“Sex is supposed to be enjoyable. It is supposed to be pleasurable. Intimacy can help you improve your physical relationship with your partner. But if you suffer from pain during intercourse, sex has likely become an emotional drain. And you’re not alone. MILLIONS of women worldwide suffer from pain before, during, or after sex, a condition called Dyspareunia.
I take pelvic health seriously, and I want you to know that a healthy pelvic floor means you can live a pain free life. If you’re not familiar with your pelvic floor, you may want to check out our blog on the it “Forget Leg Day… Don’t Skip Pelvic Floor Day.”
What is Dyspareunia?
Dyspareunia is a medical condition, and one that there is no reason to be embarrassed about. Essentially, dyspareunia is any pain in the pelvic floor that occurs before, during, or after sexual intercourse. It is closely related to vaginismus, but dyspareunia may or may not be painful at the point of insertion due to involuntary muscle contraction.
When we frame pelvic pain and pain with intercourse as a medical issue, it opens us up for a discussion about how to treat the condition. The good news is that Dyspareunia is a treatable condition, not just one to be managed and dyspareunia doesn’t require surgery or medication.
But dyspareunia isn’t going to go away on its own.
You need to seek a pelvic floor physical therapist who can help you Love Your Life. That is exactly what my team of pelvic floor physical therapists here in Oklahoma City do. We help identify the cause of the pain during intercourse; we tailor a treatment plan to reduce your pain and eliminate your dyspareunia.
How Common is Dyspareunia?
Dyspareunia is common. It is estimated that 1 in 10 to 2 in 10 women in the US suffer from dyspareunia. That means there are nearly 33,000 women in Oklahoma City who need treatment for dyspareunia. But too many women are not talking to their doctor, they are not talking to their friends and family, and they are suffering in silence.
I treat women in Oklahoma City with dyspareunia every day. It is easy for me to talk about, it is easy for me to see the need, but I’m a pelvic floor physical therapist. I know that with really personal topics, like pain with intercourse, it can be hard to start the conversation. But you need to access the pelvic floor physical therapy and the life you deserve.
If you are not sure where to start, talk with someone. You deserve to Love your Life! One of our Oklahoma City based pelvic floor physical therapists are always available for a free consultation. And we can even do a consultation through telehealth pelvic floor physical therapy if you have to travel from a distance.
Treatment for Dyspareunia
Because sex is so personal, we are too often taught not to talk about it, which means sometimes we don’t know when things aren’t going right. The women of Oklahoma City need to know that sex shouldn’t be painful, they shouldn’t have to deal with dyspareunia alone, and it is time to talk to someone who understands your pain.
For most women, dyspareunia is… different for each woman. That’s right, if you have dyspareunia it may not be “just like your best friend’s, cousin’s, so and so who had that.” It can be there from the very first time you have intercourse (primary dyspareunia), or it may develop after years of pain free sex (secondary dyspareunia). But the common symptom is pain with intercourse (although it can be at entry or with deep penetration), and that pain is generally due to some form of muscle tightness.
Physical therapists are experts in treating conditions impacting the muscles, especially pain. And the pelvic floor physical therapists at FYZICAL Oklahoma City are trained specifically in how to treat pain impacting the vagina and pelvic floor.
What do you do in pelvic floor physical therapy for Dyspareunia?
Because you are different from every woman with dyspareunia, you need a treatment plan for your dyspareunia. When one of our pelvic floor physical therapists treat you for dyspareunia, we do a thorough evaluation of your pain and other symptoms. Then we develop your personal plan of care. There are six treatment elements I use in varied combinations for most of my patients with dyspareunia.
Partner on Board
One of the most important steps to treating Dyspareunia is getting your partner on board. When you suffer pain during sex, the last thing you want to do is jump in bed, but stopping intercourse can be confusing and isolating for your partner. He needs to know that it is not his fault any more than it is yours and that through treatment for Dyspareunia, you can actually improve both the physical and emotional aspects of your relationship.
I always encourage those women, in a healthy relationship, who I treat for Dyspareunia to bring their significant other in with them. Ultimately, an engaged partner is going to improve your outcome.
After education about Dyspareunia and getting your partner on board, the first place I start working with my patients on is coordinated breathing. Your diaphragm is tightly connected to your pelvic floor, which means tension in your pelvic floor muscles can be made worse with poor, shallow breaths.
Babies intuitively know how to breath, but life and stress makes it so that we as adults breath short shallow breaths, up in our chests. This poor breathing contributes to stress, anxiety, and pain. If you can't properly relax, it is no wonder sex is painful.
