Experiencing pain during sex can be a devastating condition for many women. The inability to enjoy a physical connection with their partner can leave a person with deep emotional pain alongside their physical pain.
If you have experienced any of the symptoms associated with painful sex, it’s important to remember that you are not alone! Pelvic pain during sex is a common condition that we can help our patients manage & treat. That’s why this week, we will examine the issue of painful sex and some of the pelvic health conditions associated with it.
Painful sex is any pain or discomfort that prevents you from becoming aroused or engaging in sexual activity (either alone or with a partner). The pain experienced can be either internal (cramps or pressure) or external (dry and sensitive vulval skin), depending on the causes.
Everyone likely has a different definition for what qualifies as “pain”. As such, a good rule of thumb to keep in mind is that if your situation causes you feelings of anxiety and an inability to enjoy sex then you should consult a pelvic health specialist about your symptoms.
Symptoms Of Painful Sex
Experiencing pain during sex can come in different combinations of symptoms. Below we will take a more in-depth look at some pelvic floor-specific conditions that may cause this. First, however, we should define some of the symptoms and sensations commonly associated with this pain. These symptoms include (but are not limited to):
- An aching feeling in your pelvic region
- Sharp or stabbing sensations in the genitals or bowels
- Painful, uncontrollable muscle spasms
- Pain when inserting/removing tampons
- Inability to become or stay aroused
- Inability to produce natural lubricant
Painful intercourse is unique in that the symptoms can occur both during vaginal contact/ penetration as well as linger for a period after the contact has occurred.
What Causes Pelvic Pain During Sex?
While experiencing pain during sex may sound like it’s a strictly gynecological problem, it should come as no surprise that your pelvic health plays a direct role as well. If you are unsure of where your pelvic floor muscles are, they are the ones that you would tighten if you wanted to quickly stop urinating for some reason.
If you caught our recent blog where we introduced you to Penelope the Pelvis and the pelvic floor, you would have seen how the various pelvic floor muscles surround and support the genital organs and their functions.
A little bit of tension is necessary for these muscles to do their jobs. This includes maintaining a healthy blood flow to the pelvic organs (such as the genitals). Too much (or too little) tension and blood flow to the pelvic muscles can cause issues like an inability to support normal genital function or become aroused.
Often, symptoms such as dry, uncomfortable sex or repeated bladder infections are an early sign that an underlying pelvic condition. If this is the case, you will likely notice the symptoms becoming more painful or potentially even new symptoms appearing over time. If this is the case, you should set up a consultation with a pelvic health specialist to determine the cause of your pain.
Is Experiencing Pain During Sex Normal?
The symptoms and conditions associated with painful sex are not uncommon. In most cases, the issues are treatable and benefit significantly from pelvic floor therapy alongside any additional treatment the patient may require.
While it can be uncomfortable to talk about, nobody should ever feel too embarrassed to talk to a pelvic health specialist about their symptoms. You are not alone. Confronting these conditions as soon as possible is the best way to get back to enjoying your sex life while minimizing any potential long-term damage.
Here at Grace Physical Therapy, we have proudly helped many patients overcome their painful symptoms and regain control over their sex lives. There’s no reason for you to keep living with the unpleasant symptoms and side effects of painful sex. If you’d like to know more about how pelvic floor physical therapy helps our patients, our guide on What to Expect In Your First Pelvic Floor Physical Therapy Session is a great place to start.
Common Conditions Related To Pelvic Pain During Sex
What Is Dyspareunia?
Dyspareunia (pronounced “dis-puh-roo-nee-uh”) is the general medical term for pain with sex. There are multiple potential causes of dyspareunia, including tight pelvic floor muscles, tissue quality issues, and hormonal changes.
Symptoms may include:
- Vaginal tenderness
- Burning or itching feeling
- Vaginal Dryness
- Urinary Urgency
- Urinary Pain
- Frequent urinary tract infections
- Discomfort or pain during or after intercourse
We will discuss in more detail two different types of dyspareunia that cause women to experience pain during sex below.
What Is Vaginismus
Vaginismus is one of the most common conditions linked to painful sex. For many women, it is often the culprit of their discomfort. The term vaginismus is used specifically to describe contraction-like spasms in the pelvic floor and felt in the genital region.
