and tantric sexual healing if needed, as well as myofascial, craniosacral, Neurokinetic therapy, neurology, traumatology, Karsai Nei Tsang, manual therapy, etc. This has allowed me to extend the number of issues covered to menopause issues, menstrual issues, interstitial cystitis, vulvodynia and other chronic pelvic pain, infertility, low libido, ovarian and cervical cysts, breast issues, fibroma reduction, endometriosis, etc. Furthermore, by working with a whole-body approach involving the emotional and sexual levels, results are faster to achieve and more durable.
Since the body works as a whole, I rarely offer a gynaecological massage without massaging the abdomen, releasing the muscles and the fascia of the rest of the body. Prolapses, for example, happen partly because of pressure from above or from lack of support from below. Neuralgia is often the result of nerve compression by muscles, scars, fascia or ligaments. The whole-body approach takes longer, but the results are much faster than from a pure gynecological massage. Most of my sessions take 3-6 hours. However, my clients need fewer sessions than if they received only a genital massage, and the results are in my experience more satisfying.
My approach can involve pleasure, but only if the client consents to it and in as much as it helps the healing process. Clitoral pleasure, for example, can be used in combination with breath work to tense up the cardinal ligaments, which will help lift a uterus that is prolapsed. K-spot orgasms have been shown to reduce or eliminate ovarian and cervical cysts. And in both of these issues, we see radical results in 1-3 sessions. For most other issues, pleasure is not necessary and thus not the goal, although it may arise spontaneously and I embrace it if it is within the boundaries of the client.
Consent and boundaries — to be discussed before the session starts
Before any bodywork session, there should be a discussion on the needs and boundaries of both the client and the practitioner. This is essential to build trust and to ensure that both are working towards a common goal. Once the work has started, boundaries can be restricted but not opened, in order to avoid regrets afterwards. Boundaries for the practitioner are also important. Personally, I do not mind when a client touches me for comfort, or because of a need of contact, but not for my arousal. I always stay clothed. Another of my boundaries is that I never use my mouth or genitals during sessions; only my hands and forearms.
Typical steps in my gynaecological massage sessions
My sessions normally start by an extensive discussion of the physical, psychological and emotional issues that affect the client. I often do Compassionate Inquiries if there are traumas. The client then gets undressed to their level of comfort, usually keeping their underwear and sometimes a bra. Thongs are preferable because we almost always work on the buttock muscles and pelvis. If there are important structural issues, a postural and gait analysis is conducted.
I normally start with an assessment of muscle inhibitions and fascia tension. Inhibitions are resolved through reactivation exercises (NKT) that will be given as homework; if done regularly, Neurokinetic Therapy exercises are nothing short of magic! Surface fascia tightness is resolved by skin stretching and rolling. I also include lymphatic drainage if needed. Only then will I start massaging the body in a systematic way.
I usually start by massaging the belly with traditional Chinese abdominal massage, as any pressure in the abdomen will naturally result in pressure on the pelvic floor, and tensions in the fascia of the belly have an impact on the fascia of the rest of the body. This also involves the release of the psoas and iliacus.
I then release the thigh muscles, back, neck, chest, breast, face and head, arms, shoulders, back, before massaging the buttock muscles. These have a lot of impact on the pelvic floor muscles, because the deep muscles of the butt are part of the same fascia line, the Deep Front Line. Finally, I release the calves and feet. After this, we start genital and/or anal/rectal work.
Genital work can be done by working directly on the vulva, but it is better to start by caressing the body in a more sensual way to transition from very physical and sometimes painful work to slower and more delicate work. If there is any pain genitally, it is always easier to take in a state of arousal, even if the arousal is limited. This is always discussed with the client before the session, and she decides on the approach. If she consents to arousal, then she will be caressed on the legs and belly, breasts if it is within her boundaries, and the rest of the massage will be more sensual. Otherwise, the massage will proceed directly onto the vulva, without added sensuality. Genital work is performed slowly and with low pressure.
The work on the vulva will focus on finding milias, a deposit of proteins, and identifying painful or numb areas. Milias are often found on the hood of the clitoris, on the original attachment of the hymen and in the crux of the vulva. They are eliminated with gentle massage and stretching techniques. Adhesions around the clitoris are also common. These can be eliminated by rolling the prepuce around the clitoris to mobilize it.
Then, with the permission of the client, I will insert my finger slowly into the vagina. Focus will be initially on the status of the glands (same location as pleasure spots), muscle tension, and any pain or abnormal structure. We can help decompress the hip joint and the sacroiliac joints from inside the vagina. I also check the state and the condition of the cervix. Finally, I work on the rectum and the anus from inside the vagina.
If the client suffers from constipation, sacroiliac dysfunction, chronic pain in the rectum or any other rectal issue, I will recommend working in the anus and rectum. Some women are reluctant of receiving anal or rectal work, but I have developed an approach that is pleasant to most people. We can also do any work that could not be done by the vagina through the anus and rectum if there is too much pain or infection (see my blog on anal massage for women).
The session ends when we have done the work agreed upon or when the client decides that the session is finished. We will then debrief about the session, review any recommendations for further sessions, as well as exercises given as homework.
I offer training for gynaecological massage 2-3 times a year in Thailand, Berlin (Germany), and hopefully in Canada soon. This training is very heavy in anatomy and can get very technical, but does not require any prior training. I have divided the curriculum into three 6-day programs. Contact me to get more details.