Does sex hurt?

Lets begin with: it is not all in your head.

It is reported that 7.5% of people with vaginas will report painful intercourse to their primary caregiver across their lifespan. Pain with sex is a set of symptoms that have been traditionally under-reported as women do not feel they can report it, or when it is reported, women are not listened to. It is often linked to other symptoms such as vaginal dryness, depression, relationship challenges, previous non-volitional experiences, vulvodynia, vulvar vestibulitis, vulvar skin conditions (eg. lichens sclerosis).  It is often years between onset of symptoms to actual diagnosis. With all this complicated structure, women can feel like maybe it’s not real. It is. And it is treatable.

Treatment occurs best in a Whole Person framework where all contributing factors or influences may be considered and addressed. This is often supported by multiple disciplines.

If you have painful sex, physiotherapy is a treatment option because, while there are many factors that must all come together to allow for a positive sexual experience, one of those factors is physical. Muscles, nerves and connective tissues need to be able to accommodate to the size of whatever is going inside a vagina. These tissues need to be strong enough to provide support for erectile tissues like the clitoris for optimal excitation and climax. They need to be considered without fear or negative thoughts for their performance to be truly optimized.

Treatment of painful sex conditions always begins with a detailed conversation about your health, surgical, movement and applicable sexual history. Your goals are clearly defined and regularly referred to throughout the process.

Have you considered that sex is executed via dynamic whole body movements? No matter your partner or position, your body needs to be able to move in specific ways to allow for successful intercourse, including penetration. To this end, we may assess your whole body first, so that I may learn your Driver Profile (See What to Expect). Only then will we entertain the idea of an internal vaginal or rectal assessment to learn what your pelvic floor muscles and tissues are doing during penetration/intercourse related activities.

Usually, people with vaginas who have pain with intercourse also have pain with insertions of tampons or with having their annual pelvic exam, especially when a speculum is involved. This means when they hear that I will attempt an internal exam they are justifiably concerned, even scared, of this idea. Often the pain has been intense, and they know that going inside will hurt again. 

This concern is something I take very seriously. I do not want to activate your pain pathways. To place your experiences of penetration in their proper light, I cannot activate those pathways and be successful in treating you. I have rules about this. It’s simple. And allows you as the patient and me as the therapist to move safely through a process that is potentially aggravating, scary and challenging.

We will refer to your individual treatment plan often. If we think you need to be referred to other practitioners to support your process (such as a clinical counsellor that works in this area) I will provide recommendations when possible.

Treatment often involves relearning to use your pelvic floor muscles to allow for things to go inside in whatever body position you might choose. This can be accomplished with clinical visits where I use manual techniques and biofeedback to release and train your pelvic floor muscles, and homework with vaginal dilators. Not all people with vaginas need to use dilators so if you don’t have them, or are not sure, don’t purchase any until after our assessments are complete. I will advise you about this.

A positive sexual experience often involves more than one person. If you are involved in a relationship and wish to allow that person to be with you on this journey you are welcome to bring them to any of your appointments. I do not need to know in advance, if they are with you in the waiting room, I’ll make room for them. These people often want to be involved, often have suffered with you and as such want to find solutions with you. Most importantly, if you do need to use vaginal dilators for homework, they can be an invaluable partner in that particular homework task. I welcome partners!

Trans-men and trans-women have some special needs with regard to intercourse that are relatively common, and are often treatable.

If you suffer from painful sex, book an appointment today at North Shore Wellness Centre in the Lonsdale Corridor of North Vancouver to get on the path to wellness.