When we think about IC, we think about urinary symptoms - urgency, frequency, and getting up to use the bathroom at night - and bladder, pelvic or abdominal pain. But one of the most common symptoms with IC is also the least talked about.
Painful intercourse has been reported in up to 90% of women diagnosed with interstitial cystitis. Yet women often aren't even asked about this symptom by their urologist! Men also experience pain with intercourse and sexual dysfunction with interstitial cystitis and chronic prostatitis.
These symptoms may even be under-reported, because almost a quarter of adult women with interstitial cystitis report not being sexually active (as compared to 9% of those without the condition).
What Causes Painful Intercourse with IC?
Painful intercourse is caused by tight, strained, and irritated muscles within the pelvic floor. These muscles help control arousal, the physical act of intercourse, and orgasm for both genders. Knots, or trigger points, form in the pelvic muscles. When the muscles are exerted and irritated with intercourse, they can cause significant pain.
In women, penetration is often painful, both in the moment and often for days afterwards. Intercourse can cause long-lasting flares, and fear of intercourse can amplify the problem.
The pelvic floor has to relax in women to allow penetration
(Image courtesy of The Interstitial Cystitis Solution)
For men, painful intercourse often manifests as pain with erection or ejaculation, which can also last for days afterwards. Men may also struggle with erectile dysfunction as a result of pelvic floor dysfunction and interstitial cystitis.
How is Painful Intercourse Treated?
Pelvic floor physical therapy works to address the underlying pelvic floor dysfunction that causes pain with intercourse. Manual therapy alleviates the trigger points that form in the pelvic muscles. An IC Stretching Regimen helps relax the pelvic floor before and after intercourse. For women, a dilator set can let the body become used to penetration in a safe environment, working to gently stretching the vaginal tissue.
Home Tips for Overcoming Painful Intercourse
While you should always seek professional medical help from a physical therapist, sex therapist, or medical doctor, these at-home tips can help augment your treatment.
Take it Slow - Make sure to have an open dialogue with your partner, knowing they will take it slow or stop if it becomes painful or uncomfortable. Trust is key!
Lubrication - A lubricant that is good for sensitive skin can be an important aid to pain-free intercourse.
Change Positions - Some positions put less strain on the pelvic floor, especially for women. Lying on your back with your legs drawn up (like the Happy Baby stretch) can relax the pelvic floor, while being on top gives you more control over the depth and speed of penetration.
Stretching and Deep Breathing - The muscles of the pelvic floor have to clench during intercourse, and sex puts strain on the pelvic floor. Stretching out afterwards - especially with the Happy Baby position - can help the pelvic floor to relax again. Deep breathing can help relax the nervous system and alleviate any anxiety associated with intercourse.
Take a Bath - Like stretching, the warmth of the water can help the pelvic floor relax, either before or after intercourse.
Other Ways to Express Affection - Sometimes, intercourse may just not be a possibility. Finding other ways to express affection and show intimacy can help. Some couples cook together, take a walk, exchange back rubs, or simply cuddle on the couch to regain that feeling of closeness.
Painful intercourse is an extremely common symptom with interstitial cystitis - don't be afraid to mention it to your doctor or physical therapist. Working to eliminate the underlying pelvic floor dysfunction can restore a normal, pain-free sex life.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.