Pain with sex? Physio can help…
by Physiotherapist Sami Cattach
Pelvic Health Physiotherapist at Pear Exercise Physiology & Physio, natural mover, Mama of 2
Pain with sex?
Seems like an unusual topic for a physio to be involved in, however sexual pain and dysfunction makes up around 30% of the patients I see at Pear. It is an incredibly rewarding area to treat as you see the results and each individual's confidence grow!
While it is an area of taboo - not often talked about between women of previous generations, there is now a lot more research and awareness around female sexual pain and I'm pretty excited to be spreading the word.
Consensual intimate touch and sexual intercourse should never. be. painful.
Some women might experience pain with sex from their very first encounter, particularly if there are strong cultural beliefs around sex. Though for others it can be something that develops over time or in response to a particular event such as an injury, infection, childbirth (vaginal or Caesarean), stress, or sexual abuse.
The term for painful intercourse is Dyspareunia and can be further broken down into Superficial (felt around the entrance of the vagina) or Deep Dyspareunia (deeper inside). Pain and discomfort from touch and/or penetration occurring in the absence of infection can be due to one (or a combination) of the following reasons: Decreased arousal (both deep/superficial) Certain positions (usually deep) Decreased lubrication (superficial) Tightness/spasm of the pelvic floor muscles (both deep/superficial) Vaginismus (superficial) Vulvodynia (superficial)
*It is quite uncommon that a woman can be too small for a penis. Remember that the muscles and tissues lining the vagina are very stretchy and are designed for a baby to be able to pass through!
Decreased Arousal, Positioning and Lubrication
When you are aroused and ready for things to heat up, a few things happen: Increased blood flow to the vagina stimulates secretion of lubricating fluids to decrease friction and the cervix actually rises up and moves out of the way. Some women take a bit more time to become aroused and prepared for intercourse - so don't be afraid to take your time with foreplay. For postpartum Mamas, know that your natural arousal and lubrication can be decreased as influenced by your hormones (as well as available time and tiredness!)
Contact with the cervix can be quite uncomfortable and often feels like a deeper pain. This can be avoided by trying different positions, such as
Girl on top. This is basically the missionary position, except the female is on top. Being on top allows you to be in control of the pace and degree of vaginal penetration. Plus, being on top gives you more direct access to the clitoris, which may help you experience more pleasure.
Reverse cowgirl. In this position, you're on top but instead of being face to face with your partner, you're facing their feet. Because you're still on top, you can control the depth, speed, and intensity that works best for you. The angle of penetration may avoid some trigger spots.
Sideways. For some, the "doggy style" position can be excruciating - but that doesn't mean you can't enjoy other from-behind positions. The sideways sex position allows for shallower penetration without sacrificing intimacy.
External lubrication in the form of a gel or oil can be useful for superficial dyspareunia - but remember to check the labels! Certain lubricants contain harmful chemicals, such as glycerin which can irritate sensitive skin, as well as parabens (known carcinogens). We love Olive & Bee as an all natural lube - and we sell it in the studio!
Pelvic Floor Muscle Dysfunction (the goldilocks muscle!)
Increased tone/tightness, or spasm of the pelvic floor muscles can be a cause of deep dyspareunia. As with any tight muscle, repeated pressure can cause either immediate or latent discomfort. Trigger points within the muscles of the pelvic floor can also refer pain to the abdomen, creating menstrual cramping sensations and also hip and groin. Internal release work with our Pelvic Health Physiotherapy team can provide effective relief and improvement, as well as learning how to down-train the pelvic floor, and figuring out why they are becoming tight in the first place.
Vaginismus
Vaginismus is involves the involuntary reflexive contraction of the pelvic floor muscles around the opening of the vagina with attempted penetration, whether it be during intimacy or with a tampon or speculum, sometimes even just the thought of penetration can cause this response. It can be a mild tightening, which causes pain initially with penetration and then eases, or could be a more severe contraction - with penetration being completely impossible, and partners often report feeling like there is a block or wall preventing further entry. Vaginimus can respond well to both Pelvic Health Physiotherapy and support from a sexologist, counsellor or therapist.
Vulvodynia & Vestibulodynia
Often characterised by a burning, itching or raw pain around the vulva (externally) or vestibule (inside the labia minor and around the vaginal entrance). Even though the burning and itching can mimic symptoms of an infection, there may only be a slight redness visible and cultures for yeast or bacteria will often come back negative. Vestibulodynia is due to irritation or hypersensitivity of the nerves that supply the vaginal area, and can make light touch feel like a sharp/stinging sensation. This can respond very well to Pelvic Health Physiotherapy - learning how to desensitise and retrain the nerves and calm down the pelvic floor muscles, and can be done in conjunction with topical numbing creams or medication.
Sami Cattach - Pelvic Health Physiotherapist at Pear Exercise Physiology & Physio