Painful Sex
Dyspareunia, or pain with intercourse, is experienced by 75% of women according to the American College of Obstetricians and Gynecologists. It is a common problem among post-menopausal women and can affect 10-28% of the population in a lifetime.
Symptoms
Women may report a burning and/or throbbing pain with penetration before, during, and/or after intercourse. Women may also complain of pain with tampon insertion or speculum insertion during a gynecological exam.
What Causes Pain with Intercourse?
Dyspareunia can be due to many different factors:
- decreased lubrication-vaginal dryness due to menopause, childbirth, breastfeeding, medications (such as birth control pills)
- childbirth trauma or episiotomy
- pelvic surgery such as hysterectomy
- infection, skin disorder
- muscle spasms of the vaginal wall, also called vaginismus
- vulvodynia (chronic pain of the vulva region)
- vaginitis (vaginal inflammation)
- pelvic inflammatory disease
- endometriosis, uterine fibroids
- decreased sexual desire
- stress/anxiety, fear, history of abuse
Treatment
Pelvic physical therapy is a non-invasive approach to treat dyspareunia. A specialized physical therapist will do a full evaluation from head to toe. Things like posture and range of motion of the hips and back are evaluated. The therapist will also perform an external and internal pelvic floor examination to look for any pelvic floor muscle tenderness and assess muscle strength. Physical therapy treatment will include manual therapy techniques to help relax tight musculature of the hips, low back and pelvic floor, relaxation techniques, and neuromuscular techniques to improve pelvic floor strength. Each person will receive an individualized home program which is adjusted as symptoms improve and goals are met. Sometimes concurrent talk therapy with a mental health specialist may also be recommended.
Tips For Home
- Pelvic Floor Squat Stretch
- Use of water-based vaginal lubricants
- Use of dilators to help vaginal wall stretching (see our blog on dilators)
- Trial various positions during intercourse (see our blog on positions)
