As a pelvic floor physical therapist, I treat women of all ages who are dealing with dyspareunia, or pain with intercourse. Dyspareunia is what I call an umbrella term, which means it is very general and doesn’t tell us why a woman is having pain. There are many diagnoses which fall under the category of dyspareunia. One common cause of pain with intercourse that I see is overactive pelvic floor muscles. The pelvic floor muscles are a group of muscles that run from the pubic bone to the tailbone. They have several functions including: Supporting your organs, keeping you continent and sexual appreciation. These muscles form a ring around the vaginal opening and surround the vaginal canal deep inside, so if they are overactive they can contribute to pain. This pain is often described as sharp and burning or sometimes a deep, aching pain. Some women report it feels like there is a barrier at their vaginal opening that prevents their partner from penetrating.
Treatment for pain with intercourse involves manual therapy to decrease muscle tension, instruction in stretching to lengthen short muscles and training in relaxation of the pelvic floor muscles.
In my practice I also find that dilators combined with manual therapy can be very beneficial in decreasing pain with intercourse. Dilators are a medical device that can be used to help “dilate” or expand the vaginal opening. Patients are taught during their physical therapy appointments how to relax their pelvic floor muscles and use dilators at home to practice relaxing these muscles while inserting something vaginally. Typically women start with a small size and gradually work up to a dilator that is comparable or slightly larger than the size of their partner.
I encourage all women who are having pain with intercourse to have an evaluation by a pelvic floor physical therapist to address any muscle over activity. Physical therapy and a dilator program really work best together. In the past I had two women that I started treating the same week who had pain with intercourse. Their histories were very similar. One patient came weekly for physical therapy for eight weeks, then every other week for two visits. At the end of the three months she was having intercourse without pain. The other patient came weekly for two weeks then decided to work on her dilator program on her own at home and stopped coming to physical therapy. When I followed up with her three months later, she was still using the same dilator size as when she stopped coming to see me and had made no progress. Having a physical therapist who can guide you through any issues that may come up when using your dilator and treat your muscles is extremely valuable and in my experience gets women better faster.
Often overactive muscles are at least a contributing factor to pain with intercourse if not the cause. If you have pain with intercourse, please talk to your doctor about getting a referral to see a pelvic floor physical therapist.