Painful Intercourse

When I ask my clients who have endured painful sex for years why they didn’t seek help sooner, most of them say they were too embarrassed to discuss it with their doctors. Sadly, others just considered it “normal” after having children or after menopause.

It doesn’t have to hurt!  You can enjoy sex again.  Pain during or after intercourse is not normal, and you don’t have to live with it anymore!

It’s important to know that you are not alone and should be talking about painful sex and ways to treat it without shame or embarrassment.

It is important to see a physician to rule out infection if you experience pain with intercourse.  Once we know that it is not infection, it could be one of the following issues that are easily treatable at Female Pelvic Health Care.

Muscle tension of your pelvic floor (“kegel”) muscles: 

Just like other muscles in your body, the muscles that make up your pelvic floor (the sling of muscles from your pubic bone to your tailbone) can get tight and sore.

This happens if they are worked too hard (too many kegels), held tightly throughout the day (fear of leaking or feeling like your insides are falling down), or if they are overused to support the pelvis and back (compensation for weak or uncoordinated core muscles). 

Nerve irritation: 

The pudendal nerve innervates the perineum and vaginal region, and it can be injured during labor/delivery, or with chronic constipation.  Some patients may irritate the nerve via direct pressure (from sports like biking, or prolonged sitting in an office, etc).

Burning, itching or general pain in certain areas of the perineum may indicate nerve irritation.

While the pudendal nerve is usually blamed for burning, itching perineal pain other nerves can certainly cause similar symptoms.

This is particularly true in postpartum women as some labor positions or c-section incisions can cause injury to other nerves creating symptoms of pelvic pain. When these nerves are irritated or injured, intercourse can be excruciating and often not even possible. A pelvic health physical therapist can help determine which nerve is injured and help facilitate healing by protecting the nerve through postural and behavioral modifications and manual therapy techniques if scars are contributing to neural irritation.

Hormonal changes: 

Hormonal changes are often a significant factor for females who have pain with intercourse. Estrogen makes tissue plump, soft and pink. Low estrogen levels can cause vaginal tissue to be dry, thin and fragile. Postpartum and perimenopausal women are likely to experience changes in vaginal tissue which can sometimes lead to pain with intercourse. If this is the case, using a good amount of high quality lubrication and speaking with your doctor about the possibility of topical estrogen cream can be helpful.

Scar tissue: 

Tissue around the pelvis, perineum and vagina is meant to be mobile. Imagine trying to move around in jeans that are way to tight in the pelvic region- it is uncomfortable and limiting! When scars form around the perineum, vagina or pelvis (c-section or other abdominal surgeries), motion can be restricted causing pain with movement. This is particularly true around the perineum and vagina as the vaginal tissue must slide and glide during intercourse. Sometimes even sitting with the legs in a more open position (butterfly or criss-cross applesauce position) is enough to create pelvic pain. Gentle scar tissue mobilization or other manual therapy techniques can improve scar tissue mobility reducing or eliminating pain with movement or intercourse!

Emotions: 

Sex is intimate and emotional. Whether we recognize it or not, engaging in a sexual relationship can elicit emotions that can make the body tense up or react in a way that makes sex uncomfortable. The mind and the body both play a role in painful sex- maybe pain is causing an emotional reaction or visa versa. We frequently ask people to explore emotions/feelings around intercourse to discover if this may be a contributing factor.

If you are suffering from painful sex, know that you don’t have to!