How Pelvic Floor Dysfunction Can Cause Painful Sex (Dyspareunia)

Dyspareunia refers to pain before, during, or after sex. It can happen to anyone, no matter your genitals or gender identity—though it is more common for those with a vagina. It can occur at any point in a person’s life, even after experiences of painless sex. 

Although this condition is very common, many hesitate to seek professional care due to embarrassment or shame. No one should feel shame for experiencing dysfunction or seeking better sexual health! It is just as important as any other form of health, and no one should feel like they have to live with their pain. 

It is important to note that dyspareunia may seem purely physical, but it is also very interconnected with mental health. It can be stressful, anxiety-inducing, and detrimental to one’s confidence. Never diminish your health concerns! Sexual dysfunctions are very treatable. You just have to take the first step.

Painful sex can vary from person to person. It may not occur every time, or it can completely prevent an individual from engaging in sex. It can be superficial (occurring mostly externally) or may feel like pain deep in the pelvis. We’ll explore the different symptoms based on genital type below:

Individuals with a vagina may experience…

• Pain with certain positions
• Pain with orgasm
• Pain after sex
• Pain with insertion at the vaginal opening or deeper insertion
• Muscle spasms
• Burning, throbbing, or sharp pain externally or internally

Individuals with a penis may experience…

• Pelvic pain
• Skin irritation
• Pain in the head or shaft of the penis
• Pain in the testicles
• Painful erection
• Pain during or after ejaculation

Painful sex can be caused by many things. In more simple cases, it can be a lack of preparation. Not using enough lubricant, not engaging in enough foreplay, using irritating condoms or lubes, or even just not communicating with your partner can make sex painful.

However, in other cases, it can be due to physical causes that will need professional treatment to address. Some examples include:

Pelvic Floor Dysfunction

One major cause of painful sex is pelvic floor dysfunction. The pelvic floor is a group of muscles located in your pelvis. Everyone has them, regardless of their genitals. They play a very important role in your daily life as well as sexual function. In terms of sexual function, they allow for sensation, erection, orgasm, and painless sex. 

Unfortunately, your pelvic floor muscles can experience dysfunction. This occurs when they are too tight, weak, inflexible, or uncoordinated.

When this happens, penetration can be painful, erections can be difficult, and orgasms may be painful or difficult. Having your pelvic floor in good working order is essential to sexual function and appreciation.

Pelvic floor dysfunction can be caused or worsened by a variety of things, including the other causes of sexual dysfunction explored below.

Pre-Existing Conditions

There are many conditions out there that can disrupt sexual function, cause pelvic pain, and contribute to pelvic floor dysfunction. Examples include:

• Vulvodynia
• Vaginismus
• Peyronie’s disease
• Endometriosis
• Neurological conditions
• Infections such as urinary infections, vaginal infections, pelvic inflammatory disease, or sexually transmitted infections
• And more

All of these conditions can cause stress, pelvic pain, and muscle tension that can make sex more difficult or painful. This stress and muscle tension can often cause or worsen pelvic floor dysfunction.

Luckily, many of these conditions can often be better managed with pelvic floor physical therapy alongside other forms of treatment that may be necessary.

Hormonal Changes

Hormonal changes that occur with perimenopause, menopause, medications, or birth control can affect your sexual experiences.

Not only can they affect your sexual desire, but they can also impact physical factors that may sex painful. Menopause can cause weakened tissues, lowered elasticity, less lubrication, and thinned vaginal tissues, making sexual activity more difficult.

While pelvic floor physical therapy cannot prevent menopause or hormonal changes, it can significantly support individuals experiencing these changes. Pelvic floor physical therapy can lessen the symptoms associated with hormonal changes and provide a higher quality of life through improved function and comfort.

Tissue Trauma

As mentioned before, the pelvic floor plays a massive role in sexual function and sensation. Unfortunately, the pelvic floor can be damaged and weakened by significant trauma, such as with childbirth, surgery, or injury.

These forms of trauma damage the tissues, create scar tissue, and weaken the pelvic floor—making them struggle to perform during sex. Proper rehabilitation and pelvic floor physical therapy after any of these scenarios is absolutely essential for restoring function and comfort during sex!

Fear or Mental Trauma

Enjoyable sex is not just physical—it’s psychological, too. Painful sex can be caused or worsened by stress, anxiety, depression, shame, or fear. Having previous negative experiences with sex, low body confidence, sexual trauma or other forms of trauma can make sex very difficult. It can make an individual struggle with penetration or erection.

