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Painful Sex

Is sex more painful than pleasurable for you? It shouldn’t be and it doesn’t have to remain that way. Physical therapy can help. It seems odd, right? Most people think of physical therapy for their back or knee, but some physical therapists have special training in the pelvic region.

Our pelvis is shaped like a bowl with the bottom of the bowl having not much bony structure, but rather is covered by muscles. This group of muscles is called the pelvic floor. Physical therapists are trained in how to assess muscles, joints and movement of the body and pelvic floor therapists have extra training in the pelvic floor muscles.

For some women, and gay men, sex is painful. I haven’t met any straight men who have pain when having intercourse with a woman, but I’m sure they are out there. If you are one of them, please contact me I would love to try to help you.

female pelvic floor, looking from below

Let’s talk about female anatomy first. The female pelvis is generally wider and has two openings. A vaginal opening and an anal opening. Either could be painful. The openings are surrounded by muscles that are under voluntary control and should be able to tighten and relax, just like our bicep or quadricep or any other muscle in our body. Sometimes these muscles don’t respond as well as they should and that can be the cause of painful sex. Sometimes we hold tension in our pelvic muscles unknowingly. Some people have had trauma from giving birth or from sexual abuse and may have scar tissue that doesn’t expand and contract the way normal muscle tissue reacts. If there is scar tissue it may be pulling on other tissues and causing pain. These are a few examples of the causes of pelvic pain.

male pelvic floor, from below

As you can see male anatomy is quite similar. The male pelvis does not have a bony covering on most of the bottom of the pelvis, just like the female. The muscles are the same, just in slightly different locations. The major difference is that the openings are different, however the muscles function the same and therefore males can have the same pelvic floor pain and dysfunction that females can have.

The good news is there is help. Pelvic physical therapists can assess the pelvic floor muscles and surrounding muscles and tissues. We do this using our hands and feeling how the tissues feel at rest, if they can contract and relax properly, and how they feel after contracting. Sometimes they don’t come back to a full resting state. There are also sensors called biofeedback (meaning: information from the body) that can place a numerical or objective value on the muscles ability to contract and relax. The use of biofeedback can give us even more information how to retrain the muscles.

Once you have been evaluated by a pelvic physical therapist we can create a treatment plan for you. Every patient is different so there is not one exact protocol to follow, but guidelines. Treatment can consist of stretches and exercises for our legs and core, biofeedback training for the pelvic floor, manual therapy from the PT, meaning the PT stretches the pelvic floor tissues that are tight. Some patients need dilator therapy to help stretch their pelvic floor tissues. These are just a few examples.

The message I want you to hear is there is help. Sex should not be painful and it does not have to remain painful. Check out some of my videos in the stretching series. That is a good place to start. Come see me so we can create a plan to having more enjoyable sex, because it should be pleasurable for both partners!

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