Painful intercourse, also known as Dyspareunia, is a common occurrence among women; however, few women feel open and comfortable enough to discuss their painful intercourse. Yet it’s an issue that can impact sexual pleasure, feelings of intimacy, and ultimately your relationship with your partner. Unfortunately, most women struggle to address these issues.
So, why do so many women suffer in silence? Why do so many women settle and accept this pain and feel that it’s something to adjust to?
As a pelvic floor physical therapist, I come across many reasons why women feel the need to keep sexual discomfort to themselves. It’s personal. Women often feel isolated and alone, and have a hard time sharing their issues with others. Some women are embarrassed, and feel like it’s their fault. Most of the women that I see have been misguided and don’t know where to turn for help. While I wish I could fix the stigma that comes along with painful intercourse with this one article, unfortunately this is a social issue that needs to be addressed by women like you and I.
The good news is that this article is an opportunity for me to tell you that there’s help for this issue.. From the perspective of a practicing pelvic floor physical therapist, I hope to provide you with a little bit of knowledge to open up your thoughts, and make you aware of the help that is available to you with hopes that in the near future, you will find the support needed to engage in pain- free, and hopefully enjoyable intercourse.
Pelvic floor physical therapy is a specialized area of physical therapy practice that focuses on the pelvic floor muscles, while also taking the whole body into consideration during assessment and treatment. The pelvic floor is composed of three layers of muscles that are housed at the bottom of the pelvis. This group of muscles span from the pubic bone in the front of the pelvis to the coccyx (tailbone) in the back of the pelvis. The muscles have 3 main functions:
- Supportive function – to assist in distributing pressure, as well as supporting the pelvic organs and structures above.
- Sexual function – assisting in desire, pleasure and orgasm.
- Sphincteric function – wrapping around the anus and urethra, to assist in maintaining continence.
I see many patients that struggle with pain during intercourse. They often come into my clinic thinking that this is normal and that it’s something they will always have to deal with. The first thing to understand regarding pain with intercourse is that it’s not normal. If you’re experiencing pain, your body is telling you something and sending you a signal that something is not right. When our knee is sore and we have issues walking we go see a physical therapist. The same is true with your vagina. It is important to listen to your body. It is also important to get a proper physical therapy pelvic floor assessment to determine the cause and the best course of treatment.
Given that there are a number of possible causes of intercourse pain, it is imperative that you get a proper assessment. Below are a few of the most common problems that I see in my practice that can cause intercourse pain.
Possible Causes of Intercourse Pain
- Improper positioning during intercourse
- Lack of communication between partners
- Lack of lubrication
- Prolapse of pelvic organs(s)
- Vaginal dryness and/or atrophic changes, micro tears of vaginal tissue due to hormonal changes (menopause, medications, pregnancy, postpartum)
- Tightness of pelvic floor muscles
- Scar tissue potentially from pelvic/abdominal surgeries, childbirth tears/episiotomies
- Bladder conditions and other pelvic conditions/diseases
- Nerve irritation or compression
- Pelvic floor muscle weakness
- Dysfunctional core muscle system
- Low back, pelvis, hip dysfunction
I know!! It seems a bit overwhelming.. Intercourse is a multifaceted human activity involving not only our physical dimension but also our emotional, spiritual and psychological dimensions. It is for this reason that a multidisciplinary approach is often needed when dealing with painful sex. There may be partner dynamics that need to be addressed. These can include communication issues, past traumatic events, or painful experiences associated with either intercourse or the pelvic floor/pelvis. When I work with patients who experience painful intercourse, I work closely with other practitioners during treatment, and each of these dimensions are taken into consideration. We are very fortunate in the field of pelvic floor physical therapy to have the opportunity to work simultaneously on the pelvic floor muscles and any anxiety that is present.
There are a number of treatment options that may be used, depending on the cause of your pain.
Treatment options
- Manual therapy to stretch and release
- Education on intercourse, male and female response, pleasure, desire
- Bladder education and retraining
- Intercourse positioning advice
- Breathing and relaxation training
- Advice on vaginal tissue, blood flow and skin health
- Lifestyle habits and diet modification
- Pelvic floor muscle re-education
- Use of modalities such as muscle stimulation, biofeedback, dilators, laser
- Scar mobilization (abdominal, pelvic floor)
- Desensitization
- Postural alignment
- Core coordination
- Education and treatment during pregnancy and postpartum
- Pregnancy pelvic girdle pain, changes during pregnancy
- Advice postpartum
The bottom line and what I continue to see in my practice is that each body and each vagina is different. My treatment is individualized and patient focused. It is an approach that strives to restore natural form and function as well as simultaneously working towards patient goals and most importantly the patient is always in control.
Remember, it’s not normal to live with this pain. A pelvic floor physical therapist can assist you and help you learn more about your body and what you need. Please feel free to share this information with your friends, as you never know who may be suffering in silence. It is important to share our stories and knowledge, and raise awareness. When you educate yourself and educate others, we can all help each other. Every woman deserves to experience pleasurable intercourse.