There are generally two types of vaginismus that affect women, which you should be aware of. Primary vaginismus is when a woman has experienced pain anytime there has been vaginal penetration (i.e., tampons or a penis). On the other hand, secondary vaginismus describes a situation where a woman develops vaginismus later in life that she never experienced previously.
While we don’t know the exact causes of vaginismus, it’s thought that anxiety plays a significant role. Whether the anxiety is the cause or result of vaginismus is not always clear. At a minimum, it seems to intensify the symptoms. Some physical triggers that seem to connect with vaginismus potentially include infections or diseases, childbirth, menopause, childbirth, or pelvic surgery.
The key symptom of vaginismus is that it involves pain felt when there is vaginal penetration. In other words, it requires external contact. Penetrative sex and tampon insertion are usually the cause of the symptoms.
Often, the sensation that accompanies vaginismus comes as a burning or tight feeling. During sex, women have described the feeling as though the penis has “hit a wall,” somehow.
It’s important to remember that the symptoms of vaginismus are entirely involuntary and generally require treatment to control.
Vaginismus treatment often requires pelvic floor physical therapy to help strengthen and stretch the pelvic muscles. Since these muscles surround the genital organs, physical therapy exercises help the patient establish or regain control over the muscles. This helps improve blood flow and function to the area.
Postpartum and Postmenopausal Dyspareunia
A change in hormone levels can contribute to postpartum dyspareunia and perimenopausal dyspareunia.
Postpartum dyspareunia occurs when a woman has recurring genital pain while having sex in the first year after giving birth. Reduction in estrogen levels can be a contributor to postpartum dyspareunia. However, tissue trauma as a result of giving birth (i.e., tearing, infection, pelvic organ prolapse, poorly healed stitches, etc.) can also be the root cause.
Perimenopausal Dyspareunia is a condition that occurs as a woman begins to go through menopause.
The painful symptoms that come with postmenopausal dyspareunia can result from a drop in available estrogen levels and vaginal atrophy. Vaginal atrophy describes the overall thinning, drying, and inflammation of the vaginal walls.
Dyspareunia Treatment Options
Treatment for dyspareunia is often focused on two goals. Reducing tension in the pelvic floor muscles and minimizing restriction in any tissue that could be contributing to that tension (such as the fascia of our abdomen or the muscles attaching to the outside of our pelvis). Manual interventions are often very effective at achieving tension reduction but are seldom used in isolation. Stretching and strengthening the muscles that work with the pelvic floor muscles helps to ensure that they are not working too hard and developing tension as a result.
Dilator work can also be very helpful in reducing pain with intercourse. We will discuss dilators in more detail in a future post. Many individuals find them beneficial for gradually improving their tolerance for penetration.
Pelvic floor therapists can also guide patients through strategies to downregulate, or calm, their central nervous system when pain occurs. This can be particularly useful during intercourse, as the body may react to pain by tensing up or reducing arousal. These strategies serve as a gentle reminder to our nervous systems that, in that moment, the threat level is low, that we are in control, and that increased tension is not needed. As an added bonus, these strategies also work extremely well for stress and anxiety management and may prove useful the next time you find yourself nervous before a presentation or managing a hundred things at once!
How Pelvic Floor PT Can Help
At Grace Physical Therapy, we understand that experiencing pelvic pain during sex can be a distressing and embarrassing condition for any woman to confront.
Though it may feel helpless, there is always hope! Pelvic floor physical therapy has been able to help many women improve their symptoms and regain the ability to enjoy a healthy sex life. Whether you have been living with the symptoms or are just noticing them for the first time, we can help!
As pelvic health specialists, we understand that pelvic pain issues are complicated and unique to each woman. By considering all aspects of your pelvic health, we can help determine the cause of your pain. Evaluating your unique situation helps us to determine the best treatment course.
If you have suffered from persistent symptoms related to painful sex, then it’s time to schedule a consultation today to begin your recovery. We have in-person appointment options available at our three locations Raleigh, Durham, and Chapel Hill. We have telehealth consultation options available as well!
Until Next Time,
The Grace PT Team