Fertility Care

Fertility care physiotherapy is a preconception service that looks at how the pelvic floor, deep core, hips, and surrounding connective tissue are functioning before pregnancy begins. For some people this means addressing pain that makes intercourse, exercise, or even sitting for long periods uncomfortable. For others it means preparing tissue and movement patterns ahead of a planned pregnancy or a cycle of assisted fertility treatment. It is not a fertility treatment itself and does not diagnose or treat infertility — it works alongside your fertility specialist, gynecologist, or family physician as one part of a broader plan, with the goal of helping your body feel more comfortable and better prepared.

How the pelvic floor and deep core work together

The pelvic floor is a layered group of muscles that spans from the pubic bone at the front to the tailbone at the back, forming a supportive sling underneath the bladder, uterus, and rectum. It works in coordination with the diaphragm above and the deep abdominal muscles — particularly the transverse abdominis — around the sides, forming what is sometimes described as a pressure-managing canister. When you breathe, cough, lift, or simply stand upright, this canister adjusts its pressure and tension continuously. When one part of that system is either too tight (hypertonic) or too weak to respond appropriately, the rest of the system often compensates, which can show up as pain, a sense of heaviness, or discomfort with touch or penetration.

Why pelvic tension or pain can develop before conception

Pelvic floor muscles can become chronically overactive for a number of reasons: ongoing stress and a nervous system that stays in a guarded, protective state; prior pelvic or abdominal surgery such as a laparoscopy, appendectomy, or a previous caesarean birth, where scar tissue can restrict how layers of tissue glide against each other; or conditions such as endometriosis, where repeated inflammation and pain signalling can sensitize the nervous system over time, so muscles guard even when there is no active tissue damage. Postural habits and breathing patterns — for example, chronic breath-holding or shallow chest breathing under stress — can also keep the pelvic floor in a persistently short, tense state rather than allowing it to fully lengthen and relax. Left unaddressed, this tension can contribute to pain with intercourse, referred pain into the hips or lower back, and bladder or bowel symptoms. The autonomic nervous system plays a central role in this pattern: when the body perceives ongoing physical or emotional stress, it tends to favour a sympathetic, fight-or-flight state that keeps muscles — including the pelvic floor — primed and slightly contracted, which can make it difficult for that tissue to fully release even during rest or sleep.

What fertility and preconception physiotherapy can help with

• Pain with intercourse or pelvic pain (dyspareunia, vulvodynia, endometriosis-related pain): gentle assessment and treatment of overactive pelvic floor muscles and myofascial trigger points, which are often a significant contributor to pain even when there is an underlying gynecological diagnosis.
• Pelvic floor tone imbalance: some pelvic floors are underactive and benefit from graded strengthening, while others are overactive and respond better to downtraining, breathing work, and manual release — assessment helps clarify which pattern is present.
• Scar tissue and mobility restrictions: hands-on techniques to address adhesions and restricted glide following prior abdominal or pelvic surgery, which can otherwise limit tissue mobility and comfortable movement.
• Core and alignment preparation: building coordinated breathing and deep core activation patterns ahead of pregnancy, when these systems will be asked to adapt to significant physical change.

What a thorough assessment involves

An initial assessment starts with a detailed conversation about your health history, pain patterns, prior surgeries or diagnoses, and what you are hoping to prepare for. From there, your physiotherapist typically assesses posture, breathing mechanics, and hip and lumbopelvic mobility externally. Where relevant to your goals, an internal (vaginal) pelvic floor examination can be included to assess muscle tone, coordination, and areas of tenderness directly — this is always optional, fully explained beforehand, and only performed with your informed consent. A great deal of useful information can also be gathered externally if you prefer not to proceed with an internal exam, and you can change your mind at any point.

How treatment works

Treatment is individualized and may include manual therapy to release myofascial trigger points or mobilize scar tissue, breathing-based relaxation techniques to help an overactive pelvic floor learn to lengthen, and graded strengthening exercises where underactivity is contributing to symptoms. Your physiotherapist may also provide guidance on pacing intercourse or physical activity around pain, and positioning strategies that can reduce discomfort. Throughout, physiotherapy is intended to work alongside your fertility care team, not in place of medical investigation or treatment — your physiotherapist can communicate with your referring provider when helpful and will encourage you to keep pursuing any medical workup or treatment plan already underway.

Who this can help

• Anyone experiencing pelvic pain, pain with intercourse, or pelvic floor tension while preparing for pregnancy.
• People with a history of endometriosis or chronic pelvic pain who want additional support alongside their medical care.
• Anyone with prior abdominal or pelvic surgery whose scar tissue may be contributing to discomfort or restricted movement.
• People preparing for assisted fertility procedures who want their pelvic floor and core assessed and supported ahead of time.
• Anyone who simply wants a baseline assessment of pelvic floor and core function before pregnancy.

If you are in the High Park area of Toronto and thinking about starting or growing your family, a pelvic health physiotherapy assessment can be a helpful starting point, alongside guidance specific to your fertility journey. You can book an appointment to discuss your history and goals.