Dyspareunia, or painful sex, as it is more commonly known, is a condition that is not often talked about but is one that we see quite regularly at our pelvic physical therapy practice.
You might be saying, “What the heck is that?”
Dyspareunia is actually a pretty common condition. One in five women will suffer from painful sex at some point in their lives. The sad thing is that many women suffer with it needlessly for months or even years. Even when they bring up the issue with their doctor, they are often given the awful advice of “Just relax” or “Drink some wine.” This simply is not acceptable!
Painful sex can take many different forms. Pain can be present at initial entry, with deep penetration, only with certain positions, or even after the act. The pain can be diffuse around the pelvic area or very focal in one spot in the vagina.
A common but often overlooked cause of painful sex can be the pelvic floor muscles. The pelvic floor muscles are a bowl of muscles that go from the pubic bone to the tailbone. They are muscles just like any other muscles in the body, and they need to be able to contract, relax, and stretch. The pelvic floor muscles help support the pelvic organs, keep pee and poop in until it is time to go, and are involved in sexual function. If the pelvic floor muscles do not have enough flexibility or are spasmed with a lot of tightness, then that can cause pain with sex.
There are many reasons why a person might develop pelvic floor issues and subsequent pain with sex. Some common ones are:
- prior pelvic surgeries
- childbirth injuries
- scarring
Other culprits include:
- pelvic infections
- pelvic inflammation
- postural dysfunctions
Many people do not realize it, but stress and chronic holding patterns like butt-clenching or constantly doing a Kegel, can also contribute to muscle dysfunction and potentially pain with sex. Another potential cause for painful sex can be hormonal changes and/or menopause. This can cause vaginal dryness and tissue irritation that can lead to pain.
If all of this is sounding all too familiar to you, first, let me reassure you that you are not alone. At our practice, we work every day with women dealing with painful sex. There is help, and it is often much simpler than you think. Partnering with a pelvic physical therapist can be the first step to a pain-free, enjoyable sex life. A pelvic physical therapist can help by guiding you through breathing exercises, stretching, performing massage, teaching pelvic floor relaxation techniques, and educating on pain, posture, and returning to sex that is pain-free and pleasurable.
Dr. Brooke Kalisiak, PT, DPT, WCS is a Board Certified Women’s Health Physical Therapist and owner of Legacy Physical Therapy. She opened Legacy Physical Therapy in January 2009 in St. Louis, Missouri to offer specialized pelvic rehabilitation services to the public. She has a passion for helping women and men enjoy healthy active lifestyles, restoring dignity and confidence in bladder, bowel, pelvic and sexual function without relying on pain medicines or surgery. Her mission is to educate the public about the importance of pelvic health. 
