Resolving Painful Intercourse with Physical Therapy
Pain with sexual activity or penetration is never normal, and can be addressed naturally!
WHAT IS PAINFUL INTERCOURSE?
One of the primary tasks of the pelvic floor is controlling sexual function in both women and men. In women, sexual dysfunction can manifest as pain with intercourse or penetration, a feeling of dryness, difficulty in reaching orgasm, and pain following sexual activity or intercourse, sometimes for days.
Sexual activity is among the most challenging tasks for the pelvic floor, as it has to both contract and relax in a short period of time, and involves close coordination of the muscles. Often, tight areas of the pelvic floor aren't able to relax during penetration, causing painful intercourse.
Childbirth is a major risk factor for painful intercourse. Almost one in four women reports painful intercourse for months following delivery, and it often does not resolve on it's own. Importantly, these muscles are often too tight and strained after pregnancy (not 'loose' or 'stretched out').
Painful intercourse often accompanies other pelvic floor dysfunction as well. Many patients don't realize their pain with sex is related to urinary symptoms, low back pain, or other pelvic floor issues. In one study conducted at PelvicSanity, we demonstrated that 69% of patients who came in for other reasons also had sexual dysfunction.
NAMES FOR PAINFUL INTERCOURSE
If you've been to see a doctor for your symptoms, there are a variety of names you may have heard. Ultimately, most of these names are simply descriptive, and don't provide a reason for the underlying issue.
Dyspareunia - From the Greek roots, this literally means 'difficulty lying with' and is a generic term for painful intercourse, either during or after sexual activity.
Vulvodynia - 'Dynia' is a suffix meaning pain, so this term literally means pain in the vulva area. Vulvodynia is often exacerbated by intercourse, but the pain can be constant or occur with other activities throughout the day.
Vestibulodynia - Similarly, this term means pain in the vestibule, a specific area within the vulva.
Vaginismus - The literal definition of this term is 'condition of the vagina.' It's most often used to describe a spasm of the pelvic floor muscles that makes penetration difficult or impossible
Regardless of the specific term used, the pelvic floor always plays a role in painful intercourse, and working with a pelvic PT can alleviate symptoms and restore normal, pleasurable sexual activity.
HOW DOES PELVIC PT HELP?
A qualified pelvic floor physical therapist can evaluate the muscles and determine the underlying cause of the sexual dysfunction. If tight pelvic floor muscles are to blame, pelvic PT can release trigger points in these muscles and work to restore them to normal function.
A home program can also be beneficial, and often includes a stretching program, self-trigger point release, training with dilators, targeted strengthening, or other methods as appropriate.
CAN'T I 'JUST KEGEL'?
'Just Kegel' is never the answer for pelvic floor dysfunction. First, it's much more likely that your pelvic muscles are already too tight and strained, which is causing the pain; they need to be relaxed, not given even more work! Even after childbirth, it's a myth that the muscles are stretched out and loose - often they tense and tighten up after delivery to protect the traumatized region.
Even if Kegels were indicated, more than half of people can't Kegel correctly with verbal instructions, and about 25% do it so poorly it actually causes more harm than good! If they are used, a Kegel exercise should only be a fraction of your home program.
About one in three women experience painful intercourse during their lives. Pain with sex is common, but it's not normal, and pelvic floor physical therapy can resolve the underlying issues.
Of new mothers experience painful intercourse that can persist for months or years following delivery.
"The second I walk through the door at Pelvic Sanity, I instantly feel better. The environment is wonderfully calming, and I know I'm always in good hands."
Working with a pelvic floor physical therapist can help regain normal sexual function, no matter how long you've been dealing with painful intercourse
THE PELVICSANITY DIFFERENCE
At PelvicSanity, your physical therapist will be a specialist in the field and an expert in dealing with painful intercourse. Many of our patients have been to multiple doctors for their symptoms before finding success here at PelvicSanity.
We believe full-length sessions are crucial to success with pelvic PT, so all appointments at PelvicSanity are an hour in length and spent entirely with a pelvic floor specialist. You’ll never be hooked up to electrodes, see an aide instead of a physical therapist, or be told to ‘just do your Kegels.’ We create a positive, calm environment for healing in private treatment rooms.
We also believe the pelvic floor can’t be treated in isolation, so your treatment will address both the pelvic floor and the external muscles that connect and influence the entire pelvis for optimal results.
YOUR INITIAL EVALUATION
Your initial evaluation will be an hour in length, and have three major components:
Consultation: Most of our patients have been to multiple doctors, but have never really felt listened to in their appointments. In your initial evaluation you’ll have a chance to go through your medical history with your physical therapist. We’ll listen to you and ask about your personal goals for physical therapy.
Assessment: Next your physical therapist will do a complete assessment. They will look at your posture, hip and pelvic alignment, fascia, scar tissue, and anything else influencing your pelvis. Then they will do an internal evaluation, looking for trigger points and dysfunction within the pelvic floor muscles.
Treatment: We also want to know how your body responds to treatment, so your initial evaluation also includes targeted treatment. You’ll also leave with ‘homework’ that you can be doing in between your visits to build on the improvements with physical therapy.