Sex shouldn’t hurt! Vaginal pain with sex is referred to as dyspareunia. The pain may be sharp, dull, burning, or stabbing and you may feel it with initial penetration, deeper penetration, or both. Painful intercourse is unfortunately something that many women experience, and they are often told that this is a normal part of the sexual experience. Women are also often told that if sex hurts, they should just “have a glass of wine and try to relax”, that “you can have a relationship without having intercourse”, over even to “just try to get through it”. This is not acceptable, nor is it an adequate solution to pain during sexual intercourse.
What causes the pain with penetrative sex?
Intercourse with a partner can be an important part of romantic relationships, and you shouldn’t try to mask your pain with alcohol or other substances. Addressing the underlying cause of your pain and the factors surrounding painful intercourse is the only way to improve the situation. Dyspareunia is often related to dysfunction in the pelvic floor muscle group. These muscles are found in the base of your pelvis, and have several important functions such as support for your pelvic organs, sphincter control, postural stability, and sexual appreciation. The pelvic floor muscles can often be too shortened, or tight, and this can produce pain upon attempted penetration by a partner.
In addition, the pelvic floor muscles are the first to respond to a perceived threat. If a woman has repeatedly experienced vaginal pain with sexual activity, each time she attempts to have sex her body anticipates pain. Her pelvic floor muscles will tighten to guard and protect against pain, resulting in a vicious circle. In order to fully address dyspareunia, the cycle needs to be broken in a gentle and methodical manner.
What can be done to treat dyspareunia?
This is where pelvic floor physical therapy enters the picture. Physical therapists are movement and musculoskeletal experts. Pelvic health physical therapists are highly skilled and extensively trained to address a variety of pelvic floor and abdominal muscle dysfunction and restore normal function of these muscles while empowering you to take charge of your health at home.
Techniques used in physical therapy in order to treat women with dyspareunia include manual stretching of pelvic floor muscles, relaxation techniques, stretches and exercises to improve pelvic floor muscle function, and the use of vaginal dilators. Dilators are an excellent way to safely and slowly introduce the mechanical forces of intercourse to the vaginal tissues and pelvic floor muscles in a controlled manner. All pelvic floor therapy sessions are conducted in a private room away from the main clinic gym. The primary goal of any type of physical therapy is to give you to tools and skills that you need in order to manage your own care. Patients are taught how to use and progress a dilator program at home, how to transition from dilators to intercourse, and how to relax their own muscles through stretches and breathing techniques.
If you’ve been experiencing pain with intercourse, consider contacting a trained pelvic floor physical therapist to assess your muscles and help you return to pain-free sex.
Writing by Genevieve Tatara DPT – women’s health/pelvic floor specialist (Evie is available to see patients at our Lewes, Delaware and Ocean City, MD office.)
Aquacare/Fitness Forum Physical Therapy
