February: the month of love whether that be self love or love between you and your partner.

 

For people, sex plays a big role in deepening intimacy when partnered and for self care. 

 

So what happens when sex hurts?

 

Media paints a pretty picture of pleasurable, hassle free, and pain free sex. 

 

In reality, an estimated 20-50% of women will experience dyspareunia (painful penetration) at some point in their lives (Basson et. al, 2000). And those are old numbers and not representative of all identities or types of sexual activity, meaning the real figure is likely much much higher. 

 

While a lot of media portrays a rosy picture of sex, thankfully, the social media community has brought a new awareness to pain with sex. 

 

Awareness is a step in the right direction, but there are still many people who believe painful sex just “is what it is” or don’t know where to start and get help. 

 

Here is your introductory guide to pain with sex and where to start.

 

Terminology

 

Dyspareunia- this term represents pain with vaginal penetration. Dyspareunia can be felt further in the vaginal canal, also called deep dyspareunia. You may feel pain superficially with initial insertion, called superficial dyspareunia, or maybe a bit of both. (Trahan et al., 2019)

 

Vulvodynia/vestibulitis –  Technically these are slightly different but represent pain anywhere on the vulva or in the vestibule (surrounding the vaginal opening). Besides pain to the touch with sexual activity, people living with vulvodynia may experience pain wearing tight clothing, pain with sitting, or sensitivities to certain products interacting with the vulvar area ie toilet paper.

 

Vaginismus- this can be a cause of dyspareunia, but more specifically, the first layer of pelvic floor muscles involuntarily spasm making penetration difficult or nearly impossible. 

 

If you don’t have a vagina, you can still have painful sex.

 

Chronic prostatitis/ CPPS (Chronic Pelvic Pain Syndrome) is a condition that affects individuals with a penis. CPPS encompasses a cascade of symptoms including but not limited to abdominal pain, urinary symptoms, bowel symptoms, testicular pain or penile pain which can make sex very painful.

 

This list is just a brief introduction into the world of painful sex. Painful sex also includes pain with anal penetration, pain after sexual activity, or pain during or after orgasm. 

 

Also important to note, you can experience pain from your very first sexual experience, it can be inconsistent, or just seemingly appear out of nowhere and all presentations are typically of pain with sex. 

 

What to do about it?

 

1. Find a medical provider primary care, gynecologist, urologist etc. who listens to your story and that you can rely on for support and guidance and …a script to pelvic floor PT.
2. A script is helpful but you can also come into PT via direct access (self-referral). Pelvic floor specialists have the training and tools to help you navigate your journey towards painfree enjoyable sex. 
3. If you are partnered, share with your partner. Share with a trusted friend. Seek out the support of a mental health specialist. This is NOT easy to navigate all on your own. 

 

If you’re not familiar with pelvic floor physical therapy treatment includes but is not limited to:

• Skilled external or internal pelvic floor muscle assessment depending on your tolerance
• Education about your condition
• Pelvic floor coordination training, typically relaxation training
• Hands on fascial, neural, and muscular techniques 
• A home exercise program that gives you the tools to improve at home and handle any flare ups after discharge.

 

What if you don’t have access to a pelvic PT?

 

Pelvic floor physical therapy will introduce you to tools for self management. While we recommend a full evaluation and training on using these tools, access may be an issue based on where you are living. 

 

Here are some of our favorite tools for home management. 

 

The pelvic wand

You can purchase a pelvic wand for rectal use or vaginal use or one with different ends for both. A wand can be very helpful for self stretching internally and de-sensitizing painful tissue. 

 

Intimate rose makes a great wand with all sorts of options. They also have some helpful videos on use if access to a pelvic PT is an issue.

 

https://www.intimaterose.com/collections/pelvic-wands?gclid=CjwKCAiAuOieBhAIEiwAgjCvcizIDYS0ln6ek3n5Q_G3MMVk8uq3s0ajAN6_0tkJrlheI9jixaWb1RoCqnYQAvD_BwE

 

Dilators

Dilators are devices made for gradual stretching specifically at the vaginal opening or anus depending on the goal type of penetration. 

 

Intimate rose also makes both vaginal or rectal dilators https://www.intimaterose.com/collections/vaginal-dilators. 

 

The oh Nut

 

If depth of penetration is the issue for you, the ohnut is the answer.

 

These stackable rings are made to be worn on a toy or penis and act as a comfortable buffer to limit depth of penetration. 

 

You can check out the ohnut here https://ohnut.co/. 

 

Sex should not be painful. You do not need to just accept pain or navigate this journey alone. Our pelvic health specialists have the expertise to help you. 

 

 

1. Basson R, Berman J, Burnett A, et al. Report of the International Consensus Development Conference on Female Sexual Dysfunction: definitions and classifications. J Urol. 2000;163(3):888–893.

 

1. Trahan, Jennifer SPT1; Leger, Erin SPT1; Allen, Marlena SPT1; Koebele, Rachel SPT1; Yoffe, Mary Brian SPT1; Simon, Corey DPT, PhD1; Alappattu, Meryl DPT, PhD2; Figuers, Carol PT, EdD, MS1. The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review. Journal of Women’s Health Physical Therapy 43(1):p 28-35, January/March 2019. | DOI: 10.1097/JWH.0000000000000117