Pain With Sex

Let’s talk about painful sex. A lot of women assume that pain with sex is “just how it is” and often suffer in silence because they are embarrassed, no one has told them otherwise or they feel that it’s something they are doing wrong. 

When women do find the courage to bring it up with their doctor (because the doctor rarely brings it up), their pain is dismissed. Women are given ridiculous “advice” like “you just need to use more lube, use it or lose it, have some wine and just relax or are you really into your partner?” (Those are all word-for-word suggestions from docs my patients have reported...ugh!!!!!!). 

No is talking about painful sex. It seems everyone is talking about “amazing sex” leaving many women feeling broken, isolated and hopeless. 

I’m here to tell you that there is hope. You are not alone, in fact, 1 in 7 women have pelvic pain (and I would guess that statistic is low due to underreporting). As a pelvic floor physical therapist and women’s health coach, I work with women experiencing pelvic pain every day. There can be many causes of pelvic pain, and almost always, the pelvic floor is playing a role. 

What is the pelvic floor? 

The pelvic floor is a group of muscles that sit at the base of our pelvis like a hammock. These muscles keep us dry, aid in sexual pleasure and help with core strength. These muscles tighten (think of a kegel) but they also lengthen and relax or stretch. 

These muscles can be injured and weakened from surgery, childbirth or can become tight and painful as a response to trauma, surgery, persistent pain (i.e. painful periods, endometriosis, etc) or intense exercise. 

It has been said, “A woman's pelvis is where her energetic sensation of safety rests.” If you are feeling unsafe, anxious, fearful...you know, just being a human in the current world, your body is going to do everything it can to protect you...including tensing these muscles. 

A Vicious Cycle 

The pelvic floor muscles act just like other muscles in your body. Let’s use your upper trap muscles as an example. (You know the ones. They live at the top of your shoulders/base of your neck where you hold a bunch of tension). So let’s say you sleep on your pillow wrong, and your neck hurts. What do those muscles do? They tighten, guard and protect your sore neck. It makes it difficult to turn your head and when someone comes in for a big hug or pat on the shoulder, you instinctively pull away. 

Your pelvic floor muscles do the same thing. They are anticipating pain with sex because they’ve experienced it before. They’re going to guard and protect, and be more sensitive to touch. (They’re probably tightening up as you read this blog). 

Advice like “just keep trying, it’ll get better” is not helpful! Continued trying and thus having a painful experience, leads to a heightened pain response. Over time, this can lead to making everyday activities painful, from sitting, wearing tight clothes to interference in all aspects of your life. 

A physical therapist for my vagina?! 

Yup! As a pelvic floor physical therapist, I underwent advanced training to assess pelvic floor muscles and how they interact with the rest of the body. In a typical evaluation, we review your medical history, your pain history as well as discuss stress, diet and other lifestyle habits like sleep and exercise. 

We then take quite a bit of time looking at diagrams and models of the pelvic floor and how it works. (Often the anatomy review you get from me is more than most med students get in school). We discuss what exactly the evaluation will entail and decide together what you feel comfortable with. 

After the evaluation, we discuss the findings and most importantly come up with a plan to move forward! This includes tools that you can begin at home to take control of your pain. This might include breathing exercises, yoga-type poses and 

stretching of the pelvic floor muscles. You’ll leave learning about a very important part of your body, an idea of why you’re having pain and a plan to move forward! 

Learn More 

I own Koru Physical Therapy and Wellness where I work with women in person in Portland and Brunswick, Maine and virtually as a women’s health coach. 

You can give me a follow @korumaine on Instagram and Facebook. I also have a lot of info and resources on my website and blog at www.korumaine.com. 

I offer complimentary phone consultations where we can chat about your story and determine next steps. Schedule here. 

You are not alone. Your pelvic pain is real; it is not “all in your head” and you deserve to feel heard. You deserve to be offered valid treatment options to make you feel empowered to feel like yourself again!