Dyspareunia & What You Can Do About It

Have you ever gone to your doctor with an embarrassing problem? Like, one that you might not tell your mother about? But one that you might tell your girlfriends about? Like a problem that you think NOBODY else would have? Like a problem like painful sex?

As women, a lot of us have experienced it, but we tend not to talk about it. Many women who experience painful sex have thoughts like, This is SUPPOSED to feel good; what is the problem? Did I do something wrong? Is my partner too big? Is it our position during sex? Are my hormone levels the problem? Worse yet, they may ask the question, Is it my fault? because somehow they were made to feel that way by their partner or caregiver, or society at large.

The situation of pain with intercourse that many women harbor is called dyspareunia, which is the clinical term for experiencing pain with attempted vaginal penetration. For some women, that means that they cannot use a tampon, and for others, they have pain that either limits vaginal intercourse, or prevents it entirely.

In fact, pain with sexual intercourse is so common that:
• 40-50% of women in the United States have experienced dyspareunia for a period of time shortly after pregnancy
• Another third or so of women have experienced pain with attempted vaginal penetration not related to pregnancy
• And 5-10% of women have experienced dyspareunia ever since their first try at vaginal intercourse.

So now that we are finally talking, what are we going to do about it? And what does Physical Therapy have to do with dyspareunia? …Well… Lots!

First and foremost, you need to tell your doctor about it, in order to make sure that no disease process or hormone issue is the problem. Your doctor will perform a few tests in order to make sure that you don’t need medical treatment. And when your health checks out, your doctor will probably refer you to physical therapy, but if they don’t, it doesn’t hurt to inquire about it.

The reason is rather simple: our pelvic floor has muscles in it, just like any other region in our body. If you don’t have something that can be treated medically, then chances are, the problem lies within the pelvic floor musculature. The medical professional best equipped to help you rehabilitate an injured or dysfunctional muscle is a physical therapist.

There are plenty of women out there who experience pain with vaginal penetration, and they think if they just relax it’ll go away…only to feel extreme disappointment when sex hurts, again and again. And there is a vicious circle accompanying the problem, whereby the muscles of the pelvic floor tense up simply by ANTICIPATING the pain. This very real mind and body connection will lead to pain every time one tries to stretch an already tight muscle. The pelvic floor is meant to stretch, and when you think about it, you realize the functions of the pelvic floor muscles include allowing for intercourse and childbirth without catastrophic consequences, for example.

We do, in fact, have conscious control over most of the muscles in our body (except for muscles in the organs, like the heart muscle for example). But it’s easier said than done. One potential reason is that the muscle is in a state of chronic spasm, meaning, it’s not going to relax simply because you want it to. The cycle of spasm needs to be broken. And this is definitely possible.

So what are you going to do about all this? How are you going to climb this mountain to reach the summit of fulfilling, intimate vaginal sex?

Well, once you have been cleared of any medically treated problem, the next step is to become aware of your body, specifically the pelvic floor muscles. Through awareness exercises and muscle re-education, you will be able to sense when your muscles are in a relaxed state versus a tense state. You will learn how to relax a tense muscle, and even how to gently stretch a tense muscle. Your physical therapist can help you with this process.

The next step is to realize that first you will tolerate penetrative intercourse BEFORE it is actually a pleasurable experience. Meaning, you might achieve vaginal intercourse before it actually feels good. That is not to say that it should hurt, because it shouldn’t. And if it does hurt, then you are not quite ready to be back in the sack, so to speak.

Finally, realize that there is a solution. You don’t need to live with this. And fixing the problem can dramatically improve the quality of your sex life, and thereby the most important of your relationships.

Michelle Landsverk is a Doctor of Physical Therapy at PT Center for Women, 3232 Ballard Road, Appleton, WI 54911. To make an appointment with Michelle call or text 920.729.2982.

PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.