Pelvic Floor Physical Therapy for Painful Sex: You Don’t Have to Live With Pain
Pelvic Floor Physical Therapy for Painful Sex: You Don’t Have to Live With Pain
Sex should not be something you have to “push through.”
Pain with sex is common, but that doesn’t mean you have to accept it as normal. Whether you experience pain with initial penetration, deep pelvic pain during intercourse, burning, tightness, or discomfort that lingers afterward, pelvic floor physical therapy can be an important part of finding answers and improving your comfort.
What Causes Painful Sex?
Pain with sex, also called dyspareunia, can have many different causes. Sometimes the pelvic floor muscles are a significant part of the problem. These muscles form a hammock-like support system at the bottom of the pelvis and play an important role in bladder and bowel function, sexual function, and pelvic organ support.
When the pelvic floor muscles become overly tight, sensitive, or unable to relax appropriately, penetration can become painful. This can happen for many reasons, including:
Pregnancy and childbirth
C-section or perineal scar tissue
Endometriosis or other pelvic pain conditions
Vulvodynia or other causes of vulvar pain
Recurrent bladder or vaginal infections
Hormonal changes, including menopause and postpartum changes (this can lead to tissue dryness)
Pelvic trauma or injury
Chronic constipation or straining
Stress
Often, there isn't just one cause. Pain can create a cycle in which the pelvic floor muscles tighten in anticipation of discomfort, which can then make penetration more painful.
How Can Pelvic Floor Physical Therapy Help?
A pelvic floor physical therapist can evaluate the muscles, tissues, and other factors that may be contributing to your symptoms. Treatment may include the following:
Learning to Relax the Pelvic Floor Muscles
If your pelvic floor muscles are tense or overactive, treatment may focus on helping you recognize and release that tension.
You may learn breathing and relaxation techniques that allow the pelvic floor to lengthen and relax rather than continually contract.
The use of a pelvic wand can also be a useful tool to help release tight pelvic floor muscles.
Hands-On Treatment
When appropriate, and with your consent, your physical therapist may use gentle hands-on techniques to address areas of muscle tension, tenderness, or restriction. There are several internal and external techniques physical therapists use to release tight muscles.
It's important to note that internal pelvic floor treatment may be recommended as part of therapy, but it is not required for everyone. Your treatment should be individualized to your symptoms, comfort level, and goals.
Addressing Scar Tissue
Scar tissue from a C-section, vaginal delivery, episiotomy, or other pelvic surgery can sometimes contribute to discomfort or restricted tissue mobility.
Your physical therapist can teach you techniques to help improve scar mobility and address surrounding tissues that may be contributing to your symptoms.
Improving Breathing and Body Awareness
Your breathing and pelvic floor are closely connected. Learning how to coordinate your breath with pelvic floor relaxation can be a powerful tool for reducing tension.
You'll also learn to recognize when you are unintentionally clenching your abdominal muscles, glutes, or jaw muscles which can all lead to your pelvic floor muscles becoming overactive.
Returning to Comfortable Penetration
If penetration is painful, the goal isn't to simply “get through it.”
Instead, treatment may involve gradually improving your tolerance to touch and pressure while teaching your body that these sensations do not need to trigger a protective tightening response.
Treatment may include vaginal dilators to help desensitize the muscles and to help them tolerate being stretched.
What If I'm Embarrassed to Talk About Painful Sex?
You are not alone. Pelvic health physical therapists talk about these concerns every day. There is no need to feel embarrassed or ashamed about your symptoms. A good pelvic floor physical therapy appointment should feel like a safe, respectful space where you can ask questions and discuss concerns without judgment. You are always in control of your care. Your therapist should explain what they are doing, ask for your consent, and respect your boundaries throughout the evaluation and treatment process.
When Should You See a Doctor?
Painful sex can sometimes be related to an underlying medical condition, so it is important not to assume that pelvic floor muscle tension is the only cause. Talk with your gynecologist, primary care provider, or other healthcare professional if you experience new or worsening pain with sex especially if you have bleeding, unusual discharge, unexplained pelvic pain, or other concerning symptoms.
You Don't Have to Accept Pain as Part of Your Normal
Perhaps you've been told that painful sex is “normal after having a baby.”
Maybe you've assumed that discomfort is simply part of getting older.
Pelvic floor physical therapy can help you better understand what's happening in your body and address contributing factors.
Ready to Talk About Your Symptoms?
If painful sex is affecting your quality of life or your relationship, consider reaching out to a pelvic floor physical therapist who can help you understand your symptoms and create an individualized treatment plan.