Let’s talk about sex.
It feels good, it can be enjoyed alone or with company, and there are lots of different ways to make it fun. When sex hurts or is not pleasurable, it can be isolating, frustrating, and painful physically and emotionally. Some people are able to navigate changes in sexual function by finding alternate ways of staying intimate that are mutually satisfying. Others may feel strain in the relationship due to feelings of guilt, resentment, and blaming. Other still may continue to be sexually active, with one partner hiding their pain in efforts to keep their partner satisfied or because they think it is normal.
First things first: Painful sex isn’t normal. Even if it has always been painful, it doesn’t mean that it always has to be, or that it always will be. Many of our clients come to us with pain during intercourse. Sometimes, this is the symptom that brings them to our door. Other times, it may be pain, incontinence or general abdominal weakness that they are seeking treatment for, only to identify (when asked) that sex is an issue too. Different things can factor into pain during intercourse, including infection, skin conditions and hormonal changes. In some cases, the muscles, joints and soft tissue of the pelvis, hips, spine and genital region can contribute to tension and pain during sex. This can mean pain during arousal, with touch to the penis, clitoris and vulva, and/ or during penetration or orgasm. In others, the muscle system is weak or coordinating inadequately, affecting erection and ejaculation. Both men and women may experience changes in sexual function related to the musculoskeletal system and which can be successfully treated with physical therapy. So if it’s a muscle problem and Kegel exercises work the pelvic muscles, that should help, right? Well, not so fast. There are lots of things to consider when establishing a treatment plan related to pain or problems with intimacy, and pelvic physical therapy can help.
Talk about it! Physical therapists will start your first session by asking the right questions to lead them to the best exam. Finding the contributors to intimacy issues involves sharing personal information with your therapist. It can be difficult to come to a PT appointment prepared to talk about incontinence or hip pain, but another thing to talk about sex. Pelvic PT’s are skilled in talking to their patients about all aspects of sexual function, and they may ask you to share intimate things about what and where it hurts, what positions are best or worst, whether things have changed or have been different with other partners, and what your goals are related to sex. It’s important to be honest both in answering questions and in setting boundaries with your therapist related to what you feel comfortable discussing. Open communication helps to provide a comfortable environment and excellent care.
Take a look: Yes, your PT will want to perform a thorough exam to determine what may be contributing to your symptoms. And yes, that may include a vaginal and/ or rectal examination on the first day, but also includes looking at your spine, hips and pelvis as well. Taking a look at your whole body allows us to answer all of the questions we have related to your muscle system and sexual function: Do your muscles contract and relax appropriately and have adequate endurance? Can your back and hips maintain comfortable positions to remain erect, aroused and able to participate in intercourse in a way that feels good? Are your tissues gliding and sliding appropriately to allow for comfortable erection and ejaculation? Are you fearful of intimacy or avoiding sex due to previous painful experiences?
Treatment: Let’s face it- we all want the fastest way to feel better, especially when it comes to sex. Your goals are our goals, and there are different components of each plan to help you get out of our office and back in the bedroom.
Hands-Off: Exercise and movement are an important component of your treatment plan. Specific programs are tailored to the individual- some may require less resistive exercise and more breathing/ relaxation exercise in the beginning to restore movement in the pelvic and abdominal muscles. Others may benefit from an aerobic program or strength training.
Hands-On: Sometimes there may be manual techniques that are helpful for increasing joint or soft tissue mobility or decreasing pain. Some techniques may be external over the hips, spine or buttocks; others may be in the genital region, externally and/ or internally. Some of our assessment and treatment techniques require a hands-on approach. We may also use manual cues to help you learn a new movement pattern or task. Any of the manual techniques applied in the clinic may be shown to you or a partner to perform at home as part of the complete plan to meet your goals.
Home Program: Of course, it wouldn’t be physical therapy without some home work. Our goal in clinic is to further your ability to manage your symptoms by empowering you (and your partner, when appropriate) with the tools necessary for self-care from the first visit to the last. Your therapist may temporarily modify your current exercise routine in order to focus on your specific needs. Relaxation breathing, aerobic exercise, lengthening, strengthening and/ or coordination exercises and a graded, progressive start or return to sexual activity are all part of a comprehensive plan to get you on track.
Team up: Last but most importantly, we refer our patients to other specialists when there are additional factors contributing to intimacy issues. Our role as physical therapists is to treat the muscles, joints and soft tissue, and there may be times that we need additional professionals to optimize your care. Our team includes sex therapists, specialty physicians and pain management providers. We strive to collaborate with other providers and assist you in assembling your healthcare team for the best outcome.
Call us! If sex is a problem for you, you’re not alone. And you’re not destined to live with your symptoms. If you are ready to take the next step in determining what might be causing problems during sex, or if you just have some questions, schedule your 15 minute consultation today. (919) 571-9912.