When you have painful sex, it’s easy to think you must be alone in this experience. However, you’re absolutely not! Many people share your concerns, and there are many potential treatment approaches to make sex pain-free.
- During vaginal intercourse, about 30% of those with female anatomy and 7% of those with male anatomy had pain
- During anal intercourse, about 72% of those with female anatomy and 15% of those with male anatomy had pain
Painful sex can occur in many forms, and treatment depends on each person’s experience.
- Primary pain: Pain has been present since first attempt at penetration
- Secondary pain: Sex was originally pain-free, and became painful later in life
- Commonly occurs after childbirth (vaginal or cesarean), infection, surgery, physical or psychological trauma, or hormonal change. Check out this article for some more of our thoughts on postpartum sex.
What causes painful sex?
Especially in the genital area, the nervous system is sensitive to feelings of pain and “threat.” Regardless of why sex was initially painful, our body tries to guard against this negative experience the next time. Our beliefs about sex and the relationship with our partner(s) can also influence our body’s response. Over time, this can reinforce pain with sex because the body’s responses actually make it more uncomfortable to have sex. This reaction can create physical tension and muscle guarding, a higher sensitivity to touch, and a lower desire for sex.
How can I treat painful sex?
When you come to pelvic physical therapy, your PT will:
- Ask questions about your pain experience and the circumstances around when it started (if you know them)
- Screen you for medical contributions to pain, and refer you to a doctor for further testing if needed
- Seek to understand your goals for PT. What sexual activities do you want to participate in? Are you trying to conceive? Do you need to be able to tolerate routine tests? Etc.
If you do not have medical contributors to your pain, or they’re being appropriately managed, pelvic PT is the perfect place to work on teaching your body to be less sensitive to penetrative activities.
Pelvic physical therapy sessions may include:
- Education about pelvic floor anatomy and how the pelvic floor muscles work
- Practicing consciously contracting and relaxing the pelvic floor muscles to gain control and confidence
- Learning about the physiology of sex, and how to set yourself up for success with foreplay, lubricants, etc.
- Discussing options for maintaining or regaining sexual connection with your partner, if you currently have one
- Using vaginal or anal dilators in the clinic and at home
- Using mindfulness strategies to calm the body’s stress responses during your day as well as during sex
It’s important to know that no matter your experience, pelvic PT is a safe and judgment-free place. You can learn about your body, ask questions about sex, and work towards your individual goals in a supportive environment. We’re looking forward to working with you!