Painful Sex? How Physiotherapy Can Help

physiotherapy for painful sex

Vaginismus is a condition in which the muscles at the entrance to the vagina involuntarily tighten or spasm, making sexual intercourse and other forms of vaginal penetration painful or impossible. The vaginal entrance can feel blocked and partners can describe a ‘wall’ of resistance. Insertion of a speculum for a medical exam or pap test, or even a finger or a tampon might not be possible. 

There is likely to be a stinging, burning, or sharp pain in the perineal area.

What Causes Vaginismus? 

Vaginismus is now called Genito-pelvic pain/penetration disorder (GPP-PD). This newer diagnostic label is given if vaginal penetration is difficult due one or more of pain, muscle spasm, or fear.

Vaginismus can be triggered by a number of factors, including skin irritation, fear of damage or injury, anxiety concerning body image or performance, past trauma, having grown up with a belief that sex is going to be painful, or having been told that sex is sinful or dirty. 

Women with vaginismus can get stuck in a loop of fear and pain. A painful sexual encounter can create a memory of pain, which can set up an expectation and a fear of pain with the next attempt at intercourse. The anticipation of pain causes a subconscious protective pelvic floor muscle clenching response, and of course the clenching makes the next encounter painful, and penetration or insertion may become impossible. 

As the cycle continues, the woman loses confidence, starts to avoid sex, and loses her desire. Larger fears can take hold, like the fear that a partner might leave, the fear that she won’t be able to conceive, or the fear that there is a serious disorder inside. Anxiety never helps sexual performance, as the body is now effectively operating in ‘fight or flight’ mode. 

Fight or flight mode actually diverts blood flow from the internal organs to the muscles and skin of the arms and legs, to prepare an individual for escape- e.g., running, or for defence, e.g. punching or kicking. In doing so, blood flow to the pelvis is reduced. 

In preparation for sexual activity, it is very important to have adequate blood flow to the pelvis. Female erectile tissue lines the entrance to the vagina, and when this tissue is engorged, it provides softness and padding around the entrance. Increased blood flow to the vaginal walls provides the lubrication necessary for reduced friction. There are 2 glands at the entrance to the vagina which help moisten the vulva and outer vagina and they require good blood flow to function properly. During sexual arousal, increased blood flow to the vaginal walls allows the vagina to elongate, and this lifts the cervix (the entrance to the womb) up out of the way, making penetration more comfortable. 

And of course, for a satisfactory sexual experience, the clitoris needs to engorge with blood too, in a similar way to the male penis.

Physiotherapy for Painful Sex

Pelvic health physical therapists are trained to work with individuals experiencing vaginismus and other sexual health concerns. Our therapists are careful to create a safe, non-judgmental space for you to discuss your concerns and experiences. We work to really understand your situation, helping you to feel comfortable and supported throughout the treatment process.

The therapists at Penrith Pelvic Floor Physiotherapy use a combination of techniques, including education, relaxation exercises, and gradual gentle stretching of the vaginal muscles, to help you overcome the condition.

Dilators are just one tool used in women’s health physiotherapy to help treat GPP-PD and painful intercourse. Dilators are small, cylindrical objects that come in various sizes and are designed to be inserted into the vagina. They can help stretch the muscles and tissues of the pelvic floor, and gradually increase the size of the vaginal opening. Women’s health physiotherapists can teach patients how to use dilators safely and effectively, and provide guidance on how to progress to larger sizes over time. Note they are not appropriate for all women, and your therapist will have a discussion with you regarding their use so you can decide if this is appropriate for you.

In addition to addressing the physical symptoms of vaginismus, our pelvic health physiotherapists also work to address the emotional and psychological factors that may be contributing to your condition. This may include helping you to identify and address any underlying fears or anxieties, helping you to build healthy communication and intimacy skills, or referral to a sex therapist.

Consult a Pelvic Health Physiotherapist Today

With guidance and support, you can learn to manage and overcome this condition, for improved quality of life and a better relationship! Book in with one of our pelvic health physiotherapists today.

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