Does it hurt when you have sex? Has any health care professional asked you this seemingly small but potentially life altering question? As with many other topics in pelvic health, we tend to not discuss when sex hurts. Matters such as painful sex, are often considered “taboo”. In my experience, “do you experience pain with sex” is not a standard question at my yearly physical. However, I do believe it should be! After all, our sexual health and activity is an important aspect of life. If you are having an issue with your sexual response, it can affect your physical, and emotional well-being. It can also impact your social relationships.
It is NEVER normal for sex to hurt
1 in 7 American women ages 18-50 experience pelvic pain, with 61% of those women being without a diagnosis. Is it ever normal for sex to hurt? No! Yet so many women suffer in silence, too afraid to ask for help. There are many classifications of female sexual disorders that result in pelvic pain. Two of the most common are: Dyspareunia and Vaginismus. The medical term “Dyspareunia” refers to persistent pain with intercourse or attempted intercourse. “Vaginismus” is characterized by the involuntary contraction and spasm of the perineal muscles. The perineal muscles are the outermost layer of muscles and tissue of the pelvic floor surrounding the urethra, vaginal opening, and anus. To have sexual intercourse, these muscles need to relax and stretch. Vaginal penetration becomes difficult, painful, or impossible when our pelvic muscles are in spasm.
What causes these painful sex conditions?
There isn’t one definitive cause as many factors can influence your sexual response. Women may experience painful sex with interstitial cystitis, after having a baby, after experiencing a UTI, or due to back or sacroiliac pain. If you have irritable bowel syndrome, you may notice increased discomfort with intercourse. You should consult with a doctor to rule out any medical condition (STDs, endometriosis, hormonal changes, dermatological conditions, etc).
There is help!
Women who suffer from sexual disorders and pelvic pain often avoid sexual activities out of fear. This avoidance can result in perpetuation of a cycle of fear, muscle spasm, pain, and further avoidance. Physical therapy with a trained pelvic PT can help. Physical Therapists are musculoskeletal experts. A thorough evaluation of your posture, movement, and flexibility will help rule out any musculoskeletal dysfunction contributing to your pelvic pain. A pelvic physical therapist will also perform an internal exam to help determine the causes of your pain within the pelvic floor muscles. This may sound intimidating, but the examination is done within your level of comfort. No stirrups or speculum are used. After performing a thorough assessment, your PT will use various modalities in your treatment plan depending on your needs. Biofeedback, downtraining, manual techniques, trigger point massage, and scar treatment are some examples. Remember, you don’t have to live in pain.
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