Pelvic Floor Pain During Sex

Do you have pelvic floor pain during sex? Do you have pelvic pain or sexual pain? Have you ever wondered, “Why does it hurt when I have sex?” If so, you aren’t alone – one in five women will experience pain with sex or pain in the pelvic region at some point in their lifetime. Pelvic floor pain during sex is common, never normal, and luckily, treatable.

What could be causing pelvic floor pain during sex

There are many physical, psychological, and emotional reasons you may feel pain during or after sex. From a physical perspective, pain can be due to:

• Infection including sexually transmitted infections
• Hormonal imbalance
• Nerve entrapment
• Scar tissue
• Tense pelvic floor muscles
• Various other causes

The pelvic floor

Your pelvic floor muscles, the muscles in your vagina, are likely the source of painful sex. These muscles sit at the base of your pelvis. They support your pelvic organs, keep pee and poop in until you are ready to empty and play a role in sexual activity. Yet, these muscles are like any other muscle in your body. They can get short and tight, go into spasms and be too tense.

This can cause vaginal penetration to be brutal and, sometimes, impossible. Pain from deeper penetration can also occur, as well as pain with orgasm. Pelvic floor pain after sex is also common with overactive muscles.

Vaginismus

Vaginismus is a muscle spasm of the outer third of the pelvic floor muscles. This condition prevents pain-free penetration into the vaginal canal. Pain occurs upon insertion of a finger, tampon, speculum, or during vaginal intercourse. Ways to treat vaginismus include:

• Breathing exercises
• Stretches to relax the pelvic floor muscles
• Using lubricant – try a water-soluble lubricant or natural oil (I love coconut oil) during intercourse
• Working with a pelvic floor physical therapist and a mental health or sexual health therapist. They can address physical and psychological symptoms.

You’re postpartum

You might be ready to go emotions-wise, but your body may not be! Injuries from pregnancy and childbirth delivery can lead to overactive tissues causing pain. These include perineal tearing/scarring and cesarean scarring. 

Hormones

I love to blame everything on hormones, and, in my defense, they are the reason to blame a lot of the time! Changes from hormonal contraceptives during lactation or breastfeeding and/or menopause can cause:

• Vaginal atrophy
• Vaginal dryness and thinning

You may have another medical condition

Many other medical conditions, may be the culprit:

• Vulvodynia
• Endometriosis
• Fibroids
• Ovarian cysts
• Cervix irritation
• A vulvar or vaginal infection, such as:
  • Lichen sclerosus
  • Bacterial vaginosis
  • Yeast infection

All genders can experience pelvic floor pain during sex

The anatomy of the pelvic floor is almost the same for all genders. This means everyone is susceptible to pelvic floor dysfunction. Everyone can experience pain with sex. Common causes of painful sex in those with male anatomy include:

• Pelvic floor muscle tension
• Peyronie’s disease – repetitive penile trauma. This causes scar tissue inside the penis that causes a painful and curved erection.
• Prostatitis: swelling of the prostate
• Erectile dysfunction: inability to get or maintain a firm erection

What are some things I can do to relieve pain with sex? 

Practice diaphragmatic breathing

Diaphragmatic breathing helps to calm the nervous system and reduce muscle guarding. It does this through good mobility, blood flow, and relaxation to the pelvic floor and abdomen. How to do it:

1. Place one hand on your chest and the other on your abdomen and relax your jaw and shoulders.
2. Take a slow, gentle breath, letting the abdomen and rib cage expand. You want your stomach and ribs to move the same in all directions. Blow like you are opening an umbrella with your rib cage. Then breathe out and let your abdomen fall back downwards.

Use lots of lubrication

Moisture is important to reduce friction, tearing, and rawness during intercourse. Less estrogen can decrease self-lubrication. This can happen during breastfeeding, in or post-menopause, or when using birth control. Not all lubricants are the same! Ingredients that you want to avoid in lubricants are:

• Glycerin
• Nonoxynol-9
• Petroleum
• Propylene glycol
• Chlorhexidine gluconate

I recommend two water-based lubricants that rarely cause irritation. These brands are also safe with latex and non-latex condoms. They are Slippery Stuff & Good Clean Love. You can also use a natural oil such as coconut oil. But, oil and latex don’t mix well, so if you use oil-based lubricant, avoid using a latex condom as it may tear.

