This article is part of InDependent’s Wellness Unfiltered™ program, a multifaceted program addressing the tougher, harder-to-discuss wellness topics affecting military spouses, including substance abuse, suicide ideation, trauma, postpartum depression, miscarriage, eating disorders, mental illness, terminal/chronic illness, sexual intimacy, death in the family, and more. This program is our commitment to you to create dialog, connect you to experts, and provide a formal structure to boldly address the areas of wellness that we all want to have conversations about, but sometimes don’t want to bring up. Our hope is we can provide you with the knowledge, confidence, and language necessary to proactively build a stronger, thriving military community.
If you have sought help for painful intercourse and were told to “drink a glass of wine and relax,” you are not alone. What you should have been told is the truth: this is a common but treatable issue and pelvic floor therapy can help.
“Dyspareunia” is the medical term for painful sex. It can be a stand alone diagnosis or an umbrella term used for more specific diagnoses that cause pain with sex.
Dyspareunia is much more common in women, affecting 10-28% at some point in life compared to 5% in men. Postpartum is a common time painful sex creeps into the bedroom. As many as 87.5% of women have pain with their first postpartum romp, according to a cohort study of 1500+ first-time moms. This improved throughout the first year, but 20% of women continued to experience symptoms after 12 months.
For an activity that is intended to be orgasmic, these stats suck (pun intended).
WHAT CAUSES DYSPAREUNIA?
Many factors could be contributing, such as pelvic floor muscle imbalance or restriction, poor lubrication, prolapse, hormone levels, endometriosis or cysts, or skin disorders. Aside from physical factors, emotional and social influences can also play a role, such as high stress levels, and a history of trauma or abuse. In these cases, it is important to consider adding a mental health professional and possibly a sex counselor to your healthcare team.
Pelvic floor therapists (PFT), either physical therapists or occupational therapists, can play a crucial role in addressing dyspareunia, as they are the muscle and movement specialists. PFTs are trained to assess and treat the muscles of the pelvic floor both externally and internally.
Externally, PFTs look at movement patterns, joint range of motion, muscle strength, and breathing mechanics, all of which influence how the pelvic floor and core system function.
During an internal exam, PFTs assess how pelvic floor muscles can lengthen and shorten, trigger points within the pelvic floor, how muscles respond to breathing mechanics and intra-abdominal pressure, and tissue mobility. With this information, they can help identify the root cause of symptoms and teach you how to address the causes to get back to enjoyable intercourse.
If you or your partner have ever experienced painful intercourse, you know how detrimental this can be in relationships. Yes, intercourse is a means of reproduction, but equally important, it is a source of connection and plays a vital role in many relationships.
As a person who experiences the pain, it can be frustrating and defeating to feel like the roadblock in the bedroom. Having to choose between engaging in intercourse that does not feel good in the interest of your partner or avoiding intercourse to save yourself discomfort is not a fun position to be in.
On the flip side, it is disheartening to want to connect with your partner but not want to cause them pain.
Nobody wins in a dyspareunia scenario.
SIX TIPS THAT HELP
The good news is education and access to appropriate treatments can be a game changer. There are answers; you can (and should) enjoy sex!
Here are some tips if you are in the dyspareunia boat:
1. Find the cause. Discuss your symptoms with your primary care provider. (Find a new provider if you were told “drink wine and relax.”)
A primary provider can start investigating or refer you to an appropriate specialist. Working with providers that have training and experience with dyspareunia, genuinely listen to you, and explain treatment options are important factors in quality care.
2. Get a referral to a pelvic floor therapist. Experts are out there. Whoever told you to drink wine is not an expert in treating dyspareunia.
All 50 states in the US have some degree of direct access to physical and occupational therapy, meaning you do not need a doctor’s referral to start treatment. Insurance companies may require referrals for reimbursement, so call your insurance if you have questions about your benefits.
You also have the option to self-pay. More therapists are switching to this business model because it allows them more freedom and flexibility in deciding the best treatment for each individual scenario. Insurance companies can be restrictive with what treatments they reimburse, regardless if a treatment may benefit you.
3. Communicate. Talking about these things can be complicated – but also necessary.
It may sound basic, but communication is huge when you or your partner is experiencing dyspareunia. If you are the one having pain, communicate how you are feeling, what positions feel best, how they can adjust their position or movement, and anything else that helps them understand your experience and boundaries.
If you are the partner of someone having pain, be open to changing things up and helping them feel supported and heard. You may even be able to help them with their therapy homework or self-treatment techniques.
4. Use lube. All of the lube.
It is one of the easiest things you can do to reduce friction which may be contributing to muscle guarding. Choosing a high quality lubricant without scents or harmful chemicals is important as the skin is very absorbent and the vaginal flora should not be disrupted.
Popular lubes PFTs use include Slippery Stuff, Uberlube, Good Clean Love, and Coconu. If using condoms, it is important to know what kind of lube you are using to prevent condom breakdown (example: oil based lubes should not be used with latex condoms).
5. Positioning. Hips don’t lie.
How you position your body dictates muscle position and how effectively muscles can relax and contract. A PFT would be helpful in guiding you to what positions may feel better.
One trick you could try is putting a pillow under your pelvis. This can help with prolapse (the pelvis is higher so gravity helps organs move away from the vaginal opening) and can help improve balance between the front and back halves of the pelvic floor for better function.
6. Breathe. More specifically, exhale.
Breathing is a direct link to the nervous system and the nervous system impacts muscle tension/guarding. If you have had pain in the past with sex, the nervous system may go into a “fight or flight” response as a means of protection which increases muscle guarding and tension.
Focus on full, relaxed exhales allowing ribs to close like an umbrella. Try to avoid forceful inhaling and breath holding as they increase the fight or flight response.
OTHER PLACES TO FIND HELP
If you need help finding a pelvic health provider, www.pelvicguru.com has a comprehensive provider directory to help guide you. Herman and Wallace Pelvic Rehabilitation Institute provides pelvic health training and also has a provider directory at https://pelvicrehab.com/.
Addie Holzmann is a Doctor of Physical Therapy with a focus on women’s pelvic health. She is certified in Postural Restoration and is a Postpartum Corrective Exercise Specialist. In her twelve years of practice, she’s worked in multiple settings including acute/subacute care, pediatrics, and orthopedics. She found her true calling by combining her love for athletics and the pelvic floor working with female athletes. Addie started her own practice, NeuMe Physio, in 2018 to focus her efforts on empowering women to move without pelvic floor or core symptoms. Addie treats clients in-person and online, along with providing education through her online programs (to include a PT’s Sexual Positions Guide), podcast (Don’t Beat Around the Bush), social media accounts (Instagram, Facebook), and affiliation with SLAM.