Women can experience pain in the vagina or deeper in the pelvis, during or after sex. The medical term is Dyspareunia.
What causes pain in the vagina during/after sex?
Vaginisimus – (high tone pelvic floor) is the term used for tightness in the pelvic floor muscles causing them to shut tightly when the penis tries to penetrate (superficial pelvic floor) and/or during deep penetration (deep pelvic floor). Physiotherapy treatment using a combined holistic approach can treat this issue successfully. Read below for further information.
Vulvodynia – hypersensitive to touch the vulva (outer opening of vagina, inner and outer lips)
Infection – Sexually Transmitted Infections such as Chlamydia and Gonorrhoea and other common infections such as UTI (urinary tract infection), thrush (yeast infection) and BV (bacterial vaginosis) may cause pain due to inflammation of the vaginal tissues. Your symptoms may feel like burning or itching and unusual discharge from the vagina is common. You will need to see your GP for a swab and prescription medication.
Menopause – changes in hormone levels during the menopause can make your vagina dry, making sex uncomfortable. Using lubricants can help or see your GP to discuss hormone replacement therapy.
Time of the month – at different stages of your cycle your hormones will affect your sexual desire and the amount of cervical mucus present.
Lack of sexual arousal can make your vagina dry and tight during sex. Sexual arousal produces natural secretions in the vagina creating a slippery environment and reduced friction during penetration. Stress levels, low mood, hormones or a lack of connection with your partner are some of the reasons you can feel less “in the mood”.
What causes Pain deeper in the Pelvis during Sex?
- IBS (Irritable bowel syndrome).
- Tissue trauma (surgery, childbirth, fall on coccyx, repetitive strain – dancers).
- Prolapse read more about prolapse on my blog post.
- PID (pelvic inflammatory disease).
How can we help you with pain during sex?
As with all medical conditions, finding the source of your pain helps you find a solution to your problem. Some conditions will require a GP visit or a referral to a gynaecologist. A holistic approach to treatment is the key to success. Holistic treatment means treating the whole body, looking at both physical and psychological influences.
Vaginisimus (tight pelvic floor muscles) is one of the most common causes of pain during sex. Pain is commonly experienced when the penis is being inserted (also during smear tests or even using tampons). Because some women find it difficult to relax their pelvic floor or they expect to feel pain – they often tense up when the penis/tampon is inserting.
Tightness in pelvic floor can also lead to constipation or excess straining when trying to have a bowel movement (have a poo). The pelvic floor muscles are strong and this can lead to a clamping shut of the vagina.
Assessing the pelvic floor muscles can help us to establish whether they are very tight and if you are having difficulty relaxing them. We can gently release the muscles in conjunction with relaxation exercises.
Everything is Connected – from Head to Tail!
Amazingly, the pelvic floor muscles are connected to the jaw muscles, tummy muscles and diaphragm (breathing muscles). When trying to relax the pelvic floor we must relax the jaw and enable full movement of the diaphragm through deep/relaxed breathing.
Jaw clenching (bruxism) during sleep is very common when people feel stressed. You may feel tension in your jaw in the morning or feel a lump in the inside of your cheeks – if you run the tip of your tongue around. If you are clenching your jaw at night then you most probably have a tight pelvic floor – as they are both contracting together. Therefore feeling stressed and anxious is a major cause for tight jaws and pelvic floors.
In addition, when we are stressed we tend to take shallow breaths at the top of our lungs and our diaphragm does not move properly. Small breaths cause reduced diaphragm movement and tightness in our tummy muscles – again leading to tightness in the pelvic floor. Often when women are about to have sex and are expecting to feel pain they naturally clench their jaw, hold their breath and squeeze their pelvic floor in anticipation of pain, this only makes the problem worse. We need to work on physically controlling our breathing pattern and relaxing our jaw and pelvic floor, using our brain to do so.
We also need to work on managing our stress levels and perhaps processing negative experiences such as sexual abuse. For some patients we highly recommend you see a specialist psychotherapist/counsellor in order to overcome some of your fears or past experiences. For other patients learning coping strategies for dealing with stress/anxiety is the key to successful outcomes. Meditation and regular exercise such as yoga can also be a great benefit. Patients who are open to a holistic treatment approach often achieve the best clinical results.
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