Did you know that up to 95% of women with low back pain have underlying pelvic floor dysfunction? Your pelvic floor is the foundation to your core, but it interacts with your hips, your lower back, your abdominals, and your legs, and if you’re having issues with one of those it’s likely to impact all of them in someway.
Learning how to properly stretch tight muscles across all of these muscle groups is going to have multiple benefits not the least of which is reducing stress and improving muscle health. Healthy muscles, after all, are both strong and flexible.
Many women have pelvic floors that could be far healthier. Even strong, physically active women can have weak pelvic floor muscles. And tight pelvic floor muscles are not necessarily strong.
However, starting to do Kegels (i.e., pelvic floor muscle contraction) with dyspareunia can make things far worse. You need to learn to relax your pelvic floor muscles, first.
Your pelvic floor muscles are the foundation of your core and vital to most daily living activities. When one muscle group is weak, other muscles have to take up the slack. With our pelvic floor muscles as the foundation of our core, they are the last line; so, we often brace by tightening (or contracting) our pelvic floor muscles. For many women, this can the initial cause for their pelvic pain.
In addition to healthy muscles being strong and flexible, healthy muscles can work independently and as combination. When you are suffering from dyspareunia, you need to learn to use your abdominal muscles, inner thighs, and gluteals separate from a pelvic floor contraction.
If you unsure, or you have increased pain, stop your strengthening exercises. You need to consult a pelvic floor physical therapist like we have at FYZICAL Oklahoma City. Once we know which muscle groups you can activate separate from your pelvic floor, we can start strengthening those muscle in support of your pelvic floor muscles. Until then, stick with stretching and breathing.
Manual Muscle Manipulations
Remember pelvic pain is a medical condition, and just like your OB/Gyn, our pelvic floor physical therapists take their role in your health seriously. That means there are some things that can feel uncomfortable at first blush, just know that we do this everyday and we need you to be open to the best available treatment options for your condition.
One such treatment element is manual muscle manipulation. Your pelvic floor physical therapist may call manual muscle manipulation "pelvic floor releasing," or "manual therapy." No matter the term used, manual muscle manipulations are one of the most important tools your pelvic floor physical therapist has in the treatment of your dyspareunia. They allow your physical therapist to manually release tightened muscles.
With the vaginal muscles, trigger point release can be achieved with a finger (“digital”), pelvic dilators (like our friends over at VUVA Tech make), or a Therawand. The goal of manual muscle manipulations is to reduce the tension, pressure, and pain caused by muscle trigger points. And it is a technique that can really work well when you have a partner helping to relieve you pain. By this point in treatment, we really hope your partner is on-board.
Yes, I am pelvic floor physical therapist. Yes, I have treated tons of women with dyspareunia. Yes, I have some patients who would really benefit from manual muscle manipulation, but they do not want to do any internal work.
I respect that, some women are always going to be uncomfortable with the thought of "down there." And while I hope my patients trust that I am doing what's best for them, you have to be comfortable with your body and be an active participant in your treatment. If you're not ready for manual muscle manipulation, biofeedback can be used. (It can also be a really great tool for those who are comfortable with pelvic floor massage). Because biofeedback is more personal than stretching or breathing, but less invasive than manual muscle manipulation, I use it for many of my patients being treated for dyspareunia.
Biofeedback uses real time electrical signals from your muscles to show you a visual representation of how well you contract and relax the muscles of your pelvic floor. Using a handheld unit, or a computer model we can better teach you how to coordinate your breathing with a Kegel, how to downregulate your nervous system, and how to relax your pelvic floor for maximum benefit.
By incorporating properly coordinated breathing, stretching, targeted exercises, manual muscle manipulations, and biofeedback, you can enjoy a healthy pelvic floor and you can live your life without the pain of dyspareunia.
If you have questions, please call. We are always happy to help other women, we are here to help you “Love Your Life!”
-Lauren C. Peterson, PT, DPT
Clinical Director, FYZICAL Therapy & Balance Centers of Oklahoma City
FYZICAL Therapy & Balance Centers of Oklahoma City provides pelvic floor physical therapy in Lakeside, The Village, Nichols Hills and surrounding NW Oklahoma City. Our pelvic floor physical therapists are specially trained to treat all types of pelvic floor dysfunction including pelvic pain and dyspareunia. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.
For those needing pelvic floor massage, we recommend Therawand to our Patients. Checkout the link below.