By Dr. Brooke Meinema, DPT, FAFS The pelvic floor consists of a group of muscles…
By Dr. Brooke Meinema, DPT, FAFS
First things first: for some people, talking about sex may feel a bit uncomfortable or taboo; however, sex is normal and healthy. If you are experiencing pain with intercourse, mention it to your medical providers! Trust me: they have heard it all and want to help you! What may feel like TMI to you may help your providers give you the best treatments designed around your specific needs and goals. That being said, sex should not be painful. There are many potential reasons for discomfort with sex: childbirth, scarring, trauma, hormonal changes, and hypertonic (overly tight) muscles to name a few. The beauty is that these issues are treatable! Let’s dive into each one separately to break down why this might cause discomfort with intercourse and what steps you can take.
- Childbirth: Having sex after delivering a child oftentimes does not feel the same as it did before delivering (for both vaginal or cesarean delivery). After delivery, our hormonal levels quickly decline and can decline even more if the mother is breastfeeding. These hormones help to produce vaginal moisture and keep the tissues plump and happy. As you can imagine, decreasing the hormones decreases the moisture, and, well, things can get a bit dry. Knowing this beforehand can help make the transition to sexual activity a bit easier. Lubrication is your friend postpartum! There may be other issues including scarring (addressed next) or muscle spasms (also below) that can create some pain with intercourse.
- Scarring: Scars in the pelvic floor, just like anywhere else you may have scars form, can increase tenderness and soreness. Some deliveries or pelvic surgeries may result in tearing, which can lead to a bit of discomfort during intercourse due to pressure on the scar tissue. There are other conditions, such as lichen sclerosis, that may result in scarring and pain if left untreated. If this is creating an obstacle, a dilator or pelvic wand may be able to help, but many others find seeing a pelvic floor therapist can be very helpful for reducing discomfort and helping to ease back into things. Changing sexual positions to avoid pressure along the scar tissue can be very helpful, so, as should be the norm any time you have sex with someone, communicating with your partner is a must.
- Trauma: Experiencing a trauma (physical or psychological abuse, surgeries, or childbirth) can lead to increased tension and guarding through your pelvic floor muscles. When I talk with women about why their pelvic floor responds this way, I like to bring up how every time a stray hair brushes my arm, my brain screams “spider!” and makes my arm quick jerk away. Realistically, I know it’s probably not a spider and my arm didn’t need to respond that way, but my body’s reflexive movement is to jerk my arm away as fast as possible regardless. That’s how our pelvic floor muscles can respond to insertion after a trauma: the pelvic floor muscles scream “panic!” and spasm even when there isn’t a threat present. This can be combated in a number of ways depending on the cause of the trauma. Physical therapy can help to desensitize the pelvic floor (retrain the muscles to not have that immediate response of panic) as well as address the tension and pain that may be experienced. If you have experienced abuse, it is important to address this with the help of other professionals (and, no, seeing a therapist DOES NOT mean it is “in your head”; your body is responding to something it has experienced, making it a very real response that needs a real treatment). There are various workbooks, readings, and other content that may help you sort through this as well.
- Hormonal changes: Childbirth is not the only time you may have hormonal changes. Menopause, following a hysterectomy, and various medications can lead to changes in hormones that can impact the well-being of our pelvic floors. If you are experiencing dryness leading to bleeding or pain, finding a lubricant that works well for you is a must. Different lubricants work for different people, so try a variety to find which works best for you. While a pelvic floor therapist can address the pain associated with these issues, working with your OBGYN or other medical providers to address the hormonal changes can be a great place to start.
- Hypertonic muscles: Hypertonic muscles are muscles that have too much tension. This can be caused by several things: response to trauma (whether from sexual abuse or the trauma of delivering a child), overactive pelvic floor, high stress, excess Kegels, or other conditions leading to high tone. Ignoring the problem and “just pushing through” the pain will likely just lead to increased problems since these muscles respond just like any muscle does to a strain or painful experience: by spasming. Some women experience feelings of tension, pain, and guarding, and this may make attempting sex that much more difficult. Working to reduce tension, opening the hips and pelvis, and reducing this strain is key. Once again, things like pelvic wands, dilators, and buffers can help, but seeing a pelvic floor therapist to address this can be very successful!
The biggest takeaway from this whole post should be this: sex should not be painful, and there are things you can do to help if you are experiencing pain with intercourse. Hopefully, this post helps you understand a little more about why you may be experiencing discomfort and where to start. If you are experiencing pain and are ready to take a step forward towards improving this, I would encourage you to set up a time to talk with one of our pelvic floor therapists (we offer free 10-minute phone consults as well as free 30-minute in-person assessments). Call 616.847.1280 today to request an assessment.
I mentioned a few products throughout this post. Some of these products include:
- Come as you are by Emily Nagoski
- Emily Nagoski has multiple books and Ted Talks which many people find helpful
- Sliquid: discount code MP20 for 20% off
- Good Clean Love: discount code SAMPLES30 for 30% off
- GoLove (CBD infused lubricant): Save $5 with code comfort
- Desert Harvest: no promo code🙁
- 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
- Ohnut: save $7 with code BROOKE7
*Note: each person’s body responds differently, so be sure to look up any ingredients they may have to make sure they work for your body*