“You just need to use lube”
“Drink a glass of wine first… you need loosen up a bit”
“Just take a shot first”

Those are three of the most common phrases I hear my patients repeat in the clinic from their providers! That is absolutely ridiculous!!

Repeat after me:

• YOU DO NOT NEED MORE LUBE! 
• YOU SHOULD NOT NEED TO BE DRUNK TO ENJOY SEX!
• PAINFUL SEX IS NOT NORMAL! (unless you are into pain during sex and have consented to it - no kink shaming allowed in this house)

Fun fact: the phrase “painful sex” is Googled 17,000 times per month! Seventeen THOUSAND! That is way too many times.

The common diagnoses you may find if you conducted that search are

• Dyspareunia
• Vulvodynia
• Vaginismus
• Vulvar Vestibulitis
• Erectile Dysfunction
• PGAD (persistent genital arousal disorder)
• Pelvic Inflammatory Disease
• Endometriosis
• PCOS (polycystic ovarian syndrome)
• Interstitial Cystitis (IC)

The list goes on. But what does it mean??

It means something is causing pain - but what? And where is that pain occurring? And what does it feel like?

The most common descriptors of painful sex that I hear in the clinic are: sharp, stabbing, rubbing, raw, sandpaper, pinching, poking, needles, tearing, burning, and shooting. Occasionally I will hear “it feels so deep that it [a penis, finger, toy] could come out of my belly button or mouth.” Who in the world would want to keep having sex if that is what you are experiencing during the act? The good news is that many of the causes for painful sex can be treated with pelvic floor physical therapy! 

That means it is time to search out that magical unicorn of a therapist who has specialty training in the pelvic floor and can work on your body on both the outside and the inside.  No, not the inside like the brain (but we definitely recommend working with a mental health therapist as well). I mean the inside like inside your pelvic floor... Yep! With your consent, we put our fingers anywhere we medically need to to assess your muscles and connective tissues so that we can give you the most well rounded care. 

So now that we know what it could feel like, let’s cover when and where you may feel this.  Pain with sex may be experienced with light touch, during the start of penetration, with deeper penetration, with erection and/or with orgasm.  You can experience these pains on the outside muscles/skin, inside the vaginal or rectal canal, deep into the cervix, at the base or shaft of the penis, at the tailbone, in the bladder, in your abdomen, and/or in your back or hips. 

What in the world is causing all of this?!

Often times pain during sex can be a result of: 

• tightness/muscle spasms of the pelvic floor
• nerves (pudendal neuralgia vs pudendal nerve entrapment)
• scar tissue (after surgery or child delivery)
• inflammation of the pelvic glands
• previous injuries to the pelvic region
• dryness due to menopause/breastfeeding
• as a result of a medical condition (endometriosis, PCOS, lichen sclerosus, Peyronie's disease, prostatitis, UTIs, yeast infections)
• Anxiety or past trauma that is manifested as pelvic pain (cue that mental health therapist - they are crucial!)

At this point it can seem overwhelming but I promise you with the right care team, these symptoms can be managed and can even be completely resolved depending on the exact causes of your pain. Medical treatment for painful sex may include medication, physical therapy, acupuncture, and talk therapy.  Medications include either oral or topical/suppositories to address inflammation, nerves, muscle spasms, hormone imbalances, and/or dryness. 

In pelvic floor physical therapy we will have thorough discussion about your symptoms to ensure we can uncover as much relevant information as possible.  Then we will perform an examination to identify the cause(s) of your pain, typically a combination of the things we discussed above, which may take a few visits.  After this we will start to address the tissue issues with a combination of hands-on work by your therapist, education, exercises/stretches, and home self treatment (if desired by the patient). 

Things you can do to help with the pain you experience is to talk to your partner(s) about what you like during sex and make changes with your approach to intimacy.  Start by talking about the things that feel good to your body and the things that don’t feel good. 

If you aren’t sure, start by exploring your body alone in a quiet and relaxing space.  Once you have decided the types of touch and places you like touched, you may be better able to relay this to a partner. 

Keep in mind sex is not just penetration (penis/finger/toy into vagina/rectum).  You can still be sexual and have sex with your partner by performing things like oral sex or mutual masturbation. 

The end game in therapy is that we help you to achieve your goals related to painful sex.  We will use any combination of providers and of things discussed above to help you get there. 

Luckily we also have a few tools up our sleeves that can help you out at home.  These are some of my favorite tools to help treat pain with sex. Before you start using any of these tools, please consult with a pelvic floor therapist to ensure you are using the right tool and that you are using it correctly. (Please note: Each link shared below is an affiliate link.)

Pelvic Wand: Intimate Rose makes an amazing pelvic wand that is now available in three options: original, vibrating (great for desensitization) and hot/cold (so soothing!).  While either end can be inserted in the vaginal or rectal opening, most people find the narrower end more tolerable rectally and the wider end is best for the vaginal opening.  Some people do prefer to start with the narrow end in the vaginal opening and work their way to the wider end. Use JOY1 for $5 off your order.