Painful Intercourse Treatment

Painful intercourse is a serious issue affecting many couples. Pain is a message your brain receives when your body senses trouble. When pain occurs during a time when you should be experiencing immense pleasure, such as having sex, there is an issue that needs to be addressed.

If you’re experiencing painful intercourse, you’re not alone. In the United States, 46% of men and women will experience painful sex at some point, but women are more likely to report it.

The medical term for painful intercourse is dyspareunia. Pain can be felt before, during, or after intercourse. Because sex is a physical act strongly associated with emotional and psychological experiences, the cause of dyspareunia can be complicated.

There are many potential causes of painful sex, including:

• Pelvic floor muscle dysfunction
• Pelvic organ prolapse
• Scarring and adhesions
• Infection
• Psychological
• Trauma
• Hormone imbalance

Additionally, cancer of the bladder, cervix, rectum, ovaries, uterus, and prostate can affect the pelvic floor. After surgery and radiation therapy, soft tissue dysfunction, spasms, trigger points, adhesions, scarring, and pain along your pelvis can develop.

It is important to speak with your doctor, gynecologist, or mental health professional to get to the bottom of what’s causing your dyspareunia.

You should tell your doctor if you experience pain before, during, or after penetration. It’s important to report all pelvic pain, whether it’s achy, throbbing, sharp, or burning. Report pain even if it lasts for moments or many hours after intercourse.

If painful intercourse goes untreated, not only can your symptoms worsen or become chronic, but pain can also lead to: 

• Anxiety
• Depression
• Isolation
• Negative body image
• Relationship tension

Many physicians may not know to refer patients to physical therapy when sex hurts. Instead, people suffering from painful intercourse end up in an endless cycle of medications, injections, and surgeries. 

Sex has physical, emotional, and behavioral implications. Addressing your anatomy is an important element in treating painful intercourse. This is where pelvic floor physical therapists come in. 

The Smart Body pelvic floor physical therapists are physical therapists who receive additional training on pelvic floor anatomy and function and treat pelvic floor dysfunctions. Any changes in your pelvic floor, such as pelvic floor muscle weakness, overactivity, or nerve damage, can lead to pelvic discomfort. 

Our pelvic floor physical therapists are trained to treat underlying musculoskeletal causes as a result of:

• Endometriosis
• Vaginismus
• Vulvodynia
• Lichen sclerosis
• Vaginal delivery
• Sexual Trauma

We understand your anatomy, the science behind pain, and have multiple tools in their chest to treat your symptoms.

The Smart Body pelvic health physical therapists will complete an examination which includes assessing the pelvic floor muscles externally by touch or sight. An assessment is completed internally via vaginal or rectal evaluation. Let your therapist know what will make you the most comfortable.

Conservative, non-surgical options should be your first step. Our treatments for painful intercourse include:

• Manual therapy
• Exercise
• Biofeedback therapy
• Electrical stimulation
• Education

Manual therapy is a hands-on treatment that involves individualized planning and care by your therapist. These treatment methods utilize mobilization, kneading, and stretching of soft tissues such as skin, muscles, and joints to increase range of motion and decrease pain. 

Specific manual therapy techniques include:

• Theile’s Massage
• Trigger point release 
• Myofascial release
• Scar tissue mobilization

You and your therapist can discuss and decide on which approach to use. The decision will depend on your tolerance and goals.

Therapeutic exercise requires you to be an active participant in your care. After your pelvic floor evaluation, your therapist can prescribe the level and intensity of training to begin your road to recovery.

You’ll work through progressive exercises that target your pelvic floor and core muscles. Finally, you’ll spend more time focusing on the very activity you came in to get treated.

Sometimes, you have no idea which muscle is contracting or where your pelvic floor muscles are! Biofeedback is simply the principle of connecting your brain to your body and your body to your brain.

There are several biofeedback tools in the marketplace to assist in reconnecting with yourself. Biofeedback machines provide images, blinking lights, or sounds that alert you when you contract or relax your muscles. With this real-time cueing, you develop improved muscle control and coordination.

Neuromuscular Electrical Stimulation (NMES) is a type of electrical stimulation used to help you connect with and coordinate your pelvic floor muscles. Once you can identify them, you can start progressing your pelvic floor muscle training.

You might have heard of TENS units (Transcutaneous Electrical Nerve Stimulation) and have used the machines to help reduce your pain. TENS targets sensory nerves while NMES targets and recruits muscle fibers.

NMES has settings to help you improve the strength and endurance of your pelvic floor muscles. You have two types of muscle fibers in your body: Type I (slow-twitch) to help with posture and stability throughout your day and Type II (fast-twitch) to provide quick, powerful contractions when you need them (during activities like lifting and sneezing).

With NMES, you will learn to functionally contract as well as relax your pelvic floor muscles between the intervals. Learning to let go of tight pelvic floor muscles will help reduce pelvic pain.

If you missed sex education class, it’s not too late to learn. Learn your anatomy and how it functions so you can explain your symptoms to your health care professionals. When you draw a clear map of what you feel, you can journey with your team towards meeting your goals more confidently.

Our pelvic health physical therapists can help relieve your pelvic pain. You can learn more from our knowledgeable and trained pelvic floor rehabilitation therapists. Contact the Smart Body Physical Therapy team for an appointment at 904-296-4140.