Having Pain With Intercourse? Pelvic Floor Physical Therapy Can Help!

Sex. Are you enjoying it? 

Perhaps that brings up a lot of emotions - fear, sadness, hopelessness. But as a pelvic floor physical therapist (PFPT), it is definitely a question I ask my clients. And I have helped even the most hopeless women get back to pain-free intercourse when they never thought they could!

Did you know that 3 out of 4 women experience painful sex at some point in their life? 😬Yeah. 😕 It’s that common. And is something that can totally be healed by me, your go-to PFPT, or others like me 🙌. 

Causes Of Painful Sex

There are many different causes of painful sex. 

Let’s name a few:: 

• Endometriosis

• Ovarian Cysts

• Hypertonicity or holding patterns of muscles in the pelvic floor

• Hormone imbalances

• Lack of lubrication 

• STDs

And the list could go on. These reasons or a combination of them can all cause painful sex.  But the most common reason I see in my clinic is dysfunctions of the core and the pelvic floor muscles. In most cases the pelvic floor muscles are hypertonic - or holding tight

Why do pelvic floor muscles become tight? 

There are several reasons pelvic floor muscles become tight. And a combination of factors is usually the culprit!

One reason for tight pelvic floor muscles is physical or emotional birth trauma. Tearing of the perineum during birth can cause scar tissue and/or the pelvic floor muscles to guard up and create a holding pattern.

Another potential cause of tight pelvic floor muscles is the physical changes during pregnancy and postpartum. To accommodate for these physical changes the core system may become imbalanced causing the pelvic floor muscles to over-activate and hold (ie, the abs aren’t working anymore, so now the pelvic floor muscles have to hold you upright!). 

A lot of women also hold tension or stress in their pelvic floor, causing the muscles to tense up. It’s a subconscious action, but we can consciously learn to become aware and fix this problem. 

Has Your Doctor Told You to “just deal with it”? 

The most frustrating rage-producing thing I hear is when a woman discusses painful sex with  her healthcare provider and she is brushed off and told to “just use lube” or “relax and have a few drinks” before being intimate with their partner. 😤

If you’ve been told this, I’m so sorry.  You have not been listened to. You have been given bad advice. While painful sex is common, It IS NOT NORMAL and you DON’T HAVE TO LIVE WITH IT! 

A pelvic floor physical therapist will diagnose and treat the root cause of your pain with sex!

As part of pelvic floor physical therapy, you could be prescribed any of these treatment interventions: 

• Manual therapy and self-treatment to relax the pelvic floor muscles

• Education on breathing techniques and hip, lumbar, or abdominal stretches to down train  the muscles of the lower body. S

• Strengthening other areas of your body to balance out your inner core piston

• The use of dilators to teach the pelvic floor muscles to relax when penetration is necessary

What does a PT session look like to help treat painful sex? 

Just bringing up the subject of painful sex can be triggering or sorrowful or any combo of emotions! 

I’m here to meet you where you’re at and tell you what’s going on with your body during your PT examination and following treatments. Your pelvic floor physical therapist should always be gentle both physically and emotionally.  Painful sex is a sensitive and personal topic and should be treated with respect. And if trauma is involved this should be taken into account during your treatment. 

At your PT examination (or first appointment), your physical therapist will take a thorough history, examine your posture, assess your breathing, examine your hip flexibility, and look at your gait and body movements…there’s so much to do! They will also determine based on this information if you need an internal manual pelvic floor exam. 

If your pelvic floor physical therapist does decide to do a manual pelvic floor exam, the outside of the pelvic floor is visually assessed, then internally using a finger.  During the external assessment, they should look for how well you’re able to contract and relax your pelvic floor. Then during the internal portion,  a finger inserted into the vaginal opening helps assess the tone of the muscles from the inside, and how forcefully you’re able to contract and relax the pelvic floor. This exam should be very gentle and should not cause increased pain!

Once your pelvic floor physical therapist has a comprehensive assessment of what’s going on with your body, she will show you personalized recommendations on how to heal your body! 

Breathwork is often used to down-train the nervous system. Down-training means telling our brain and nerves to decrease the nerve signals going to the pelvic floor. 

Next, hip muscle stretching is often prescribed as the hip muscles are intimately intertwined with the pelvic floor. Other exercises and movements may include posture education, sitting and sleeping positions, and sex position education. 

Later on in your PT journey, you can integrate pelvic floor strengthening (if necessary), the use of dilators, and core strengthening. 

The Takeaway - Gentleness

Dealing with painful intercourse can be overwhelming! There may be multiple factors involved in the root cause such as emotions and sensitivity tied up between you and your partner and of course physical causes. 

Sex shouldn’t hurt, and a PT session shouldn’t hurt either! Most importantly, you shouldn’t be told to “just deal with it.” I’m here to be gentle with you in everything from the exam to when you graduate from physical therapy! 

There’s so much pelvic floor physical therapy offers when treating painful sex - don't lose hope!