Understanding Pelvic Pain DuringIntercourse: A Pelvic Physiotherapist’sGuide

Author: Celina

Pelvic pain during sex is a common but treatable issue that affects many individuals. Whether it’s discomfort with initial penetration, deeper pain, or post-coital soreness, the underlying cause often stems from the pelvic floor muscles. Let’s explore what could be causing this pain, and how pelvic physiotherapy can help.

Is Pelvic Pain During Intercourse Normal?

Pain during intercourse, medically known as dyspareunia, is not something that should be accepted as a normal part of life. Many people, particularly women, experience this discomfort, but it is often overlooked or under-discussed. If sex is causing pain, it’s your body signaling that something isn’t right, and it deserves attention.

What Causes Pelvic Pain During Sex?

There are multiple reasons for pain during intercourse, ranging from muscle tension to hormonal changes and underlying health conditions. Here are some of the most common causes:

1. Pelvic Floor Muscle Dysfunction

The pelvic floor muscles form a sling that supports the bladder, uterus, and rectum. These muscles can become too tight, tense, or weak, leading to pain during sex. Muscle overactivity can cause a feeling of hitting a "wall" during penetration, discomfort in certain sexual positions, and even pain during orgasm. Tight muscles can also lead to spasms, which make sex uncomfortable and limit pleasure.

2. Postpartum Recovery

After childbirth, the pelvic floor may need time to heal from the physical strain of delivery. Scars from perineal tears, episiotomies, or cesarean sections can also contribute to discomfort during intercourse. Even after receiving the medical “all-clear” at six weeks postpartum, many new mothers may still experience pelvic floor pain, often related to overactive muscles or scar tissue.

3. Hormonal Changes

Hormonal fluctuations, especially during menopause or breastfeeding, can lead to vaginal dryness and thinning of the vaginal walls. This lack of lubrication and flexibility can cause a burning or raw sensation during intercourse, often resulting in pain and discomfort. Decreased estrogen levels are the primary culprit, but contraceptives and certain medical conditions can also affect vaginal health.

4. Underlying Medical Conditions

Pelvic pain during sex can sometimes be linked to medical conditions such as:

• Endometriosis

• Vulvodynia (chronic pain in the vulvar region)

• Uterine fibroids

• Vaginal infections (such as bacterial vaginosis or yeast infections)

These conditions need a medical diagnosis, but even after treating the underlying cause, pelvic floor tension can persist. That’s where pelvic physiotherapy comes in to help.

How Can Pelvic Physiotherapy Help?

Pelvic physiotherapy is highly effective in treating pain during intercourse. Here are some approaches a pelvic physio might use:

1. Pelvic Floor Muscle Relaxation Techniques

Pelvic floor muscles that are too tight can be manually released through internal or external techniques. Your physiotherapist can teach you how to relax these muscles, making sex more comfortable and reducing pain.

2. Breathing and Relaxation Exercises

Learning to coordinate your breathing with pelvic floor relaxation is a simple but powerful tool. Diaphragmatic breathing, for example, helps to relax both the pelvic floor and abdominal muscles, reducing overall muscle tension. This can make a big difference during intercourse.

3. Scar Tissue Management

If scar tissue is causing pain, your physiotherapist can help mobilise and reduce tension in the area, improving tissue flexibility and decreasing discomfort. This is especially helpful for postpartum individuals who may have perineal scars or cesarean scars.

4. Pelvic Floor Strengthening

If muscle weakness is contributing to your discomfort, strengthening exercises may be introduced. However, the focus will typically be on relaxation first, especially if the muscles are overactive. Once balance is restored, targeted exercises can help improve muscle control and reduce pain.

Tips for Managing Pelvic Pain During Intercourse

Here are some simple strategies that can complement physiotherapy and make sex more comfortable:

• Use plenty of lubrication. This is especially important if hormonal changes are affecting your body’s natural lubrication.

• Experiment with different positions. Some positions may put less strain on the pelvic floor muscles, allowing for more comfort. Side-lying or positions where you have more control over depth and pace can be helpful.

• Practice diaphragmatic breathing. This technique calms the nervous system and promotes relaxation of the pelvic floor muscles. Try practicing this daily or right before intercourse.

• Consider using vaginal dilators. These tools help gradually stretch the vaginal tissues and relax the muscles over time.

When to Seek Help

If you’re experiencing persistent pelvic pain during intercourse, don’t wait to seek help. Pelvic pain is treatable, and with the right guidance from a pelvic physiotherapist, you can regain comfort and confidence in your sex life. Remember, sex should be a pleasurable and pain-free experience!