Pain with Sex...What causes it and how can we improve it?
Pain with intercourse is far more common than we think. According to statistics from American College of Gynecologists and Obstetricians, 75% of women experience painful sex during some point of their lives. Because it is not a subject that is easily talked about, many women never seek help, therefore worsening their pain and pelvic floor problems.
So, what causes pain with sex? There are several contributing factors.
The first one is pelvic floor muscle tightness, which we call muscle hypertonicity. This means that those muscles have difficulty going through full range of motion, as they tend to stay in a more contracted state, instead of being able to lengthen and relax. Pelvic floor physical therapy can help to release pelvic floor muscle trigger points, decrease tone and teach you how to lengthen the pelvic floor muscles. They can also teach you stretches and exercises to improve overall lower extremity mobility which will lead to a more functional pelvic floor.
Second contributing factor is your breathing. If we hold our breath during sex, then your pelvic floor muscles will stay in a tightened position, making intercourse more painful. You may have heard that the actions of your diaphragm, which is your main breathing muscle, are directly correlated to the actions of the pelvic floor. When the diaphragm descends as we take a deep breath in through our belly, pelvic floor muscles lengthen. When the diaphragm ascends as we breathe out, the pelvic floor muscles also ascend and shorten. Therefore, not being able to take a full diaphragmatic breath in and out can lead to limited ability to lengthen the pelvic floor. Also, diaphragmatic breathing can help our nervous system calm down, which may make sex more enjoyable. Make sure you take deep, diaphragmatic breaths before and during intercourse to decrease pain.
Third contributing factor is lubrication. Some women may have more of a need of lubrication than others, depending on hormonal contributors, whether they are on birth control, what period of their cycle they are on, and medications. Feeling of "pinching" in pelvic floor during intercourse is many times a sign of needing more lubrication. Find a lubricant that is water-based and natural, you can also use something as simple as coconut oil.
And last, but definitely not least, is your mental state. Being able to enjoy sex requires being in a calm state of mind, and being comfortable with your partner. Speak to a mental health provider if these are things you may be struggling with.
If you are having pain with sex, seek help from a pelvic floor physical therapist to improve your quality of life!
Dr. Krisia Gattas, PT, DPT