The vicious cycle of painful intercourse

Sad woman on bed - Yuris Alhumaydy

I want to spend a few minutes talking about painful intercourse, and why women should not continue having sex hoping that it will get better on it’s own. Pain is our body’s way of communicating that something is wrong, and sex is no different. Sex should be a pleasurable experience and continuing with pain will only exacerbate the issue.

First, Let’s talk about some of the reasons that sex can become painful.

This list is not exhaustive, but offers some possible explanations. If your particular pain does not seem to be addressed here then please ask, and as always the best way to figure out the root cause of your particular issue is to schedule an evaluation.

1. Overactivity in your pelvic floorAn overactive pelvic floor has trigger points and tender locations within the muscles. Anything that touches these locations will cause pain

2. Scar tissueVaginal tissue is meant to be loose with folds to increase mobility and flexibility. When scar tissue is present this area may not move well and/or may pull against the tissue underneath.

3. Instinctual and unconscious contraction upon vaginal insertionThis is like making a fist in one hand and then trying to push your finger through the middle. It is just not comfortable for anyone. True vaginismus can even make it impossible to insert anything into the vagina. Similar contractions can also exacerbate other issues, If painful sex has occurred for other reasons, then unconscious contractions can start to occur with penetration.

Next, some self treatment options

1. Make sure you are really relaxed. A bath, meditation, diaphragmatic breathing, yoga, etc. Whatever works for you to be relaxed so that you are able to start your sexual encounter as relaxed as possible. This will help the pelvic floor muscles remain loose and lengthened.

2. Perform self scar massage if scar tissue is presentLie down in a comfortable position and use your thumb and finger to find your scar. Roll the scar in your hand up and down, side to side, rotating both directions, and any other direction you can. If it helps you then use a little bit of olive oil or other lubricant or position yourself in the bath.

3. Stop if pain is presentIf you are nervous that sex will be painful, or you have a history of pain with penetration, then this can become a self fulfilling prophecy. Your muscles will tighten up in nervousness and fear, exacerbating the other issues. Stop when pain is experienced and try to relax again. Make your goal that every intercourse or vaginal penetration attempt will be less painful than the last. This way you body will gradually learn that sex is not painful.

4. Use positions that help you be more confidentI find that many women will have one position that is less painful, or one position that is more painful. While it feels limiting to only have sex in one position, or to avoid a certain position, it is still a step in the right direction. It will help you to reeducate your body that sex does not have to be painful.

I hope these tips give you ideas of some self treatment options. Whatever you do, do not give up hope of pain-free and pleasurable sex.

Find out more about pelvic floor physical therapy or set up your free consult.