Sex references are in the mainstream culture on a daily basis and this can be hard for those experiencing pain with intercourse (i.e. sex). For some, sex has never been pleasurable, or has been the cause of physical, mental, and emotional pain. Articles in magazines talk about how to orgasm better and different ways of pleasuring oneself or partners but rarely focus on the experience of many others out there.

If you have always experienced pain with sex or it has come about later in life, please read on.

Sexual function is supported by the pelvic floor muscles which run from the pubic bone to the tailbone and are involved in bladder and bowel control along with the ability to orgasm.

In our patients, the main causes of painful sex we see are the following:

a) “Tight” pelvic floor muscles

Tight, overactive, or hypertonic pelvic floor muscles may be the cause of discomfort or pain with intercourse. Sometimes the vaginal entrance alone can be tight or it can also be tighter deeper in. Although it may be difficult to determine the direct cause of tight muscles, (especially if someone has had this since the first time they were sexually active), we have had clients mention sexual trauma, pelvic floor trauma from birth, and stress as contributing factors.

b) Pelvic organ prolapse

With organs shifting and putting pressure on the vaginal walls, penetration deeper inside can be painful and often patients will describe this as a block or that during sex it is “hitting something” and can be dependent on the position as well. This can be due to pelvic organ prolapse, descending of the vaginal walls + organs.

c) Vaginal dryness

This can be related to hormonal issues, outside of pregnancy, postpartum or around menopause. Use of lubrication, topical estrogen prescribed by your physician, other non-estrogen creams or hormonal treatment can be beneficial in this case.

d) Scar tissue

For vaginal deliveries, if an episiotomy was performed or there was tearing, depending on how the region healed, there may be scar tissue that can lead to sensitivity in the vaginal region or tightness.

The above causes of painful sex can occur in isolation or there may be multiple reasons at once. Pelvic Floor Physiotherapy can help reduce and eliminate pain with intercourse and move towards pleasure. Find more by reading this article - Treatment for “tight” pelvic floor muscles. Know that even though you might be experiencing these symptoms right now, there is help out there from professionals who care and will take the time to listen to your concerns.

Questions? Comment below, e-mail us at hello@kaaiaa.co, or book a free phone consult.

Tight, overactive, or hypertonic pelvic floor muscles may be the cause of various pelvic floor concerns such as painful sex, urinary and bowel urgency, frequency, constipation, urinary and bowel retention, and pelvic pain. Tight muscles may also contribute to bladder leakages. In clinic, we have seen clients with overactive muscles not being able to kegel (because they are in a constant state of “kegel-ing”) and when a cough or sneeze comes, the pelvic muscles let go instead.

Achieving a state where the pelvic floor muscles are able to coordinate being tight with relaxation is the first step in treating many of the above symptoms. The following tools may be discussed and prescribed by your Pelvic Floor Physiotherapist depending on the assessment findings.

Breathing

The diaphragm is a large muscles underneath the ribcage that helps us breathe deep into the belly and also works with the pelvic floor in a sump-pump fashion. As it moves down when we inhale, the pelvic floor also moves down and they both move up on the exhale. Using the breath to connect with the pelvic floor during the day and in different stretches can help alleviate symptoms.

Dilators or Pelvic Wand

Depending on your needs, manual therapy and release may be performed by your Physiotherapist or prescribed to you as homework at home. Both dilators and wands are useful in different ways to help stretch and massage muscles internally. Please follow your therapist’s instructions carefully on how to use these tools. To find out more about the pelvic wand, click here.

Stretches

Along with breathing, yoga and stretching can help retrain the pelvic floor muscles. Commonly prescribed stretches may include child’s pose, cobbler’s pose and happy baby. When stretching, you should not have any other aches or pains. This is a sign to stop the stretch and consult with your healthcare provider to ensure you are dong them correctly.

Consult with your Family Physician or Gynaecologist/Specialist

Sometimes tightness in muscles can be a sign of tissue atrophy, degeneration, lichens sclerosis, or be due to another condition or menopause. Your physician may prescribe additional testing or a topical cream or hormonal solution to help the tissues which may complement the above prescribed therapies.

It is best to work both with your Physiotherapist and Physician to find the solutions you need for a health pelvic floor. Never be afraid to ask questions and continue to ask questions from different providers until you get the help you need. We are here for you.

Questions? Please comment below, email us at hello@kaaiaa.co, or book a free phone consult.