It’s true. Unless you want it to be, sex should not be painful. Dyspareunia, persistent or recurrent genital pain that occurs just before, during or after sex, is more common than you think! About 10-20% of women in the US experience some pelvic pain during intercourse.
Pain during intercourse can present in many different ways - some people have pain on entry, some deep with penetration. Some people don’t have pain until the next day! The pain may be burning and tearing, sharp and stabbing, or deep and aching. You may feel the pain in your abdomen, urgency in your bladder or pain towards your butt. And it’s not just with sex - some poeple can’t use tampons or have speculum exams because of pelvic pain. One thing is for sure - it can be very debilitating and affect your psyche and relationships over time. Not fun!
The causes of pain during intercourse (dyspareunia) are many. Here are few possible causes:
Pelvic floor dysfunction - tight / tender pelvic floor muscles
Scar tissue from childbirth - vaginal or c-section
Vestibulodynia or tissue / nerve irritation in the vaginal area
Vaginismus with tightening/spasming of the pelvic floor muscles
Perimenopausal hormone changes
Pregnancy / postpartum hormone changes
Endometriosis, fibroids or Adenomyosis
Interstitial cystitis or painful bladder syndrome
Hysterectomy or abdominal / pelvic surgeries - including c-sections
Cancer treatments including radiation, chemotherapy and surgery
Infections - STIs, UTIs, chronic yeast infections
Sometimes, but not always, there may be an emotional cause in conjunction with the physical causes above. These include increased stress or anxiety with gripping and holding tension throughout your body, physical and sexual abuse, traumatic childbirth or PTSD.
What should you do about it? Talk to your healthcare provider. It’s often difficult to discuss intimate details of your sex life with your physician, BUT you don’t have to live with this pain or dysfunction and opening up is often the first step to getting relief. Most of the causes of pain during intercourse can be addressed during pelvic floor physical therapy. If you don’t feel comfortable talking to your doctor, call up a local pelvic floor physical therapist and discuss what next steps you should take. It’s important to rule out any infections or other causes of pelvic pain, however if you have any of the other above causes of your pain, PT can really help you get back (or start) a painfree sexual experience.
What should you look for in a pelvic floor physical therapist? The PFPT should listen to you, make you feel as comfortable as possible and fully assess your body - not just your pelvic floor. As a private PT at Embody Physical Therapy, all evaluation and treatments are one-on-one for an hour. I take the time to listen to the patient about what is happening in their body. I fully assess posture, alignment and movement patterns. I look for where the patient may be too tight or too weak - unbalanced throughout the body, contributing to issues that cause pain during intercourse. I assess the pelvic floor externally and, if able, internally with a vaginal finger exam (no speculums needed). I work with the patient to move at the pace that is most comfortable for the patient. At the end of an evaluation, I provide the patient with a plan for moving forward. This plan is specialized to the patient and may include seeing another practitioner for medication or injections or other types of treatments. This plan usually includes manual therapy in the office - myofascial release to improve the balance of too tight and too weak. The plan also includes a program for home - including stretches or exercises and possibly the use of dilators or a pelvic wand for home stretching. We discuss posture, sexual positions, lubricants, breathing, pelvic floor anatomy and a whole host of things to help you on the road to painfree sex! With a personalized plan most patients are very successful at getting back to a painfree sex life! Please feel free to reach out if you have any questions - embodyPTmedia@gmail.com or 484-442-0238.
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