Painful sex isn’t something we talk about. No one would look at you twice if you were complaining of pain in your elbow, but in your genitals it’s a completely different story.
Sexual health is comprised of many factors beyond just your ability to have sex.
People of any age, sex and gender can have pain that is so severe, it limits their enjoyment of masturbation and sex, or prevents sexual pleasure completely. There are many syndromes and diseases that can cause this pain. STIs can influence pain, as well as other conditions such as non-bacterial prostatitis, vulvodynia, vaginismus, pudendal neuralgia, and many more. These diseases and conditions can be influenced by poorly functioning pelvic floor muscles and vice versa.
WHAT TO DO IF YOU HAVE PAIN?
don’t panic or stress
Pelvic pain is relatively common. Some studies estimate chronic pelvic pain rates being higher than 25%. It is important, though, to act swiftly to identify the culprit. The majority of pelvic pain is treatable, but the process is much easier when started earlier on in the pain cycle.
YOUR PRIMARY CARE PHYSICIAN
Book an exam with your physician to rule out any infective or disease process that may be causing your pain. The best case scenario is that a short course of treatment will do the trick. Unfortunately, the root cause is not always identified on the first trip to the doctor, and your results might come back negative for any infectious agent or systemic condition. This is common for many patients we see. If this happens to you, consider going to a pelvic pain specialist (a physician or pelvic floor physical therapist) for a more precise evaluation.
TREATING SEXUAL PAIN
At Beyond Basics, we are experts at treating sexual pain, screening our patients and referring them on to the correct healthcare providers to help treat any systemic issues. We value a holistic approach to treating sexual dysfunction and strive to provide our patients with the best care possible. If you are in the New York area, another state, or even abroad and are suffering from sexual pain, please consider starting your healing journey with us. We have an extensive ‘out of town’ program.
EMOTIONAL HEALTH AND SEX
Masturbation and sex are about so much more than just physical pleasure: how they makes you feel emotionally also matters. Many factors can influence how we feel about sexual pleasure; if it makes you feel unhappy or anxious, it's important to find out why. Not only to maximize your pleasure, but your well-being too!
Common issues that can negatively impact sexual experiences include:
• Past trauma, including but not limited to sexual abuse and assault, past emotional and physical abuse
• Low self-esteem
• Poor body image
• Cultural and religious beliefs that lead to shame about enjoying sexual pleasure
• Mental health problems like depression, anxiety, and stress
• Issues with your partner(s) like poor communication, conflict, lack of trust, grief caused by betrayal, or general feelings of unhappiness in the relationships.
• Issues with consent: Consent is an important, complex topic that should by explored comprehensively and with nuance. Learn more about all the facets of consent from RAINN
If any of these issues are contributing to a lack of enjoyment with sexual pleasure, it may be time to reach out to a certified sex therapist.
Pelvic floor PT can treat sexual dysfunction through muscle re-education, neural mobilizations, joint mobilizations, soft tissue mobilization and therapeutic exercises. We believe in multi-disciplinary treatment and refer our patients to doctors specializing in pelvic floor pain associated with any type of sexual activity, if needed.
LIFESTYLE CHANGES THAT CAN HELP REDUCE SEXUAL PAIN AND DYSFUNCTION
• Improves blood flow
• Relaxes muscles
• Promotes parasympathetic input
• Endorphins released are the body's natural painkiller
• Increase fiber intake for constipation
• Avoid inflammatory foods (sugars, white carbs)
• Drink lots of water - half body weight in ounces is recommended
Persistent Genital Arousal Disorder (PGAD)
Causes unwanted genital arousal, which doesn’t typically get better with orgasm and if it does, orgasm only brings relief for a short period of time. The key feature of this disorder is the genital arousal is unwanted, often painful and can cause deep psychological distress.
While PGAD can affect anyone, it’s most commonly diagnosed in people with vaginas.
Treatment (special considerations):Unlike many other clinicians, we are comfortable assessing things like the mobility of the clitoral hood, the mobility of the muscles and structures surrounding the pudendal nerve and other pelvic nerves, as well as being able to treat issues involving the back and tailbone. We also have strong and robust connections to physicians who are pioneers in the treatment of PGAD and can help facilitate access to complementary medical treatment. To learn more about PGAD, read our blog.
Pudendal NEURALGIA CAN OCCUR IN ANYONE. SIGNS AND SYMPTOMS MAY INCLUDE THE FOLLOWING, BUT THEY MAY VARY BETWEEN INDIVIDUALS:
PT treatment may consist of:
Dyspareunia is the medical term to describe painful penetration. This can include pain just before penetration, pain with initial penetration, deep penetration and thrusting. It may be due to superficial scarring, adhesions, skin irritation, muscle tenderness or vaginal dryness.
Painful Sex After Giving Birth
At six months postpartum, 24% of birthing people have pain with sex (at the vaginal opening). If you can relate, please know you don't have to suffer or resign to the fact that this is your new reality.
Pelvic floor PTs can with muscle spasm, scar tissue, pelvic misalignment, and muscle imbalances to restore the optimal tissue relationships.
