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Is it normal to have pain with sex? It's Not just about Lube!

The answer to this question is no! One in 7 women experience pelvic pain of some kind. Pelvic pain is considered any pain from the belly button to the inner thighs. This pain can occur in sitting, walking, urinating, relieving the bowels, sex, gynecological exams or any activity in between! Pain is an important indicator of what is going on in your body, like an alarm signal! Pain is helpful as it alerts us when an area needs protection or is healing, however vaginal, pelvic, and rectal pain interfering with life does not have to be your normal!

Pelvic pain, regardless of pain in the bedroom or outside of the bedroom, may manifest as minimal discomfort or stabbing pain anywhere throughout your vagina, rectum, tailbone, sits bones, hips, or groin. Or perhaps it expresses itself as difficulty with bowel movements and urination, urgency, frequency. Any sensation you experience as “not normal” in your pelvis is valid! Read on to understand the messages your body is sharing!

What a pain in the vag!

There are different types of pelvic pain people experience, but today we are discussing pain specific to intimacy and sex. Pelvic pain may not occur only during intercourse, but also with the use of a speculum during a gynecological exam, using tampons or cups, foreplay with fingers, toys or oral stimulation. Whether intercourse or tampons, the quality of pain can help you and your practitioner to distinguish what pelvic muscles, organs and tissue could be causing the pain. The medical term many women hear related to pelvic pain with penetration is dyspareunia or vaginismus. Vaginismus is the medical term for spasms or a quick tightening of the pelvic muscles limiting vaginal insertion of a tampon, penis or speculum. Dyspareunia is the term for pelvic pain with intercourse.

If you experience burning or stinging pain with any kind of insertion into the vagina this pain indicates that the external muscles, the muscles closest to your underwear, are involved. These superficial muscles are the sphincter muscles which allow the vaginal opening to close and open. Think of these muscles as the gatekeepers to the inner pelvis.

The deeper pelvic floor muscles can also be affected. Deep pelvic muscular pain is considered more of a deep ache, similar to a bruise sensation. Some women also report sex feels like hitting a wall or not having enough space to allow their partner to move with penetration. The deep pelvic muscles support our organs, control the bowels and hold the pelvic bones together.

Still others do not pain in the vagina, but have tailbone pain. Tailbone pain, known as coccydynia, counts as pelvic pain as well. As an anchor for the pelvic muscles, the tailbone also needs to gently adjust to movements of the pelvis, pelvic organs and partners during sex.

Why do I have pelvic pain?

1. Hormonal changes. Your postpartum body is dealing with drastic hormonal changes due to pregnancy or breastfeeding. The drop in estrogen changes your brain’s perception of pain, sometimes making pain thresholds lower. It also affects the muscles’ ability to contract and relax, making it more difficult for your muscles to stretch with penetration, either partner or tampon/cup use.

2. Birth trauma affects the quality of the entire pelvic bowl, including muscles, nerves and skin tissue which can contribute to pain. If you experienced perineal tearing, use of forceps or vacuum, an episiotomy, or a Cesarean section during birth, the healing of your tissue can be affected. Muscles and tissues heal within 6-12 weeks after injury, but the ability for the tissue to move, stretch and contract is not as mobile as before.

3. Brain communication. The intense pressure and stretching of the abdomen and pelvic muscles, during pregnancy and as the baby moves down the birth canal, changes the physics of the pelvis and the brain’s awareness of how to control the muscles as they are elongating and shifting the body’s posture. This change in posture and the muscular ability to contract and relax decreases the brain’s ability to react with quick timing and appropriate force of muscular tension to keep the body moving happily.

4. A combination of factors. Because our reproduction system is so close to the muscles of our pelvic floor, our gynecological health is a factor to pain during and after pregnancy and childbirth. A history of endometriosis, PCOS or chronic yeast infection which may have caused minor to moderate pain prior to the baby can flare up after your body goes through such a major shift. For instance, a patient may have had endometriosis, followed by a laparoscopy, infertility treatments, and finally constipation with pregnancy. These factors add up and can be a culprit for pain during and after pregnancy.

It’s been 6 weeks since baby. I’ve been cleared by the OBGYN

Women are given clearance to return to sex after seeing the gynecologist around six weeks at the 4-6 week post partum visit. Many gynecologists say, “OK, you’re looking good, everything is normal. You’re healed.”

The “OK” given as clearance by your OBGYN means there is no infection, any pelvic tears are now closed, and the uterus is moving gracefully to home in the pelvis. However, that doesn’t mean that the tissue is contracting and relaxing normally. Pain with sex, vaginal dryness, and poor satisfaction with sex usually happen alongside other struggles, like leakage and constipation. It’s critical to get pain checked out. Pain is not just an uncomfortable feeling; it’s an alarm system that lets you know what the nerves and your muscles in your body are doing.

I always joke about how happy French women always seem to be, so glamorous and relaxed. I believe that one reason they experience such success is pelvic therapy is a normal part of postpartum rehabilitation. Many postpartum women see a pelvic therapist six to eight times after having a baby to encourage optimal pelvic health. Sometimes in the US, we receive dismissive, trite replies from professionals: “You’ll get over it. Just use more lube, have a glass of wine. It’s fine; You just had a baby.” Advocate for your pelvic floor and find a pelvic therapist who will help you restore and revive this area of your body so you can get back to expressing yourself in the most beautiful, sensual way!

Find a Pelvic Fairy Godmother aka Pelvic Physical Therapist

Pelvic pain is alarming and many people question if it is more serious, like cancer, a cyst, but in reality, most instances of pelvic pain are related to musculoskeletal issues. Remember the pelvic floor muscles are just like any other muscle in the body. The muscles can contract, relax and stretch. When pelvic pain occurs, the pelvic floor muscles have become tense and are protective of the body. Pelvic physical therapy encourages the muscles and surrounding tissue, including the skin and organs to move, stretch, slide and glide to function in a happy way!

There are so many aspects of life that can also be affected by pain, from sitting to standing to exercise. Pain can be accompanied by other symptoms, such as loss of appetite, difficulty sleeping, constipation, bladder problems, back and hip pain, and depression and anxiety. It’s so important to take care of every part of your pelvis so that ultimately your sex life and every other part of your life can feel full and beautiful, and you can move forward confidently. Your pelvic muscles may need a little TLC... and there’s nothing wrong with that.

If you’re fearful about getting back to sex or have any pain, whether before pregnancy, after having a baby, or post-menopause, reach out to Dr. Amanda at Breathe Life PT, who provides skilled care with one-on-one support to help you create an active, comfortable and confident sex life!

Interested in learning more about your post-partum body? Check out my “Is this Normal? -Post Partum Workshop.”

In the South Jersey area and want one on one care with Dr. Amanda? Schedule an appointment for your complimentary 15 min phone call to see how pelvic therapy can help you!

Dr. Amanda Heritage, PT, DPT is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She has been practicing physical therapy for 9 years with a strong focus on pelvic health. She enjoys encouraging women and men about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.

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