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Why Women Experience Pain during Sex

by Tara Galles, MS, OTR

Melissa started having pain with sex after having her baby. At first, it was occasional and only with certain positions. The pain became more constant and impaired her ability to enjoy sexual activity.

As a nurse, Melissa did not fill either the Xanax and Valium prescriptions her provider and urologist (both male) prescribed her. I told her the issue was in her pelvis, not her head (both medications were psychotropic) and she was good candidate for therapy.

 For Melissa, her symptoms were with penetrative sex, also known as dyspareunia. However, there are many ways women have sex and experience pain with sex. Studies tell us that 3 of 4 women will experience pain with sex at some time in her life.  For some women, the pain is only a temporary problem; for others, it is a long-term problem. 

A photo of a woman on a couch obviously experiencing pelvic pain.
A photo of a woman on a couch obviously experiencing pelvic pain.

Melissa started having pain with sex after having her baby. At first, it was occasional and only with certain positions. The pain became more constant and impaired her ability to enjoy sexual activity.

As a nurse, Melissa did not fill either the Xanax and Valium prescriptions her provider and urologist (both male) prescribed her. I told her the issue was in her pelvis, not her head (both medications were psychotropic) and she was good candidate for therapy.

 For Melissa, her symptoms were with penetrative sex, also known as dyspareunia. However, there are many ways women have sex and experience pain with sex. Studies tell us that 3 of 4 women will experience pain with sex at some time in her life.  For some women, the pain is only a temporary problem; for others, it is a long-term problem. 

The quest for a cure can be frustrating and even insulting as women are often told to “just relax.” Below I’ve provided some conditions that can cause women to experience pain during sex.

INFECTIONS

Vaginal or lower urinary tract infections can cause painful sex. Symptoms may include an odor, rash, bumps, sores, or painful urination. The good news is that infections are easy to treat and if you have seen a medical provider, they have likely diagnosed and treated any infection. The bad news is that long-term infection can cause pelvic inflammatory disease (PID). However, pelvic floor therapy is effective to resolve pain from PID.

ENDOMETRIOSIS

Endometriosis occurs when endometrial tissue, that appears similar to uterine tissue, forms on the ovaries, fallopian tubes, and other areas of the abdominopelvic cavity. It affects up to 15% of women of reproductive age, and the severity of symptoms can vary greatly.

Endometriosis is typically diagnosed via an exploratory surgery and there are not many medical options for women who suffer from endometriosis. Manual abdominopelvic therapy techniques and pelvic floor therapy are effective to reduce pain symptoms from endometriosis.

CONSTIPATION

Your rectum resides right behind your vagina, they are neighbors and are supposed to stay in their own anatomical lane. When the rectum is constantly packed, it will become sore and put pressure on the vaginal wall.

Additionally, the pelvic floor muscles are typically tight when constipated because they are in a holding pattern with the anal sphincter. This is important because the pelvic floor muscles typically need to relax for more pleasurable sex.

Let’s be real, nobody wants to have sex when they are full of poop! If pain with sex is from constipation, you will need to become regular first. Constipation has multiple causes that too are treated with therapy

VAGINISMUS

Vaginal tightness, or vaginismus, is a frequently overlooked condition of vaginal tightness due to involuntary spasms of the pelvic floor muscles. There are a variety of reasons vaginismus occurs. When left untreated, vaginismus makes the use of tampons, menstrual cups, and sexual intercourse painful. Women with vaginismus can even experience pain with sexual arousal. Pelvic floor therapy is effective in the treatment of vaginismus.

PREVIOUS INJURY

A previous injury to the back, hip, or even pelvis from childbirth can cause painful sex. Women have unique reasons for back pain that can interfere with sex. Many women don’t remember being injured until their memory is jogged. These injuries can occur from a fall, car accident, past surgery, sports injury, etc. Most women are unable to pinpoint injury to an incident, and that’s okay. When pain with sex, or dyspareunia, is from injury it is typically very easily resolved with pelvic floor therapy.

HYPERTENSIVE UTERUS OR BLADDER

Your uterus is a muscle so powerful it moves bones to create a birth canal to push babies out! She is strong, and she can be mean. Uterine contractions are a natural function of sexual stimulation. Pain with sexual arousal or orgasm can be from hypertensive uterine contractions. The bladder can also be hypertensive and create pain with sex. A moist hot pack prior to sexual activity may be just the trick to calm down your uterus or bladder. If this doesn’t work, therapy can also help reduce the hypertension of the uterus and/or bladder.

DYSMENORRHEA

Nearly 85% of women report menstrual pain (cramps) or dysmenorrhea [source]. Cramps can range from a mild discomfort to severe pain that interferes with work, school, and other daily responsibilities.  One in four women report absenteeism due to menstrual pain [source]. Dysmenorrhea is essentially caused by muscular overactivity of the uterine wall, which can also aggravate hypertonic pelvic floor muscles. The muscular pain with dysmenorrhea is why some women experience cramps with exercise or bloating while not on their period. Studies confirm that pelvic floor therapy has high rates of effectiveness to help reduce menstrual pain [source].

VAGINAL DRYNESS

Vaginal dryness can be caused by multiple reasons and is not just a painful symptom of menopause. Women as young as 18 report vaginal dryness, and it’s estimated to affect 19.4% of women in their 40’s and over one-third of women in their 50’s and 60’s.  It’s estimated only 50% of women with vaginal dryness report this to their provider because they are unaware that it can be treated [source]. Vaginal dryness is best treated with estrogen therapy (often topical) combined with pelvic floor therapy.

LICHENS SCLEROSUS

Lichen sclerosis an uncommon condition that creates patchy, white skin in the genital or anal area that appears thinner than normal. This condition occurs primarily in girls who haven’t started menstruating and in postmenopausal women. Topical corticosteroid ointments or creams can reduce itching, and therapy can help reduce pain and promote normal function of the pelvic floor.

PREVIOUS ABUSE

Previous sexual abuse will cause physical dysfunction. Survivors will often say sexual activity feels like they are being cut with broken glass. Abuse sometimes creates overresponsive sensory and the motor nervous systems’ signals to the pelvic floor muscles makes them overly tight and sensitive. Sometimes the sexual trauma causes a direct vulvar injury and women are left with scars, torn labia, incontinence, and more. Again, therapy is affective in decreasing symptoms of pain and restoring function of the pelvic floor.

Sex is supposed to be a pleasurable experience, not a painful one. This is why we only write goals to resolve pain with sex, not just decrease it. Painful sex is treatable, and you can get your sex life back or on track.  

If you are experiencing pain with sex, decide to Take CONTROL!  Talk to your doctor about therapy and call us at  765.319.8420 to make your appointment today!

Patient name and details modified to protect confidentiality. Story used with permission.

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A photo headshot of Tara Galles, MS, OTR

Tara Galles, MS, OTR

Tara Galles, MS, OTR, is owner of You’re in CONTROL! With over 20 years of clinical experience she compassionately moves each woman to take CONTROL! of their body and rehabilitates them to feel like a natural woman again. As a mother of four children she also understands what it’s like to be a pelvic rehab patient. You may contact Tara about your pelvic issue at (765) 319-8420, or make an appointment using the button at the top of the page.

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