CBD lube and suppositories

These can be game changers for pelvic floor tightness. The CBD acts alongside the pelvic floor muscles to help them relax. There are different brands out there with different ingredients and amounts of CBD. You can even make your own! ⁣Our favorites are from Foria, Simple Solace CBD, Vella, and GoLove. 

Try other positions

Try sidelying, lying on your back with pillows supporting your knees relaxed open, or you on top. These positions may offer pelvic floor relaxation and feelings of more control. Experiment with what feels best for you.

Use dilators or a pelvic wand

Our favorite brands for both dilators and pelvic wands is Intimate Rose. Pelvic wands look like a dilator with a curved tip at the end. These apply pressure to specific trigger points deep in the pelvic floor muscles. This helps the muscles relax. Dilators look like a set of tampons, large in diameter. Inserting these into the vagina can help:

• Desensitize your vaginal tissues
• Relax your muscles
• Massage any scar tissue at the vaginal opening resulting from an episiotomy or tear

Pelvic floor pain after sex

Pelvic floor pain after sex is a common issue that many people experience. Many women experience it after a hysterectomy. It can range in severity from mild discomfort to severe pain in the pelvic region. To address pelvic floor pain after sex, identify the underlying cause first. A pelvic floor physical therapist can do that! Various factors can cause it, including:

• Pelvic muscle tightness
• Pelvic organ prolapse
• Endometriosis
• Pelvic inflammatory disease
• Other physical or emotional problems

Pelvic floor exercises for painful intercourse 

Here are some stretches that help the pelvic floor lengthen and relax. Add 4-5 diaphragmatic breaths to each stretch, and your pelvic floor will thank you. You can do these daily and immediately before intercourse:

Gentle single and then double knee to chest stretch

To perform, start in a lying position on your back. Put your hands on the outside of one knee and slowly pull it in towards your chest. If you’re doing a single, keep the other foot flat on the floor. Hold the stretch. Then, switch sides. Or, place your hands over both knees to perform a double.

Happy baby stretch

To perform, begin lying on your back. Bend your knees. Keep your feet flat on the floor.

Take hold of the outsides of your feet with your hands, keeping your knees wider than hip-width apart. Draw your legs towards you, using the strength of your arms and hands to deepen the stretch.

You should feel a comfortable sensation in the inner thigh area, without any sharp pain or strain. Once you feel settled in the pose, use your breath to help relax further into the stretch.

Remain here for at least five full breaths. You should feel the stretch deepen with each exhalation.

Child’s pose

To perform, begin by sitting back on your heels with your toes together.

Then, keep your feet flat on the floor and lean forward, stretching out the arms in front of you. Ensure your arms are close together and parallel with the floor – do not let them spread too wide.

Your forehead should rest on the floor and your back should be straight.

Hold this position for 30-60 seconds, breathing throughout.

Deep squat

To perform, begin by standing with feet wider than shoulder-width apart. Point your toes outward. With your hands in front of you, lower into a squat. Bend at the hips and knees to do so. Keep your chest lifted and your back straight. Make sure to keep the knees in line with your toes, and avoid letting them roll inward or out.

Hold the squat position for a few seconds and then rise back up to the starting position. 

Pelvic floor physical therapy for pelvic floor pain during sex

If you are feeling pain during sex and don’t know where to go, you are not alone. A pelvic floor therapist is the perfect person to start with and will be able to point you in the right direction. You should not live with chronic pain!

Pelvic floor therapy for painful intercourse will help you lengthen and relax those muscles to their normal resting state. A PT can also guide you through breathing exercises, yoga and stretches and massage. PTs can also educate you on pain, posture, and more. A PT offers:

• Manual treatment techniques
• Neuromuscular reeducation
• Exercise to improve muscle pain, reduce pain, and optimize pelvic health function
• So much more!