Updated: Apr 26
By Alyssa Brunt, MScPT, BScKIN (HON)
Love making. Shagging. Dancing in the sheets. Getting it on. Fornicating. There are many ways to say it but whatever you call it, let’s talk about SEX.
Let’s be honest, sex isn’t something that we generally talk about over coffee during Monday morning Zoom meetings. Some of us even find it hard to talk about with our closest friends. Even buying condoms at the drug store is nerve-racking! Sometimes I think the salesperson is going to tell my parents or make an announcement on the PA system that a young woman with sweaty palms and flushed cheeks is having sex. But then I realize that I’m 28 years old and last time I checked, buying a pack of condoms wasn’t illegal and sex was human nature.
It’s funny though, we hardly talk about sex yet we think about it all the time. We’re wired to think about having a pants-off party with that certain someone. Take it from Woody Allen who said, “sex is the most fun you can have without laughing.” Wrestling underneath the sheets with that special someone involves intimacy, pleasure, and a sense of connection that keeps us coming back for more. But sometimes, it’s not always that easy. Sometimes, sex can hurt. And when sex hurts, it’s usually the last thing we want to talk about.
How Common is it?
In my practice, I see a lot of women who experience pain with intercourse. Young women, menopausal women, postpartum and breastfeeding mothers can all experience pain with intercourse. Let’s hear it once again for the ladies in the back. Yes, women who HAVEN’T had children can also experience painful intercourse! Here’s some food for thought:
Up to 20% of women in North America experience painful sex
62% of women experience painful intercourse in the first 3 months postpartum
Grade 2 tearing during labour increases the likelihood of having pain with sex by 80%
Women who deliver by C-section are 2x more likely to report painful intercourse at 18 months postpartum as compared to vaginal births
So, are we just doomed to a life of lackluster sex? Absolutely not! There are many reasons why sex can be painful but rest assured, a little bit of work can help make your kitty purr again.
Where Do We Feel the Pain?
The medical name for pain with intercourse is dyspareunia. It can be experienced throughout someone’s entire life (primary dyspareunia) or can occur in someone who’s previously had pain free intercourse but later becomes painful (secondary dyspareunia). The pain can range from throbbing and aching to pinching and stinging and can be felt:
With deep penetration/thrusting
With all types of penetration (tampons, toys, etc)
In certain positions
During or after orgasm
What Causes Pain with Sex?
There are many causes of pain with sex. They can be physical/biological, psychological and/or sociological in nature and can include:
Pelvic floor muscle tightness/tension
Tenderness along the vaginal wall
Weakness in the pelvic floor muscles
Pudendal nerve irritation/compression
Connective tissue dysfunction
Scar tissue build up
Stress, anxiety, depression
History of sexual or physical abuse
Thinning vaginal tissues causing micro-tearing
Postpartum Pain with Sex
Pain with intercourse is especially common after giving birth. For the first 6 weeks postpartum, sex should be avoided to ensure the tissue inside the pelvis can heal completely. I mean, come on, you just birthed a baby! Even when the outside of the body feels okay, the inside of the body can still be healing. However, after the perineum has healed following those initial 6 weeks, women can still experience pain with intercourse. Episiotomy, natural tearing, C-sections and difficult deliveries increase the likelihood of pain with intercourse postpartum. Scar tissue develops underneath incision sites resulting in tissue type changes, decreased tissue mobility, hypersensitive tissues, muscle tightness and more. Over stretching and chronic muscle fatigue from lengthy labours and obstetric trauma can also cause muscle tension, bruising, and micro tears.
Pain Post Menopause
During and after menopause, women can also experience pain with intercourse due to hormonal changes in the body. Vaginal dryness, tissue fragility and decreased vaginal wall muscle tone can occur post menopause because of the big drop in estrogen. These changes can also be seen in postpartum and breastfeeding mothers as they too experience hormonal changes. As a result, women can experience mild bleeding, pain, and decreased libido during hanky panky time.
Here’s the even bigger kicker. The longer we let pain (in any circumstance) go untreated, the more we perpetuate this viscous pain cycle. Think about this: You have a new partner and you notice that when you have sex, the initial insertion is pinchy and painful. You don’t think much of it because it’s fine once it’s in a bit deeper. But then it happens a second time. And a third time. And a fourth time. Now you just know it’s going to happen. Your body and muscles begin to tense up before insertion causing the pain to worsen. You begin to brace your body and always wait for the pain to happen each time you have sex. We anticipate the pain, our body reacts, and we experience the pain. Every. Single. Time. And now sex isn’t enjoyable. It’s painful and we don’t really look forward to it. Now that ladies, is not normal sexually functioning. That’s what we call, a learned pain experience and it’s very important that we break that cycle.
What Can We Do?
Pelvic physiotherapists have specialized training in treating pain with intercourse and can get straight to work on restoring balance to the body. They can help stretch and relax muscle tissue, break down scar tissue with manual therapy techniques, and teach you exercises for relaxation before and during intercourse. Pelvic physiotherapists can also provide information on lubricants and moisturizers as well as positioning and breathing techniques to increase lubrication and get your muscles to a normal resting tone.
So if you’re reading this and thinking this sounds a lot like you, start with this- breathing. Breathe big, deep breaths regularly during the day to relax muscle tension and calm your nervous system. Pay attention to your pain. Is it in certain positions or only on insertion? If you’re not comfortable talking about it to your friends, partner or family doctor, then come talk to me! After an initial assessment and physical exam, pelvic physiotherapists can develop an individualized program based on your body and muscles. As someone who personally experienced pain with intercourse, I know what it’s like to feel completely uneducated about your own body. But let’s make sex feel great again. You deserve to feel good. You deserve to have fun. And you deserve to get jiggy with it in any way that you like, without pain.
If you are experiencing any of these symptoms and would like more information, book an appointment or consultation with Alyssa today at Darou Wellness. Virtual options available!
DUFOUR, SINEAD. PREGNANCY AND THE PELVIC FLOOR. PELVIC HEALTH SOLUTIONS, 2019
Image source from here
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