Your Pelvic Floor: What to do when sex hurts

Many women will experience an instance of pain or discomfort during intercourse at some point in their lifetime. That is fairly normal and not necessarily concerning. However, when that pain is recurrent or chronic it is termed “dyspareunia” and it definitely calls for a trip to the doctor. Now, the purpose of this post is not to alarm or shame women who have been experiencing painful intercourse and have avoided seeking treatment, but rather to provide awareness and greater insight into this condition in hopes that women may have a better understanding of their condition and what resources exist to help them.

Myth #1: Painful intercourse only effects older and post-menopausal women

Dyspareunia can affect sexually active women of any and all ages though the leading causes tend to vary depending on the age group.

Myth #2: Painful intercourse is an indicator of a history of physical, sexual  or emotional trauma

There is no denying that trauma can have an effect on a women’s sexual experience, but painful sexual activity can occur without an underlying traumatic experience. Similarly, trauma survivors can lead healthy pain-free sex lives. Women who are experiencing these symptoms, with or without a history of trauma, can benefit from treatment with supportive healthcare providers such as gynecologists, pelvic floor physical therapists, and mental health counselors.

Now, let’s turn our focus toward some of the reasons dyspareunia can occur and some treatments and interventions that may help.

#1 Lack of Sexual Arousal

This is where things get a bit tricky. Of course, painful intercourse is not exclusively caused by a lack of arousal, but when woman is aroused she experiences physical changes (for example: increased lubrication)  that exist to help make sex more comfortable and enjoyable. The catch is that for women who have experienced painful sex in the past, it can be very difficult to “get in the mood”. In this instance, I recommend a slow start - spending time on levels of intimacy that are non-painful and working up to penetrative sex (if that is what is desired), perhaps first with a partner’s finger, then two etc. Keep in mind, this will likely take time and is best done under the guidance of a trained health care worker, intimacy counselor, or sex therapist.

Something else I want to address in this section is the importance of education. For some women, the lack of arousal is less of a physical issue and more of a misunderstanding about how their body works. This is nothing to be ashamed of or embarrassed about and it DEFINITELY is not uncommon. In fact, there is an entire website that was developed to meet the need for scientific exploration into the realm of female sexual pleasure. www.omgyes.com/ is a site I recommend for those looking to learn more.

#2 Lack of Lubrication

This is piggybacking a bit on the section above, but sometimes even when a woman is sexually aroused the lubrication created by her own body is not quite enough. This can happen for a few reasons:

●     Decreased estrogen levels, usually associated with menopause or after child birth

○     During perimenopause and menopause, women experience a decrease in estrogen which can lead to vaginal dryness. Women who are not in menopause, but have low estrogen levels for other reasons, like after giving birth and while breastfeeding, can also experience this dryness.

●     Use of latex condoms

○     Condoms are unmatched when it comes to reducing risk of STI transmission as well as a useful contraceptive tool, however even lubricated condoms may not provide enough lubrication to outlast the friction created by vaginal intercourse. Adding a bit more lubricant to the outside of the condom can fix this problem. ALWAYS use silicon or water based lubricants with latex condoms, NEVER use oil-based lubricants as this can breakdown the latex leaving you unprotected from pregnancy or the spread of STIs.

●     If your foreplay routine involves tossing back an alcoholic beverage or two.

○     Pro: alcohol can decrease inhibitions and heighten sexual desire. Con: alcohol can blunt the bodies physiological arousal response, including the creation of lubrication. No need to ditch the wine, just add a bit more lubricant and remember to always drink in moderation!

#3 Pelvic Floor Dysfunction

If you are aroused and lubricated and you are still finding intercourse is painful or uncomfortable, you may have a pelvic floor dysfunction such as vulvodynia or vaginismus. In this case, the pain is coming from dysfunction in the muscles of the pelvic floor. Treatment here is best done under the guidance of a pelvic floor physical therapist who will determine based on a thorough history and assessment the best treatment plan for you. To learn more about pelvic floor physical therapy please visit our website, www.allwellnessvt.com/pelvic-floor-therapy/  and click the link to down load pelvic floor PT FAQs, found on the right side of the page.

This is not meant to be a comprehensive list of all causes of painful intercourse. There are other factors that can cause or contribute to pain with sex. Regardless of the cause, treatment is possible. Painful intercourse can be very troubling and debilitating for a women’s mental and physical health as well as to the health of her relationship with herself and her sexual partners. It is for this reason, I encourage women experiencing this type of pain to seek treatment, not to satisfy their partners, but to advocate for themselves and their own sexual experience.

Have a question not answered here? Email our pelvic floor specialist, Karen Bumpus at karen@allwellnessvt.com.