Sex should be enjoyable, pleasurable, and pain free where you and your partner can share in intimacy! It should not be painful… at all. So if you experience pain, you may be wondering what’s normal, what’s not and what can help?
Painful sex, also known as dyspareunia, is a common diagnosis with up to 18% of the worldwide population suffering with these symptoms; however, this disorder is often neglected due to people not wanting to share these issues with their medical providers or not knowing who to go to when this issue presents. Therefore, people are not getting the help they need, potentially leading to mental health issues, relationship challenges, and an overall decreased quality of life. Fortunately, when diagnosed appropriately, dyspareunia can be managed and treated by a team specializing in pelvic health.
Let’s first talk about what could be causing your pain during sex and then we will dive into some ways to reduce your pain!
Why am I having pain during sex:
- Increased pelvic floor muscle tension- your pelvic floor muscles are like any other muscle in your body and can be tight, tense, or have difficulty relaxing during intercourse.
- Vaginismus – Vaginismus is defined as muscle spasms at the outer third of the vagina or the vaginal opening. This often feels like your partner is “hitting a wall” when trying to enter the vagina.
- Vaginal atrophy/drying/thinning – This is often due to hormonal changes from hormonal contraceptives, during lactation or breastfeeding and/or menopause
- Vulvodynia presents as discomfort at the vulva causing burning, rawness, itching with no known cause that has been lasting for 3 months or longer
- Injuries from pregnancy and childbirth delivery Such as perineal tearing/scarring and cesarean scarring can also lead to tight tissues causing pain.
- Endometriosis, fibroids, ovarian cysts, cervix irritation can contribute to painful intercourse.
- Vulvar or vaginal infection, such as lichen sclerosis, bacterial vaginosis, yeast infection can cause vaginal pain and irritation before, during and after intercourse. Treatment of these would include seeing a medical provider or physician.
What are some things I can do to relieve pain with sex?
Practice diaphragmatic breathing every day and during intercourse
Diaphragmatic breathing helps to calm the nervous system and reduce muscle guarding by ensuring good mobility, blood flow, and relaxation to the pelvic floor and abdomen. How to do diaphragmatic breathing:
- Place one hand on your chest and the other on your abdomen and relax your jaw and shoulders.
- Take a slow, gentle, breath in, letting the abdomen and rib cage expand. You want your stomach and ribs to move equally in all directions like you are opening and umbrella with your rib cage. Then slowly breath out and let your abdomen fall back downwards.
Use a lot of lubrication!
- Vaginal moisture is important to reduce friction, tearing, and rawness during intercourse. With reduced estrogen during breastfeeding, menopause, or with use of some types of birth control, self-lubrication can be decreased. However, not all lubricants are made the same!
- Some ingredients that we want to avoid in lubricants are: glycerin, nonoxynol-9, petroleum, propylene glycol, and chlorhexidine gluconate
- Some water-based lubricants that rarely cause irritation and are safe with latex and non-latex condoms are: Slippery Stuff & Good Clean Love or you can use a natural oil such as coconut oil. Just a heads up – oil and latex don’t mix well so if you use oil-based lubricant avoid using with a latex condom as it may tear.
- CBD Lube and Suppositories: These can be game changers for pelvic floor tightness. The CBD acts directly with the pelvic floor muscles to help them relax. There are many different brands out there with different ingredients and amounts of CBD, and you can even make your own! Our favorites are from Foria, Simple Solace CBD, Vella, and GoLove
Pelvic Floor Relaxation
Listed below are some stretches that help the pelvic floor lengthen and relax. Add in 4-5 diaphragmatic breaths to each of these stretches and your pelvic floor will thank you. You can do these once daily and to prepare immediately before for intercourse:
- Gentle single and then double knee to chest stretch
- Happy baby stretch
- Child’s pose
- Deep squat
- Butterfly stretch
Try other position positions
Sidelying position, lying on your back with pillows supporting your knees relaxed open, or sitting on top of your partner may work better for your body and allow further pelvic floor relaxation and feelings of more control
Use vaginal dilators
Dilators allow for prolonged stretching of the pelvic floor muscles, massage scarring at vaginal opening, allow you to practice pelvic floor relaxation, and to practice intercourse.
Pelvic Health Physical Therapy
Lastly, if you are feeling pain during sex and don’t know where to go, a pelvic floor therapist is the perfect person to start with and we will be able to point you in the right direction if you are requiring medication.
In therapy, we focus on improving muscle tone, reducing pain, and optimizing pelvic health function with manual treatment techniques, neuromuscular re-education, and exercise!
Check out our post “What to Expect in a Pelvic Floor Physical Therapy Session” to learn more
If you have pain in your parts, Download this free guide to find out if pelvic floor tightness might be to blame—and what to do about it.
Claire Schott, PT, DPT is NOLA-born and raised, graduating from Dominican and receiving her Bachelor’s of Kinesiology from LSU and Doctorate of Physical Therapy from LSU-HSC in New Orleans. Claire specializes in the treatment of men and women with pelvic health diagnoses. When not at work, she enjoys exercising, being outside, reading, cooking, and spending time with her husband and dog.