By Dr. Brooke Meinema, DPT, FAFS

Sexual pain and dysfunction

As a pelvic floor physical therapist, talking to patients about their sex lives can be a regular occurrence. Some of the women coming to see me for pelvic floor concerns have a little bit of difficulty breaching this subject, which is why it can be helpful to have a little bit of understanding before coming to that first physical therapy appointment.

Background about pain with sex:

An estimated 75% of women experience painful intercourse at some time in their lives. Regularly experiencing painful sex (also called dyspareunia) can lead to feelings of anxiety, depression, and reports of feeling relational strain. There are a variety of reasons why someone may be experiencing pain with intercourse (which was the topic of a previous blog, so we won’t dive into that here). Knowing that you are not alone in this experience and that there are treatment options available to help with this should be well known!

Treatment approaches:

Painful sex is best managed by a team; addressing not only the physical aspects but also the emotional and psychological components can make a huge difference.  So many women who experience pelvic pain also experience anxiety or depression associated with this, which is part of why it can be so beneficial for them to attend talk therapy or counseling in addition to physical therapy. There may also be underlying trauma that has led to experiencing pain, and working through this is a must for a full recovery.

Pelvic floor rehabilitation and physical therapy is one way of addressing the physical aspects of painful sex. When we experience any kind of pain, our brain associates that activity with danger and kicks into overdrive. With intercourse, this can result in our pelvic floors creating a spasm or over-activation of the muscles and pain receptors making us think our body is in danger creating the pain response. The more our body associates this with pain, the harder it is to break that pain-spasm cycle. Pelvic floor PT can work to address the muscles in the pelvic floor to help them relax and desensitize so it no longer feels the need to panic.

Talking to your PT about sex:

While some people are comfortable discussing how their sex lives may be impacting their pelvic floor, others may find this uncomfortable or embarrassing. We understand that this may be a bit new to talk about for some of our patients, but we want everyone to know that we will NEVER judge you for anything that is discussed. Pelvic pain with intercourse happens, but if this is a regular occurrence, getting into the specifics about what is triggering the pain can help us get a better understanding of how to address it. This can mean talking about positions that are painful or easier to tolerate, lubrication, duration, depth of penetration, and what you are feeling during and after. As personal as it may seem, there’s nothing to be embarrassed about or feel the need to omit (trust me, we have heard just about everything at this point!).

The goal:

The goal shouldn’t just be to be able to “tolerate” intercourse but to be able to enjoy it. If you aren’t finding enjoyment in your sex life, having an open discussion with your partner is an extremely important first step. Also, understanding your body and how it works can be helpful in understanding what works for you. This can mean reading books, self-exploration, etc.

A few products to consider:

Wearable Buffer:

• If you experience pain from the depth of penetration, a buffer may be a helpful product to consider. It goes around your partner’s shaft and is able to be customized for tolerable depth.
• Ohnut: save $7 with code BROOKE7

Books:

• Come as you are by Emily Nagoski. This book broaches different topics related to finding enjoyment in sex.
• Emily Nagoski has multiple books and Ted Talks which many people find helpful.

• She comes first by Ian Kerner
• This book is more directed for women’s partners.

Dilator/Wands:

• Dilators are used for pelvic pain or muscle guarding/tension to work on desensitizing or stretching out the muscles in the pelvic floor. Pelvic wands can be helpful for reducing tension and trigger points.

• Intimate rose offers both dilators and wands on their website: save $5 with code BROOKE7

• Milli is an expandable dilator with vibration options: save $30 with code Brooke30