Ouch S3x Hurts…

Understanding Painful Sex (Dyspareunia) from a Pelvic Floor Physical Therapy Perspective

Introduction

Sex should be a pleasurable experience, but for many individuals, it can be a source of significant pain and discomfort. This condition, known as dyspareunia, affects a substantial number of people and can lead to physical, emotional, and relational distress. Pelvic floor physical therapy offers a comprehensive approach to understanding and treating this condition, addressing both the physical and psychological components that contribute to painful sex.

What is Dyspareunia?

Dyspareunia is defined as persistent or recurrent pain during intercourse. It can occur at the entry of the vagina (superficial dyspareunia) or deeper within the pelvis (deep dyspareunia). Both men and women can experience this condition, although it is more commonly reported by women. The pain can be sharp, burning, or aching, and may occur during, after, or even in anticipation of intercourse.

Causes of Dyspareunia

The causes of dyspareunia are multifaceted and can be categorized into physical and psychological factors:

1. Physical Causes:

•    Pelvic Floor Dysfunction: Overactive or tight pelvic floor muscles can cause pain during penetration. Conversely, weak pelvic floor muscles may fail to support the pelvic organs adequately, leading to discomfort.

•    Vaginal Dryness: Often related to hormonal changes, especially during menopause, breastfeeding, or due to certain medications.

•    Infections and Inflammations: Conditions such as yeast infections, bacterial vaginosis, or urinary tract infections can cause pain.

•    Endometriosis: This condition, where tissue similar to the lining of the uterus grows outside the uterus, can cause deep pelvic pain.

•    Surgery or Trauma: Scarring from surgeries like hysterectomies, or childbirth injuries, can lead to painful sex.

•    Medical Conditions: Conditions like irritable bowel syndrome (IBS), interstitial cystitis, or fibromyalgia can contribute to pelvic pain.

2. Psychological Causes:

•    Anxiety and Stress: General anxiety or specific fear of pain during sex can cause muscle tension and exacerbate discomfort.

•    History of Trauma: Past experiences of sexual abuse or trauma can manifest as physical pain during intercourse.

•    Relationship Issues: Emotional disconnect or unresolved issues with a partner can lead to painful sex.

Pelvic Floor Physical Therapy Approach

Pelvic floor physical therapy (PFPT) is a specialized area of physical therapy focusing on the muscles, ligaments, and connective tissues of the pelvic floor. PFPT aims to alleviate pain, improve muscle function, and enhance sexual health through various techniques and interventions.

1. Comprehensive Evaluation:

•    Medical History: Detailed discussion about medical, surgical, and sexual history. This will include your bowel and bladder function, as well as birth/pregnancy history. 

•    Physical Examination: Assessment of the pelvic floor muscles, posture, movement, and alignment. Internal and external palpation may be conducted to identify trigger points, muscle tone, and any signs of tenderness. At The HOPE Doctors, we perform a very thorough examination to include head to toe function.

2. Manual Therapy:

•    Myofascial Release: Techniques to release tightness and improve muscle flexibility.

•    Trigger Point Therapy: Direct pressure applied to specific points in the muscles to relieve tension and pain.

•    Soft Tissue Mobilization: Gentle manipulation of the soft tissues to improve circulation and reduce pain.

3. Therapeutic Exercises:

•    Stretching and Strengthening: Customized exercises to stretch tight muscles and strengthen weak ones. This depends on your examination on which movements we do offer you. There isn’t one movement/exercise that works for everyone!

•    Relaxation Techniques: Breathing exercises, mindfulness, and other relaxation strategies to reduce anxiety and muscle tension.

5. Education and Counseling:

•    Anatomy and Physiology: Educating patients about their pelvic anatomy and how it relates to their symptoms.

•    Pain Management Strategies: Techniques to manage and cope with pain.

•    Sexual Health Counseling: Guidance on comfortable sexual positions, use of lubricants, and open communication with partners.

6. Behavioral Therapy:

•    Cognitive-Behavioral Therapy (CBT): Addressing any psychological factors contributing to dyspareunia.

•    Desensitization Exercises: Gradual exposure to activities that cause discomfort to reduce fear and pain associated with them.

We have a LARGE community of referral partners if there is an area we are not able to address with you and we often find that it is best to have a TEAM when healing from dyspareunia.

Case Studies and Success Stories

Many patients have found relief from dyspareunia through pelvic floor physical therapy. For example, one patient with a history of endometriosis and chronic pelvic pain experienced significant pain reduction and improved sexual function after several months of consistent PFPT, including manual therapy and functional movement training. Another patient who had undergone multiple pelvic surgeries found that targeted stretching and strengthening exercises helped restore normal muscle function and reduce pain during intercourse.

Conclusion

Dyspareunia is a complex condition with numerous physical and psychological causes. Pelvic floor physical therapy offers a holistic approach to treatment, addressing the root causes of pain and providing patients with tools to manage and overcome their symptoms. If you or someone you know is experiencing painful sex, seeking the help of a qualified pelvic floor physical therapist can be a crucial step towards healing and reclaiming a fulfilling sexual life.

For further information and personalized advice, consult with The HOPE Doctors so that we can help! You deserve it!