3 Main Causes Of Pain With Penetrative Sex
Pain with penetration during sexual activity is something that can occur anytime during the lifespan and no matter what, you don’t have to accept painful sex as your new normal. There is so much that can be done to treat pain with penetration, so if pain during intimate activity sounds familiar to you, stop what you’re doing and call your local pelvic floor physical therapist. In most states, you can schedule at least your first visit with a physical therapist without a referral from a physician. In Texas, physical therapists can evaluate and treat their patients for 10-15 days following their initial visit before needing a physician referral.
Before you go down a rabbit hole on Dr. Google, let me save you the trouble. Here are three of the most common reasons people experience pain with penetration:
Pelvic floor muscle tension
Hormonal changes
Underlying gynecological/urological conditions such as endometriosis, interstitial cystitis, lichen sclerosus, etc.
Let’s break these down one by one.
1. Pelvic floor muscle tension
The pelvic floor muscles are the muscles at the bottom of your pelvis. The urethra, vagina and anal opening all go through these muscles. So when your pelvic floor muscles are tense and/or weak they can affect bladder, bowel and sexual function. When these muscles are tense, they are essentially closing around the vagina which can make penetration painful. Sometimes, the tension lives in the muscles closer to the opening so people just have pain with initial penetration. Sometimes it’s the deeper muscles that are tight so pain only occurs with certain positions or deeper penetration. Sometimes, it’s both the superficial and deep muscles that are tight, leading to both types of pain. A pelvic floor physical therapist can evaluate the muscles, figure out which ones are tense and teach you how to work on them at home. Click here to learn more about foam rolling to release pelvic floor muscle tension.
2. Hormonal Changes
Hormonal changes may seem like a very broad topic, but when discussing painful penetration, we’re specifically referring to hormonal changes at the vestibule, or the vaginal opening. Changes can occur due to a long history oral birth control, bodyfeeding and lactation, and/or menopause. Hormonal changes at the vestibule can cause someone to have pain with initial penetration, and can even cause tissue at the vaginal opening to feel tender to light touch, depending on severity. Your physical therapist can help determine if there is a hormonal component to your pain and may refer you to your OBGYN or Urologist for medication, such as a topical estrogen cream.
3. Underlying gynecological and urological conditions
Underlying conditions such as endometriosis, interstitial, lichen sclerosus can cause hormonal changes and contribute to pelvic floor muscle tension. It is important that your physical therapist and medical doctor collaborate as these conditions need to be treated both from a musculoskeletal and medicinal standpoint. Remember that your PT is part of your medical team!
If you’re having pain with penetration (of any kind), remember you are not alone and there is help out there for you! Contact us to learn more about how pelvic floor physical therapy can help you have better sex. We work with folks local to Austin,TX and virtually with folks all over the world!
Click here to learn 10 things we wish you were taught about sex in school.
By Dr. Jessica Chastka, PT, DPT, WCS
Jessica (she/her) earned her Bachelor’s in Exercise Science from the University of Louisiana at Monroe, while playing softball. She received a Doctorate in Physical Therapy from University of Texas Medical Branch in Galveston in August 2015. In 2019 she became Board Certified in Women’s Health, through the American Board of Physical Therapy Specialists.
For the last five years she has been working as a pelvic floor physical therapist, treating people who have pelvic pain, leakage, urgency, frequency and constipation. This includes the pregnant and postpartum population as well as people with chronic pain. She is passionate about making her patients feel heard and seen, validating those who feel that their problems are not worth mentioning because everyone has them or because embarrassed to talk about them.