Talking pain with intimacy with a pelvic floor PT.
Today we are talking about a topic that can feel particularly challenging during the Month of Love.
Pain with sex, dyspareunia, is a common condition that affects 10-20% of U.S. women.
Dyspareunia is more common in menopausal/post-menopausal women, but it can affect any person at any time in their life.
Women who are experiencing pain with sex are at an increased risk of reduced quality of life, depression and relationship distress. Women can experience pain in a variety of ways including pain with touch in different areas of their genitals, pain with entry, pain with deep penetration, pain with orgasm and/or pain after sexual activity.
The female sexual response cycle is complicated and includes a beautiful feedback loop of psychological and physical changes that happen for a woman to experience desire, arousal, and orgasm.
Specifically in the female pelvic floor, the muscles do a combination of relaxation and contraction during intimacy and sex which contribute to a pleasurable experience. The muscles of the female pelvic floor relax to allow for penetration, and they contract during clitoral stimulation and orgasm!
Intimacy means much more than just penetrative intercourse and simplifying intimacy as only the physical act of penetrative intercourse downplays the complexity of the female sexual experience.
Because of this, it is important to recognize that many factors can influence why a woman may have pain during sex including factors such as hormone fluctuations, beliefs about sex, emotional intimacy changes with their partner, body image concerns, stress, trauma, and many more.
This is why treating dyspareunia often requires a collaborative, inter-disciplinary team including medical providers, mental health providers and pelvic floor therapists.
MEDICAL HEALTH
Medical providers can help in treating dyspareunia by providing medications or other medical interventions to address possible underlying conditions that contribute to dyspareunia such as infections or hormone imbalances.
MENTAL HEALTH
Mental health providers can help by addressing the very important psychological and relational contributors to intimacy including anxiety & depression, life stressors, relationship changes, & managing chronic pain.
PELVIC FLOOR HEALTH
Pelvic floor therapists can assist with performing a comprehensive assessment of the pelvic floor and surrounding areas, provide education & treatments targeted at an individual’s specific needs to address their pain and strategies to maximize sexual enjoyment. This may include assessment and treatment of areas of tension, addressing scars, down-regulation of the nervous system and strengthening of the pelvic floor and surrounding musculature to resolve pain.
At the end of the day, pain with sex and intimacy is common but it is not normal, and it can be treated. If you are experiencing dyspareunia, please know that you are not alone and we can help you have sexual experiences that you desire without pain!
Hill DA, Taylor CA. Dyspareunia in Women. Am Fam Physician. 2021 May 15;103(10):597-604. PMID: 33983001.