Your mental health should never be ignored, even in relation to sexual health. Don’t hesitate to reach out to a mental health professional as a part of your overall care plan.

While pelvic floor physical therapy cannot provide the same benefits as professional mental health services, physical therapy can support individuals who want to recreate a healthy connection with their body. Additionally, treatment can be taken at a slow and mindful pace in accordance to your comfort level.

When working with me, you’ll never be expected to engage in treatment you are uncomfortable with, nor are you required to discuss your past experiences. I will work with your comfort level and always request consent before performing any treatment. You can always rescind consent anytime, even in the middle of treatment.

Every treatment method will be explained in detail beforehand, so you can feel safe, comfortable, and heard during every session!

Pelvic floor physical therapy can significantly improve a person’s experience with sex. Not only can physical therapy reduce pain, but it can also restore function and comfort—and even increase pleasure. For some with extreme cases of vaginismus, physical therapy can serve as a gentle way to reconnect with your body and desensitize the sensation of touch. 

While seeking a physical therapist for sexual-related concerns may seem embarrassing, rest assured that I have seen many different patients and have helped restore their sexual function! There’s no shame in seeking any kind of health care—sexual health is important just like any other area of health.

I work hard to create a safe, inviting, and shame-free treatment environment for all of my patients, so don’t hesitate to get started. I’m here to help!

That being said, let’s explore the different ways physical therapy can address painful sex by treating symptoms of pelvic floor dysfunction:

Improving Coordination

Coordination matters for sexual function. When your muscles are unable to coordinate, they fail to work together with other organs and may struggle to contract and relax. Having a healthy pelvic floor that can both contract and relax is essential for sexual function and pleasure! If you cannot control these movements, you may struggle to relax or activate your pelvic floor. 

This can lead to many difficulties with sexual performance, sensation, and enjoyment. Not to mention, in order to reduce pelvic floor tension or improve pelvic floor strength, you’ll need better control over your pelvic floor muscles.

To improve your pelvic floor coordination and your understanding of how the pelvic floor contracts and relaxes, I will utilize treatments such as neuromuscular re-education and biofeedback. These are unique treatments that will help you learn to activate and relax your pelvic floor correctly while receiving real-time feedback.

Reducing Tension

Pelvic floor tension can be a cause of many sexual dysfunctions. Not only can it make penetration or orgasms painful, but it can cause general pelvic pain, difficulty with orgasm, low arousal, delayed ejaculation, and more.

 For reducing tension, you can expect the following treatments:

• Manual therapies
• Stretching and exercises to improve pelvic tissue flexibility
• Breathing techniques to promote muscle relaxation
• Behavioral modifications to reduce tension
• And more

Restoring Strength

Weak pelvic floor muscles can significantly contribute to sexual struggles. A strong pelvic floor is needed to provide sexual sensation, effective erections, and enjoyable orgasms. When the pelvic floor is too weak, individuals may experience dysfunctions like:

• A lack of sensation
• Difficulty maintaining erection
• Short erections
• Premature ejaculation
• Difficulty achieving orgasm

To improve your pelvic floor strength, I will instruct you through a variety of exercises for your pelvic floor and related areas (lower back, hips, abdominals, and more)! With my help, your body can regain strength effectively without worry of straining, improper form, or overactivation.

Desensitization

Some sexual dysfunctions such as vaginismus can make sex very scary and painful. When you fear penetration or touch, it can make your body have even more tension—making sex more difficult and painful. In order to restore a healthy relationship between your mind and body, it may be necessary to try dilation. 

Dilation is the process of using a set of tools called dilators, which are slowly and gently inserted into the vagina or rectum to encourage a better reaction to touch and penetration.

These tools can start out very small, and are used at your own pace. This process allows you to desensitize your tissues and mind to touch and penetration so that sex can become less painful and more enjoyable.

While dilation requires a lot of consistent practice at home, I can provide plenty of guidance on this unique treatment method. This can include things like how to properly dilate as well as how long or how frequently you should dilate.

As you can see, pelvic floor physical therapy offers many benefits for sexual function and appreciation. It can help alleviate pain and improve your sexual experiences overall. If you’re ready to get started with improving your own sexual health, make an appointment with me!

Again, I accept patients of all ages and gender identities, so you can feel welcome and safe in my care. If you have any questions about treatment or appointments, try a discovery call.