Painful Sex and Recommendations from a Pelvic Floor Physical Therapist

Illustration of a woman using lying on her back on a fit ball. She is being supported by a pelvic floor physiotherapist who is dressed in white. The client has eczema and a prosthetic leg fitted for an above knee amputation

Written by Dr. Kaylee Simmerman, PT, DPT

Illustration by Maartje Aletta Reggin

 

Hopefully that title grabbed your attention! The word “sex” is something that almost always grabs everyones attention!

I want to first clarify what “sex” actually means. It does, in fact, include intercourse (penis in vagina), however that is not inclusive for sexuality purposes.

So, sex actually means anything that gives you sexual pleasure, feelings. This can include use of sexual toys, oral sex, anal sex, manual stimulation, even kissing/making out!

I make this point so you understand what “sex” involves and includes so when you try to determine if you are having pain with any of these avenues, please know that you don’t have to experience pain and sex can be enjoyable, in whatever form you like to have!

Pain with sex can be with palpation or touching, the sensation you get when you are stimulated, you can have pain with insertion of finger/toy/penis at the opening of the vagina, or pain deep inside. Men can have pain at the scrotum, the shaft of the penis, or even the tip of the penis. Pain with sex also includes pain with orgasm/ejaculation.

 

Many clients who experience painful sex are told that it is “normal” or just something you deal with… 

 

Many clients who experience painful sex are told that it is “normal” or just something you deal with… or are thought that drinking a glass of wine, or just dealing with it might help. This is far from the truth, and I believe Pelvic Floor Therapists (both OTs and PTs) are doing an incredible job improving the education on the topic!

Before continuing, I want to explain what a Pelvic Floor PHYSICAL Therapist is and does. Because we are a different specialty from OT’s. We are NOT personal trainers, however, we have an expertise in exercise, movement strategies, prevention of disease, and rehabilitative practices when it comes to movement. We are experts in the anatomy and biomechanics of the whole body.

With the pelvic health aspect being a specialty, we are able to connect the pelvic floor to the rest of the body with understanding how the musculature, ligamentous, tendinous, and even organs function with the body.

An example of a client we might treat, is someone who has chronic hip pain with squatting and cannot alleviate the pain. We would be able to address the WAY they move, how their spine and pelvis move, what their hip joints and muscles are doing, as well as if this can be related to the pelvic floor. It is ALL connected. From there, we teach this client how to squat properly without pain AFTER finding the cause of the pain.

We literally get to look at the client from head to toe, keep them in some form of movement, help them lift their children or do their job, without being limited by pelvic pain, back pain, hip pain, incontinence, diastasis issues, and so much more!

That was a mini crash course, but I hope it gives you an idea of why I am writing this article!

 

When it comes to sex, Pelvic Floor Physical Therapists are addressing and figuring out the cause of the pain, and then we are addressing the cause.

 

When it comes to sex, Pelvic Floor Physical Therapists are addressing and figuring out the cause of the pain, and then we are addressing the cause. In other words, we may be working on something that is NOT in your pelvic floor. I find that often clients who have pain with sex, require some addressing of their lower back and their lower abdomen in the form of decreasing tension and pain and then strengthening through that range.

When I speak of the cause, I mean EXACTLY what is causing the pain. In my office, we often find this to be muscular (where the muscles are not able to relax, so when sex is attempted, there is no ability to “get through” the tension) or even weakness of the muscles. Our pelvic floor muscles are what helps us reach orgasm and the ability to do so depends on the strength, endurance, and coordination of those muscles. Another cause can be a nerve related issue. The nerve issues may show up as a burning, tingling, feeling raw and can be at the entrance of the vagina or even deep inside. Typically this makes sitting on a bicycle or sitting in a chair painful. Sensation issues can also be the contributor, and this goes along with the nerve related issues. The sensation can be lack of, meaning you don’t feel what you should feel, or can on the other side, where everything is over-felt.

I, myself, had a hypersensitive pelvic floor and an overactive pelvic floor. So, my pain was right at the entrance of my vagina with toys, tampons, fingers, or penis. Then once the intercourse process began, I would have pain because I was unable to relax my pelvic floor. Treatment involved learning how to relax my muscles, changing up some positions, and also desensitizing the area with different types of materials/fabrics.

Of course there are many other reasons to be experiencing pain. You may have hormonal imbalance, tissue that has been torn in the past due to traumatic births etc. or even a medication. The above are just a few of the most common that I see.

Now, for the juicy parts. I’m going to give you 3 tips to take into the bedroom to help with the pain you may be experiencing. These MAY work for you, I am in hopes they might help you a both. Obviously, please see a Pelvic Health Therapist for specific and individualized approaches for you!

Tip 1 - Switch up what you are trying to stimulate with.

The BEST option is your own touch, so do not feel overwhelmed or afraid to try to feel what you like by touching yourself. You can use toys, but be mindful that too much use of sexual toys may contribute to decreased sensation in the genitals. Switch it up. Try to explore yourself, then add in a few toys, and then add in your partner. COMMUNICATE with your partner about what you’re finding that works and what doesn’t so you can navigate this together!

Tip 2 - RELAX your pelvic floor.

The best option for this is through pelvic breathing. You want to focus on letting the pelvic floor muscles (muscles between your legs) relax fully. I like to do this and teach this as follows:

Find a comfortable position either in sitting or lying down. Place your hands on your lower belly.

Breathe IN fully into your hands and FEEL your pelvic floor muscles stretch/relax. You may feel a little pressure, as long as you are NOT pushing, this is okay.

Then breathe OUT and let everything come back to normal.

Progress this breathe by trying in sidelying, on your stomach, hands and knees, or even a deep squat. Remember to focus on the Breathe IN.

Tip 3 - For INTERCOURSE or ENTERING of things. Try a different position!

My favorites are:

Side-lying with a pillow between your knees. Then your partner enters with toy, fingers, or self from behind.

On your stomach with pillows under your hips. And the toy, fingers, or partner enter from behind.

You on top, with your partner underneath. First try first by laying on top of your partner and your knees close to their body, and then progress to being able to sit.

There are SO MANY tips I’ve found over the years personally and also professionally that work, but try these and see what you think!

EVERY one is different, and of course this is not medical advice, but again I hope it gives you some options!  

Remember to use lubricant and be intent with your foreplay, that can be the most important part.

 

If you have specific questions about this blog post, please do one of the following:

Email me at: drkgsimm@femmempower.org

Fill out a form at www.femmempower.org in the 'contact us' tab.

Thank you!

 

Dr. Kaylee Simmerman, PT, DPT (@postpartum_physio)

CEO of Down There Docs & FEMMEmpowerment and Advocacy, LLC

Creator of FEMMEmpowered Birth, Core UPGRADE, InLove Coaching, and The Bladder Solution

Maartje Reggin (@littlemaart) is a disabled designer and activist from The Netherlands who loves doing research and making everyone feel included. She is a friend to all animals (especially her two house bunnies and her cat) and can’t live without tea. 

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