Dr. Katrina Heath is a Physical Therapist specializing in pelvic floor health at The After Cancer.
Ouch!!!! Why am I hurting during intercourse now?
There is one more thing that I have to worry about, and I never expected it to affect my performance in the bedroom! Does any of this sound familiar? Perhaps you have been diagnosed with a pelvic floor dysfunction commonly known as dyspareunia or vaginismus.
Dyspareunia refers to persistent or recurrent pain experienced during sexual intercourse. This pain can occur at different stages of sexual activity, including vaginal touch, penetration, during intercourse, or after sexual activity. There are various potential causes of dyspareunia, and they can be physical, psychological, or a combination of both. Physical causes may include conditions such as cancer diagnosis, pelvic inflammatory disease, endometriosis, vaginal dryness, infections, or structural issues. Psychological factors like anxiety, stress, or a history of sexual trauma can also contribute to dyspareunia.
Vaginismus is another type of common pelvic floor dysfunction divided into primary and secondary forms of vaginismus. Primary vaginismus is the prevention of sex secondary to pain where a female has never had penetration at all. Secondary vaginismus is where one has had penetration in the past but is no longer able to have intercourse secondary to trauma, surgery, cancer diagnosis, or mental health issues including anxiety. Both vaginismus and dyspareunia have similar treatments but first one needs to identify the underlying cause.
Pelvic Floor Physical Therapy
Physical therapy can be a helpful and effective approach in managing dyspareunia and vaginismus, particularly when the pain is related to musculoskeletal or pelvic floor issues. Pelvic floor physical therapy is a specialized form of physical therapy that focuses on relaxation and strengthening of muscles, ligaments, and connective tissues in the pelvic floor and its attachments. Here are some ways in which physical therapy can help with dyspareunia and vaginismus:
Pelvic Floor Assessment: A physical therapist performs a thorough examination to identify any muscle tension in the pelvic floor muscles. This exam begins externally assessing spinal alignment, hip mobility, postural awareness. With the patient’s consent there is also an internal exam of vaginal or rectal muscles to see if these are contributing to pain and dysfunction.
Biofeedback: Biofeedback is a technique that provides visual or auditory feedback about muscle activity and relaxation.
Manual Therapy: Hands-on techniques may be used by the physical therapist to release tension in the pelvic floor
Education and Counseling: Physical therapists can provide education on anatomy, sexual function, and techniques for relaxation. They will refer out to a mental health provider as needed.
Breathing Exercises: Proper breathing techniques can contribute to overall relaxation and reduce tension in the pelvic floor muscles.
Posture and Body Mechanics: Addressing posture and body mechanics during daily activities and sexual positioning can be important, as poor posture and positions may contribute to pelvic floor dysfunction.
Collaboration between healthcare professionals, including gynecologists, urologists, mental health professionals and physical therapists, may be necessary to determine the most appropriate and comprehensive treatment plan for an individual's specific situation.