What Causes Pain With Intercourse? And What Can You Do About It?

Making love should be a pleasant experience, but many females quietly endure physical pain with intercourse.

Research suggests that painful intercourse, or dyspareunia, may affect two in 10 American women at some point in their lives. Other studies put the number as high as 74%. It’s safe to deduce that a substantial number of women in North Carolina may experience pain during sex.

And over time, sexual discomfort touches not just the affected female but also her relationship with her intimate partner.

Here are some causes of discomfort during intimacy:

• Scarring from an episiotomy, C-section, or tear during childbirth. These conditions are relatively easy to treat by releasing scar tissue to eliminate the pain a woman feels upon penetration.
• Tight hips or tense lower back muscles. These muscles are closely tied to the pelvic floor and, under tension, can trigger pelvic floor pain with intercourse. A woman with pain in the hips or back may reflexively “protect” her pelvic area as intercourse begins. Physical therapy can sometimes start to relieve this issue quickly.
• Hormonal changes. Vaginal dryness or atrophy of the pelvic floor muscles can be the root cause of pain with intercourse. A patient’s gynecologist can evaluate her hormone levels to see if hormone replacement therapy is a good solution.
• The nervous system. Nerves may play a role in our perception of pelvic pain or pain with intercourse. For example, a patient who previously had painful, unlubricated sex may retain that memory. If the brain perceives sex as a threat, subsequent rounds of intercourse may trigger the nervous system to place the body in protective mode.
• A history of trauma, such as sexual assault or a problematic childbirth.
• Uncomfortable abdominal conditions such as ovarian cysts, gallbladder pain, diverticulitis, irritable bowel syndrome, or Crohn’s disease.

A Personal, Judgment-Free Discussion

Many women feel embarrassed or uncomfortable discussing the very personal issue of painful sex with their doctor. Signature Healthcare’s top priority is referring you to a pelvic floor physical therapist who makes you feel heard and safe.

For example, at my practice, Pin Point Physical Therapy, when you come to us for an evaluation:

• Without judgment, your physical therapist asks some very private questions that are essential to your care, gathering information about your hormones, sexual history, pelvic floor, and experience with leakage or constipation. You may, of course, decline to answer any topic you’d rather not discuss.
• Your physical therapist conducts an exam to evaluate your standing posture, range of motion in your lower back and hips, how well you contract your core muscles, and how you breathe.
• Your physical therapist also conducts an internal exam to differentiate between pelvic muscle tightness and inherent muscle weakness. Before the exam, they discuss with you why it’s vital in treating your pain with intercourse. A nervous patient may hold tension in the pelvic floor, which can make it difficult to conduct a successful muscle test. And some patients (for example, those who’ve experienced sexual trauma in the past) may not be immediately comfortable with the internal.

We want you to feel safe. You’re always in charge of your body and can withdraw your consent at any time during your physical therapy consultation or treatment.

Finding Relief From Pain With Intercourse

As your physical therapist helps you explore what causes pain during sex, they assess your pelvic stability, how you activate your core, and how strong or mobile your hips are. Then they show you how to lengthen and relax the pelvic muscles. They can familiarize you (and your partner) with useful lengthening and stretching tools to try out at home.

Patients often find relief when we have them combine coordinated breathing exercises with manual stretching in beneficial postures like “child’s pose” and “happy baby.”

Physical therapists can also introduce you to exercises that help regulate both your nervous system and breathing. For example, by using your hands to lightly rub and stimulate the vagus nerve at the side of the neck, you can tap into the parasympathetic nervous system to relieve pre-intercourse anxiety (or other tense situations as well).

If we find you require attention outside the practice’s scope — for instance, to discuss hormone replacement, get relationship counseling, or process a past trauma — we’re happy to refer you to a specialist in that discipline.

Involve Your Partner

Many women find it difficult to tell a partner that sex is painful or to point out when discomfort occurs. It’s vital to open that line of communication.

Making intercourse pleasurable rather than painful should be a team effort between you and your sexual partner. Patients are encouraged to share with their partner the importance of foreplay and lubrication before sex to enable comfort and enjoyment.

Your partner can also come to us with questions and to gain insight into anatomy, potential causes of pain, and helpful positioning or manual techniques. (Sometimes even changing the angle of a pillow can make intercourse more comfortable.)

Pain With Intercourse? Ask for the Help You Deserve

If you’re wondering what causes pain during sex, don’t wonder in silence. Request professional help! Discuss your discomfort with your primary care doctor, pelvic floor physical therapist, or gynecologist.

Intercourse doesn’t have to hurt because you had a baby, suffered torn tissue, or underwent sexual trauma in the past. Pain during sex can often be remedied quickly.

(And avoid social media pundits who tell you to “just drink a glass of wine and relax.” Self-medicating masks the issue.)

Consider Signature Healthcare your trusted advisor. They’re here to relax you, restore you, and relieve your pain. Contact us for help.