It’s easy to talk about pain when you’ve scraped your knee, or been in an accident of some sort. Pain makes sense when it can be backed up with something you can see like a cut, or a bruise. Pain with sex is the exact opposite. More often than not, there is nothing visual that you can see that may be causing the pain. It’s also in an area of the body that’s generally covered up and not talked about.
Painful sex, known as dyspareunia in the medical community is much more common that you’d think. Approximately 1 in 10 women experience it, and that’s likely an understatement. Some women may just accept it as something that is normal, others are too embarrassed to bring it up with their health care practitioners, and finally most women just don’t realize that anything can be done about it.
Painful sex can be attributed to structural causes, psychological issues, or a bit of both. Pain with initial penetration can be caused by insufficient lubrication, tight pelvic floor muscles or injury/trauma/irritation of the external skin. Pain with deeper penetration, or pain after intercourse is more often related to conditions such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, and ovarian cysts. Psychological and emotional factors can also play a role. Depression, anxiety, or concerns about physical appearance can lead to decreased arousal which in turn can cause discomfort and pain. Stress can also cause the pelvic floor muscles to tense up (just like your shoulders or neck) and this can lead to a “road block” when attempting penetration.
Sometimes it may not be entirely clear whether the pain has a structural or psychological cause. Initial pain may be due to a structural cause, this leads to a fear of future penetration which can make it difficult to relax. Subsequent attempts at penetration become more painful causing more fear and tension in the pelvic floor muscles. This cycle can progress to a point where there is pain even with light touch.
The important thing to know is that painful intercourse CAN BE treated and you are not alone. The first step should be bringing it up with your primary care practitioner. They can do a pelvic exam and explore the various causes. Depending on the cause of your pain, you may be given medications or directed to physical therapy or counseling.
Physical therapy for the pelvic floor is just like any other physical therapy in that we work on muscles, soft tissues and joints. The biggest difference that you should be aware of, is that many of our treatments are done vaginally. A pelvic floor physical therapy assessment will include a thorough medical history, an external exam of the spine, pelvis and lower extremities, and an internal vaginal pelvic exam. Physical therapy treatments for painful intercourse may involve strengthening of the pelvic floor muscles, relaxation strategies, desensitization of irritable tissues, dilator use and more. Rest assured, our pelvic health physical therapists are highly trained professionals who are sensitive to the intimate issues you bring to the table. Remember, you are not alone, and painful intercourse can be fixed!