Empowering Intimacy: how pelvic floor therapy helps with painful sex
Intimacy is a vital component of any healthy relationship, and sexual satisfaction plays a crucial role in maintaining emotional and physical well-being. Unfortunately, for some individuals, the experience of sexual intercourse can be marred by discomfort or even excruciating pain. This pain can significantly impact their overall quality of life and intimate relationships. Fortunately, there is hope and help available in the form of pelvic floor physical therapy.
This blog post will explain some of the causes of painful sex and how pelvic floor therapy can help. While pain with intercourse is a common complaint that I hear in my practice, it is not something that people should think is normal. If you are reading this and experience pain with sex, know that you are not alone and there is help!
Background Info
Pelvic floor physical therapy focuses on optimizing the muscles, ligaments, and connective tissues in the pelvic area. The pelvic floor is a network of muscles and tissues that:
Support the pelvic organs (bladder, uterus, and rectum)
Keep us dry (not leaking urine, feces, or gas)
Stabilize our back and hips
Allow us to have pain-free and pleasurable sex (whatever sex means for you!)
When these muscles become weak or dysfunctional (aka don’t work right), it can lead to various problems, including pain during sex.
Disclaimer: This blog speaks mainly to those assigned female at birth who experience pain with vaginal penetrative intercourse. Painful intercourse can happen in many other circumstances as well, but this is one of the most common complaints that I see and treat.
Causes of Painful Sex
Before delving into how pelvic floor therapy can help, it's essential to understand the potential causes of painful sex. These can be due to physical or emotional reasons, but some of the more common ones include:
Shifting Hormones: Women who are going through menopause, are post-partum, breastfeeding, or undergoing treatment for different types of cancer may experience vaginal dryness because their hormone (specifically estrogen) levels are changing.
Pelvic floor Dysfunction: This is a broad category that includes pelvic floor muscles that may be too tight or weak. This change in muscle function can lead to pain during intercourse.
Vaginismus: Vaginismus is a condition in which the pelvic floor muscles involuntarily contract, making penetration difficult or impossible and causing pain.
Perineum Injury: If you experience perineal tearing of any degree during childbirth, this can lead to a buildup of scar tissue and change in pelvic floor muscles that may cause pain with vaginal penetration.
Psychological Factors: Emotional and psychological factors such as increased stress, anxiety, past trauma, or fear can also contribute to pain during sex. Emotions that inhibit arousal interfere with our body’s natural lubrication and make it difficult for muscles to relax.
Certain Illness or Conditions: Diagnoses including endometriosis, prolapse, irritable bowel syndrome, interstitial cystitis, and uterine fibroids, don’t always, but can result in pain with intercourse.
How Pelvic Floor Therapy Can Help
Pelvic floor therapy is a non-invasive and highly effective approach to addressing the root causes of painful sex. It is not always a stand-alone treatment, especially if you have an underlying condition that is also present; but, optimizing how the muscles and nerves function can be significantly helpful towards achieving pain-free and pleasurable intercourse. Here's how it can help:
Education: Pelvic floor physical therapists educate their patients about the anatomy of the pelvic floor muscles, vulvar care and lubricants, breathing techniques, lifestyle modifications, and positioning. It is amazing how much of a difference one session of education can make in improving a person’s sexual experience. Even just changing the type of lubricant a person is using can make a huge difference!
Desensitization Training: Teaching the pelvic floor muscles and nerves to not contract and “go into protective mode” when penetration occurs is extremely helpful. Most of the time, it isn’t that the muscles are too tight or short, it’s just that they contract when you don’t want them to. Dilators are a helpful tool used to teach muscles to tolerate stretch.
Manual Techniques: With your consent, therapists may use external and/or internal hands-on techniques to help decrease tightness in a joint or muscle. Sometimes, the pelvic floor muscles do get tight spots in them that need to be worked out, just like any other muscle in the body. Finding the muscles that may be the source of your pain and helping improve how they feel when pressure is applied to them is part of manual therapy.
Exercise: Exercises like stretching and holding positions of pelvic rest (where the pelvic floor muscles are automatically lengthened and able to relax) are a big part of managing symptoms related to painful intercourse.
Psychological Support: For individuals whose pain is related to emotional or psychological factors, pelvic floor physical therapists can provide guidance and strategies to address these issues, often working in conjunction with mental health professionals.
A pelvic floor physical therapist is trained to provide a safe and non-judgmental environment to help you feel comfortable with sharing sensitive information and participate in the treatment that may be necessary to help you achieve your goals. Sometimes a conversation and specific lifestyle modification is all that is needed to make a difference in your ability to be intimate with your partner. Other times, if the pain has been present for your entire life or years, it may take a little longer to achieve your goals and desired level of intimacy.
Experiencing pain during sex is a challenging, distressing, and often isolating issue. Remember that help is available! Pelvic floor physical therapy offers a holistic and effective approach to addressing the underlying causes of sexual pain, providing relief, and improving overall pelvic health. If you or someone you know is dealing with painful sex, don't hesitate to reach out to me at jbanks@activealliancept.com.
