What if sex is painful?

Sex can be a major component of life/relationship and when it becomes painful or different it can affect someone on so many levels both physically and emotionally. As a pelvic health physical therapist I want to bring light to painful sex, how common it is, where it happens, what contributes, and how it’s related to the pelvic floor. 

Pain with intercourse is common. In fact, the American College of Obstetrics and Gynecology (ACOG) reported 3 in 4 women will experience pain with sex at some point in their life. Although it’s common, it should not be normalized! 

When it comes to the location, frequency, and mechanism of pain with sex, it greatly varies from person to person. Some women report the discomfort being temporary and others report it being a long term problem. Some experience a deeper pain in the vagina, others feel discomfort in the superficial vulva (clitoris, labia, vaginal opening), and some feel both. Some people feel pain every time they have intercourse. Others notice pain with changes in their menstrual cycle, and some feel pain with different sex positions. Also some report pain radiating to the low back, bowels, bladder, and perineum (space between vagina and rectum) during/after intercourse. WOW, that is a lot of variations! Each person experiences this discomfort uniquely!

Painful sex is often reffered to as dypaureunia (just a medical term for painful intercourse). It has a wide variety of causes and contributions that are important for you and your healthcare provider to discuss.

Contributing factors for dyspareunia are:

• Vaginal dryness: read previous blog here 
• Hormonal changes: menopause and pregnancy 
• Childbirth 
• Constipation: read previous blog here
• Emotional factors: history of abuse, depression, and anxiety. 
• Vulvodynia: pain at external vulva  
• Vaginismus: muscles spasms of pelvic floor muscles 
• Endometriosis: 1 in 10 women have this. 
• Interstitial cystitis
• Vaginitis or urinary tract infection
• Pelvic floor dysfunction: taut and spasming muscles within the pelvic floor can make insertion difficult and painful.

If you are experiencing pain with intercourse I recommend seeking care from a healthcare provider. Finding a medical team is the best way to ensure you get a well-rounded treatment approach. Often for pain with sex, the team includes a MD, pelvic physical therapist, and sometimes a sex psychologist.

Pelvic physical therapy is a major component in care because the pelvic floor itself is the avenue for intercourse. Often women experience pain with intercourse from pelvic floor muscles that are tight or overactive. This can inhibit blood flow and irritate the local nerves which is a common factor in why the pain happens during sex. Visiting a pelvic health therapist will help to release muscle tension, improve pelvic fascial mobility, teach you relaxation techniques, and provide you with a home program potentially including vaginal dilators to promote independence with your treatment!

Here are some at home tips I give my patients for addressing painful sex:

Communication: having open communication/trust with your partner is key. Let your partner know what feels good and what doesn’t. If you need your partner to go slower, communicate that to them! Also sex does not always mean vaginal penetration, there are other ways to be intimate.

LUBE: proper lubrication is so important to make things more comfortable and less frictiony. Read previous blog here. 

Stretching/breathing: Stretching and breathing can help prepare the pelvic floor for sex. Try doing the below stretches for 60 secs each and timing your inhale with insertion (our pelvic floor naturally relaxes with our inhale) 

Take a bath: Warm water helps to relax pelvic floor muscles before or after sex.

Change positions: We can use positions to our advantage to change speeds/depth of penetration:

• On top: allows you more control of depth/speed of intercourse. 
• Modified missionary:  pillow under hips, knees bent/feet raised (basically happy baby) can reduce pain because it is more likely to allow the pelvic floor muscles to relax
• Side lying: allows for more control of depth. 

Okay… and if this wasn’t complicated enough, in this blog we only focused on vaginal, penile penetrative intercourse.

Pain can occur with other forms of penetration and is not exclusive to the female gender. Overall, if you are experiencing pain with physical intimacy  it is good to understand the options you have and how to address it.

As always, please contact me if you have any questions or need help searching for a local pelvic health therapist near you!