Painful sex is reported by a sizeable number of women. The population prevalence is estimated to vary from 3 to 18% globally, and lifetime estimates range from 10 to 28%. Classification and terminology are always changing in the medical community and dyspareunia is sometimes being replaced by the term Genito‐pelvic pain/penetration disorder. Pain can be superficial and/or deep. It can feel dull or sharp, burning or stabbing. Depending on underlying causes, pain can be felt throughout one’s life, or only over a certain period.
For many people discussing sex and pain in the vulva/vagina is a taboo subject and can be difficult to broach with a partner or medical professional. When seeking treatment for dyspareunia it is important to find a practitioner who will listen to your concerns and will provide an effective treatment plan. A pelvic floor physiotherapist is specially trained in this area and can work with doctors, psychologists, dieticians, counselors and massage therapists to address this condition.
There are many reasons women may experience pain with intercourse. Trauma like childbirth, abuse and post surgical scarring can cause pain during penetration. Skin conditions like Lichens Sclerosis can also be the root cause as the skin is less flexible. Hormonal changes can affect tissue tone and integrity, causing dryness and restriction at the vaginal opening. Other pelvic conditions like vestibulodynia (vestibule pain) and endometriosis (uterine lining condition often causing painful periods) cause present with pain with intercourse. Sometimes beliefs about intimacy and penetration play a role in pain. For others, there may be no identifiable reason for pain with intercourse other than very tight muscles followed by apprehension and guarding due to repeated painful experiences. For all patients, it is important to note that the pain you experience is not your fault and is not because of something you did or didn’t do.
Regardless of underlying conditions or causes, many women present in the clinic with very tight or hypertonic pelvic floor muscles. Sometimes patients have a difficult time connecting to the motor (ability to contract and relax) and sensory information coming to and from their pelvic floor.
A pelvic floor physiotherapist will determine the reason for pain during intercourse. Together the therapist and patient will make goals and set a timeline to meet theses goals. After the root cause of pain is explored, treatment will begin. Treatment will involve education on the condition and prognosis. A pelvic floor therapist may use manual release techniques, joint mobilizations, needling techniques (such as acupuncture or IMS), and pain science to improve symptoms. Patients will be instructed on a home program, which may include self stretching, breathing, mindfulness/meditation and exercises. Patients are welcome to bring in their partner or a support person for treatments. Sometimes partners can be involved in the home treatment program.
While there are many women who experience pain with intercourse it is not normal and there are effective treatments available. You do not need a doctor’s referral to see a pelvic floor physiotherapist. If you have questions about your condition and treatment please contact Lakeview Physiotherapy and ask about pelvic floor physiotherapy.