Pelvic Floor Physical Therapy: Why does it hurt to have sex? Part I- My Young Ladies
Note: this is the first of 3 blogs, because I have a lot to say, and no one has the time to read one LONG blog . . .
As a pelvic floor physical therapist I see this quite a a bit. It makes up a large chunk of my caseload in a large variety of women! Some who are young and have never had children, and have never been able to have pain free sex- ever. These we will call ‘My Young Ladies.’ Some who have painful sex after childbirth ( whether from vaginal deliveries or cesarian deliveries)- ‘My mamas.” And in perimenopause/ post menopause . . . along with some other reasons- ‘My Womanly Warriors!’
Note sexual abuse/ trauma: more common than we think, the statistic is 1/3 women have experienced sexual trauma. Of the women who have reported this, more than 1/2 report pain and/ or difficulties with intercourse. I believe both of these statistics are just wrong- these numbers are much, much higher.
** as I put this soapbox of to the side** back to original topic**
Lets talk about my young ladies- typically int heir 20s/ 30s who may have a medical condition that contributes to this, such as:
Vulvovaginal conditions ( vulvodynia, vestibulydynia, vaginismus, etc)
Endometriosis, IBS, autoimmune disorders
Painful bladder syndrome/ IC/ constipation/ coccydynia
Overexercisers/ clenchers
The list goes on . . .
The first two lines are medical diagnosis that are confirmed by your physician either by a diagnostic test are a diagnosis made of exclusion ( meaning none of the diagnostic tests came back positive, so it must be this . . .). Yes my eyes are rolling too- it isn’t a perfect system- and I will be the first to admit it is all sorts of clusterness. But there are good providers out there and I am happy to guide you to the better ones ;)
Again, back to my topic ** focus, Karen, focus!!** These medical conditions can cause abnormal input into our nervous systems causing the muscles to tighten and we then live in a state of tension. The example I give my patients is have you ever thrown out your back?! Then try and stretch it? It hurts!! So if your pelvic floor muscles are tight/ clenching from the above medical reasons (side note: you are not crazy), then yea penile penetration will probably hurt!
My over exercisers/ kegelers and clenchers- if you do the work, it get’s better relatively easily. Exercise is great, exercise makes you happy and happy people don’t kill people ( ha)! Sometimes when we exercise, we hold our breath a bit too much, or have a funky form that puts our pelvic floor muscles in a shortened position, this causes the muscle to tighten. So nothing may be wrong with you medically speaking. Just like you have a tight neck, you can have tight pelvic floor muscles- mind blowing right?! Isn’t it wild that a muscle specialist, like a pelvic floor physical therapist can help with that?!?!?
Finally, some of my young ladies, may be struggling with how sex was discussed in their homes as children and young ladies. Is it dirty? Is there shame around it? Sexual education can and does happen every day in pelvic floor physical therapy. Every patient get an explanation not he difference between their vagina and vulva is, yes I point out where your clitoris is to you. If you don’t know where it is, that’s okay. If you were taught touching it is wrong then we may have to examine that. Finally, some of my ladies aren’t ready to talk about pleasurable intercourse, but want to be able to have pain free sex with their partner . . . See the difference? If that is your goal- okay then, let’s make sex less painful for you . . .
These are just a few reasons why you could be having pain with this, but the reality is there are so many reasons, but most importantly it is very treatable for all. Not sure what your first step is? No problem, drop me an email and we can discuss if you need to see me first, a physician, midwife, whomever! But most importantly please do not let yourself suffer. Pain with sex can not only affect yourself, but your relationships, self esteem, and happiness.