I was surprised when one of my clients walked into my clinic at the end of a long workday without an appointment.
She had been in the office just a couple of days before for a scheduled appointment. I must have given her a look of surprise because she immediately welled up with tears and said, “I just came to give you a hug, the pain is gone.”
She went on to to tell me how she felt that I was the first person to really “listen” to her story. Treating her as a whole person and connecting all the “clinical pieces of the puzzle.” In just a matter of a few visits she went from shedding tears of despair, frustration, and pain to tears of joy, relief, and hope.
Intimacy allows us to connect with our partner in a way that bonds couples closer both physically and emotionally, it can be magical.
When women tell me about their pain, their stories vary in that sometimes it is their first sexual experience or their 100th, it could be during pregnancy or often it is in the postpartum period after childbirth. Sometimes, it is after surgery or as a woman enters the menopausal phase of the lifespan. It can present in certain positions or during different times of the month as hormones fluctuate.
The common thread in all their experiences is that women are devastated because the pain not only effects them, it effects their partners and their marriage. It turns what should be incredibly bonding to something that can become painful, divisive and disruptive.
Women who experience pain during intercourse often avoid intimacy due to fear of pain. This can leave their partners confused, frustrated and often resentful. Sometimes, women feel they may have to suffer with this pain throughout their lives and feel resigned to accepting this. This can lead to stress and tension in a marriage.
Some women who visit their health care practitioners to address the issue are often told that nothing is wrong with them, some are told it may be anxiety and they “just need to relax”, and some women have even reported to me that they were told to have a glass of wine prior to intimacy.
I don’t know about you, but I have never met anyone who was able to relax simply because someone instructed them to do so and women certainly don’t want to rely on alcohol to “get through” intercourse.
What all women need to know about pain with intercourse is that it is “Common but not normal”!!
According to American College of Obstetrics and Gynecology about 75% of woman will experience pain with sex at some point in their lives. It can occur at any age; in some women it quickly resolves and in others it can be persistent or get worse over time.
What can cause pain during intercourse?
Physical and emotional factors along with stress are all common contributors to pain in the pelvic region.
Here are some (but far from all) common causes of pain with intimacy:
- Pelvic Floor muscles– The Pelvic floor muscles are a group of muscles that line the base of the pelvis. They are responsible for bowel, bladder and sexual function. These muscles can become tight and lose their ability to relax during intercourse leading to pain with initial penetration, deeper thrusting, burning, throbbing or a feeling that their partners penis is “bumping against something.” In addition, when we experience pain, our pelvic floor muscles can begin to protectively guard or tighten up in anticipation of the pain which can exacerbate the situation by perpetuating a pain cycle.
- Scar Tissue– scarring can result from a vaginal tear, an episiotomy or a c-section incision during delivery. Scar tissue can also develop as a result of a surgery, trauma or inflammation. Our bodies heal by laying down collagen as a result of injury, once the healing process is complete the collagen becomes what we know as scar tissue, it can be rigid, inelastic and restrictive. This can either contribute to or be the source of pain with intercourse.
- Vaginismus- is a muscular protective response that causes an involuntary contraction of the vaginal muscles in response to or at attempted penetration. Vaginismus can make intercourse painful and sometimes impossible.
- Vulvodynia – This is a chronic pain at the opening of the vagina. The vaginal tissue can feel raw and cause pain, burning, itching and soreness during sex.
- Hormonal Changes- Is a common source of pain with intercourse; it can happen as a result of a drop in estrogen that naturally occurs after childbirth, during breastfeeding or during menopausal phase of the lifespan.
- Endometriosis, Cysts, Fibroids or infection– These can cause bleeding, a feeling of pelvic pressure and pain with intercourse. The pain can be sudden and stabbing or a feeling that your partner is “hitting a wall.”
Although many women may be hesitant to share this information, there is no need to suffer in silence and communication with your health care provider is key!
The good news is… There is great conservative treatment that can help resolve pain with intercourse.
A physical therapist that specializes in pelvic health and wellness can help you successfully resolve your pain with an individualized treatment plan.
Since every person presents in a unique way, a physical therapist will conduct a thorough assessment. This includes listening to your medical history (I like to call it a person’s story), physical assessment, and discussing your personal therapy goals. This will help your therapist develop a personalized treatment plan.
Treatment for pain with intercourse may include but is not limited to manual therapy, visceral mobilization, exercises, stretching, nervous system regulation, education on the female anatomy and arousal.
Aside from providing treatment in the office, a physical therapist should always provide clients with strategies to improve and manage their condition at home.
What is the bottom line if you are experiencing painful intercourse?
** Don’t suffer in silence; once you open up about it you will be surprised to see how many others share similar experiences.
** Don’t wait, Seek the help of a pelvic health and wellness physical therapist to help on your healing journey. Intercourse should and CAN BE a pleasurable experience.
** Be your own best advocate, knowledge is power, a pelvic floor specialist will teach you strategies and techniques that will empower you and restore your confidence in your body’s ability to heal!
** Remember… conditions that are common are not necessarily normal!!
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About Susan Winograd MPT
Susan is a physical therapist with over 23 years of clinical experience. She owns and operates a private Pelvic Health and Wellness clinic in Boca Raton, Florida called Pelvicore Rehab LLC. She specializes in Women’s Health, Men’s health issues along with Pre and Post-natal care. Susan Has also earned her Scar Release certification from Acumed and is certified in The Wurn Technique and Clear Passage approach. Susan enjoys teaching workshops throughout South Florida on pelvic health related topics.
Susan’s treatment philosophy is a “Total Body Approach to Healing.” Her passion and commitment is treating, healing, and educating her clients and healthcare providers with pelvic floor dysfunction a whole body approach to relieve pain, restore optimal function, and improve quality of life.