From Pain to Pleasure
With Valentine’s Day (and a certain movie premiere) around the corner, it seems like innuendo is everywhere. It’s hard to avoid thinking about sex! For many women with pelvic pain, an already painful experience can be even more isolating on the year’s most celebrated day of intimacy. Sexual pain is not normal and is not something you need to ‘just live with.’ Women of all ages can experience painful intercourse.
Whether you are unable to have intercourse with your first sexual partner, or whether you are experiencing pain for the first time after childbirth, menopause, or surgery you are not alone. Prevalence varies and is estimated to affect 8-22% of women during their lifetime, and a recent study in BJOG found that more than 85% of Australian women experience painful intercourse after delivery. So if you are finding yourself dreading Valentine’s day, there may be help to get you back to pleasurable and pain-free sex! If you have pain, it’s important to see your doctor or pelvic health physical therapist- treatment varies based on your symptoms. The following tips may get you started on the road to recovery.
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Lube: It’s okay to need a little extra help! There are lots of commercial lubricants on the market and it’s easy to become overwhelmed by all of the options. Astroglide and Slippery Stuff, or the oil-based natural lubes above get good patient reviews. If you like to actually test the slip and feel of the lubricants and are in the Triangle, check out Frisky Business- they have sample bottles of many of their lubes, and their staff is knowledgeable and used to assisting our patients. One caveat: Avoid any lube or enhancers labeled as ‘warming’ or ‘tingling.’ Let’s just say that nobody needs that kind of heat on her vulva. Try a warm bath instead.
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Skin care: Lubricant can help but you need to keep your skin and vulva healthy too. If your vulva gets dry or irritated, penetration, thrusting and even gentle touch can become painful. Dryness can occur due to hormonal changes, during breast feeding or menopause. Aggressive cleansing can also dry vulvar tissues (see this excellent blog post by Sara Sauder on the Pelvic Guru site for more on taking care of your vulva). Much like lip balm works for your mouth, oils or natural balms can improve the skin’s moisture and make sex more comfortable. Crisco, coconut oil and olive oil are examples of natural moisturizers.
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Breathing: Believe it or not, your pelvic muscles and diaphragm work together. On top of that, diaphragmatic breathing can help to quiet your body when you are anxious or nervous. If you have painful intercourse, you’ve probably tried to tell yourself to relax with varying degrees of success. Sometimes breathing can be helpful to quiet down your nervous system and help keep you in the moment rather than panic mode. Find a comfortable position, either in a recliner, the bathtub, or in bed with your knees and head supported comfortably. Take some gentle breaths in through the nose, allowing the abdomen and ribs to expand, and exhale through the mouth. Practice this daily for 10 minutes and take 1-2 focused breaths every 1-2 hours during the day. Need some help? The Breathe2Relax app can be useful when getting started.
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Dilators: Pelvic muscles that are shortened or unable to relax may contribute to painful sex during initial penetration and deep thrusting. We’re more likely to avoid activities that repeatedly cause pain, so it’s not surprising that many of our patients avoid sex altogether. In some cases, all intimacy is avoided as well. Your pelvic PT may recommend dilators as part of your home program based on your needs. Dilators are tapered plastic or silicone devices and are available in a range of sizes from small (finger) to large (penis) and can be useful in retraining the mind- body connection to your pelvic muscles. It’s important to listen to your body and remain mindful while using dilators, rather than just trying to insert them regardless of how it feels. If you’ve used these and haven’t been successful, your pelvic PT can likely guide you and make sure you are on the right track. Sometimes you have to work on getting comfortable with touching your vulva before trying to insert a dilator- it’s all individualized, and there’s no ‘benchmark’ for how fast you need to progress. Physical therapist Tracy Sher in Orlando has created an excellent dilator guide with helpful information. It’s not a substitute for an examination by a pelvic PT but may be a helpful place to get started or re-start if you have tried this in the past.
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Assemble your team: Putting the pieces together sometimes requires help. You may already be working with your OB-GYN, urologist or family doctor on resolving your symptoms. Sex therapists can be instrumental in resolving contributing issues individually and with couples. Physical therapists with experience treating sexual pain are experts at identifying and treating musculoskeletal contributors. Pelvic PTs are often well-connected to other medical professionals and can assist with referring you to providers base on your needs.
Painful sex may be common but it doesn’t have to be your norm. If you are having pain during intimacy, you are not alone and there is help! Contact us or your local pelvic PT to schedule an examination and reclaim your sex life. For added reference, check out the following books- they are great resources for women written by experts in the field!
Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve–Heather Jeffcoat
Reviving your sex life after childbirth– Kathe Wallace
Wanting Sex Again– Laurie Watson, Awakenings Center for Intimacy and Sexuality