A medical condition where tissue
similar to the endometrium (lining of
the uterus), is found outside the
uterus, typically within the abdominal cavity, organs, and internal side walls. Typical places be found is in scars (c-sec, laparoscopy), on the bladder, ovaries, Fallopian tubes, bowel, intestines, colon, appendix, and rectum. The chief complaint with a diagnosis of endometriosis is
extremely painful periods, which
are often debilitating. Other symptoms include pain with sex, fatigue, painful urination, painful bowel movements, and other gastrointestinal problems such as bloating and abdominal cramps. The gold standard for diagnosis of endometriosis is biopsy with laparoscopic surgery.
Pelvic Inflammatory Disease (PID)
An infection of the reproductive organs which can result in scar tissue formation or pelvic adhesions. PID can occur following a sexually transmitted disease, especially chlamydia and gonorrhea. PID may result in chronic pelvic pain, infertility, ectopic pregnancy, and abscess formation.
Symptoms of PID include:
- lower abdominal pain
- painful intercourse
- painful urination
- foul smelling vaginal discharge
- irregular menstrual bleeding
- pain in the right upper abdomen.
Physical therapy can help to break down scar tissue, once the infection has resolved, and aid in increased mobility of reproductive connective tissue. This, in turn, may decrease pelvic pain and help with infertility issues.
Inability to penetrate the vagina due to involuntary muscle spasm. Severe pain at the opening of the vagina that can be constant or occur with touch
PT treatment may include: Rehabilitation of pelvic floor muscles and vaginal dilator therapy.
MENOPAUSE AND POSTMENOPAUSE-RELATED SEXUAL PAIN AND DYSFUNCTION:
Only recognized within the last five years, genitourinary syndrome of menopause (GSM) describes the set of symptoms with genital, sexual and urological implications.
More than 50% of premenopausal and menopausal people report vulvovaginal dryness, burning, irritation, painful sex, urinary urgency, recurrent UTIs and painful urination. Caused by fluctuating estrogen levels.
PT can help maintain muscle strength by prescribing appropriate load exercise for bone health, and fix any tightness or restrictions by improving pelvic floor coordination to alleviate GSM symptoms during this transitional period.
Decreased levels of estrogen that occur during menopause causes many changes to vulvovaginal tissue that can lead to itching, burning, irritation and painful sex. Other changes include: thinning and shortening of vulvovaginal tissues and the vaginal canal, reduction in the size of the vaginal opening, loss of elasticity, vaginal dryness due to decrease in lubrication production, increased urinary incontinence and decreased blood flow.
PT treatment may consist of:
Difficulty achieving and maintaining erection:
Can be caused by tight pelvic floor muscles that inhibit blood flow required for penile engorgement.
Increased blood flow to pelvis and genitalia increases pressure on muscles and nerves. Can also be caused by tissue tightness and restrictions.
Orgasm followed by rhythmical contraction and relaxation of pelvic floor muscles.
Increased muscle tightness and sensitivity following contractions.
Peyronie’s Disease (PD) is thought to occur due to microtrauma to the delicate blood vessels and tissues of the penis during intercourse. This microtrauma is thought to cause inflammation, irritate nerves, and can eventually cause plaques to form in the tissues of the penis. These plaques can result in curvature of the penis, erectile pain, and dysfunction.
PFPT has been shown to treat the comorbid conditions associated with PD effectively, i.e. the painful spasm of the pelvic floor, as well as the downstream effects of bladder, bowel, ejaculatory issues and pelvic and genital pain conditions.
Chronic Prostatitis aka Chronic Pelvic Pain Syndrome (CPPS) or Prostadynia:
Prostatitis is one of the most common urological conditions affecting people with penises, accounting for almost 2 million outpatient visits annually.
In cases of non-bacterial prostatitis (which make up 95% of all prostatitis) it’s often very difficult to determine the cause. Often times, our patients have been bouncing from practitioner to practitioner trying to find answers and effective treatment before finally finding us.
- The sensation of having a golf ball stuck in the rectum
- Hesitant urinary stream (having trouble getting the urine to start flowing)
- Post void dribble (spotting of urine on underwear following voiding)
- Pain that radiates into the abdomen (this is one of the differences from symptoms of benign prostatic hyperplasia)
- Erectile dysfunction and decreased libido
- Painful ejaculation
- Painful or burning urination
- Genital pain: penile, testicular, groin and perineal pain
PT Treatment: Manual release of trigger points is effective in reducing symptoms of prostatitis. PTs also work to determine what lead up to the formation of the trigger points in the first place, whether that be poor habitual posture, poor strength, or tight muscles in other parts of the body. They also teach patients how to avoid clenching their pelvic floor to prevent exacerbating symptoms. Some other techniques we use include but are not limited to: joint mobilization to assist proper structural alignment, therapeutic exercise, postural and neuromuscular re-education and a detailed and individualized home exercise program.
Abnormal enlargement of the testicular veins. Due to an obstruction or defective valve, blood does not drain out and stagnates inside the testicular vein with resultant dilatation. Varicoceles are more common in the left testicle than the right are usually asymptomatic. If present, symptoms may include pain in the scrotum, feeling of heaviness in the testicle, infertility, atrophy of the testicle, and/or visible or palpable enlarged vein.