The Best Treatment for Painful Sex Explained
Suppose you’re looking to pursue sex therapy in the hopes of improving symptoms of sexual pain, just like many other folks experience. In that case, your sex therapist is likely going to ask if you have been or would be open to going to pelvic floor physical therapy (PFPT) in conjunction with talk therapy. Now, what the heck is the pelvic floor, let alone pelvic floor PT?
c/o giphy: pelvic floor
Why do I feel pain in my pelvic floor?
All human bodies have a pelvic floor, which you can think of as a “hammock” of muscle that supports the pelvic organs including the bladder, bowel, and, if applicable, the uterus. The pelvic floor works hard to prevent prolapse and incontinence but is also essential for sexual functioning. If the pelvic floor muscles are too weak or tight, for example, this can create intense pain during penetrative sex and other activities. Pregnancy and childbirth, injuries, prostate cancer treatment, or straining from chronic constipation are just a few examples of experiences that can weaken the pelvic floor. But, it is also possible that someone can also just naturally have a weaker group of muscles here than others for no apparent reason.
Someone with a weak, tight, or high-tone pelvic floor may experience pain with sex, the inability to use a tampon or tolerate a penetrative medical examination, abnormal pain during the menstrual cycle, painful urination, and hypersensitivity. Anxiety, chronic stress, trauma, and sexual shame can exacerbate the resulting pain. Folks with pelvic pain often find themselves avoiding intimacy with partners and in fear of the physical discomfort from penetrative sex.
What do you do in pelvic floor physical therapy?
It’s completely normal to feel nervous about seeing a pelvic floor physical therapist, especially if it is your first time or if other medical providers historically didn’t believe the pain you bravely reported to them. So, let’s review what PFPT looks like so you have an idea of what to expect.
Naturally, you’re going to have to have an open conversation with the PT about the pain and your perception of the pain, including how it is impacting your daily life. Your PT will also externally assess the functionality of your spine, hips, and legs as well as their mobility and strength. At some point, your PT is also going to need to do an internal vaginal and/or rectal evaluation. This is usually the scariest part as it is likely to trigger the pain and anxiety, but don’t fret; your PFPT should be responsibly moving at your pace. The internal exam doesn’t have to happen in the first session. Don’t be afraid to advocate for yourself if it is too much. Lastly, you’ll likely receive tons of education on mobility, relaxation, coordination, postural dysfunction, and pain science.
Symptoms likely will not improve from attending PFPT sessions alone; you are going to be prescribed homework exercises to practice at home. You can talk with your PT or sex therapist about how to stay on track with these practices at home and help you stay motivated. Homework may include relaxation and breathing techniques, pelvic and spinal mobility exercises to stretch the pelvic floor muscles and restore the appropriate tension-length ratio, exercises to strengthen supporting muscles, and the self-use of dilators and/or pelvic wands– all of which your PT will teach you how to do!
It’s important to have a sex therapist to support you throughout your journey of improving your pelvic pain symptoms in PFPT. While the PT will support you in restoring healthy physiological functioning, a sex therapist can help you process emotional challenges that may come up when doing this work, such as shame, anxiety, panic, or relational distress. Your sex therapist can also help you rewrite your sexual scripts so that you can practice physical intimacy with partners in a safe and pleasurable way as you work on strengthening your pelvic floor to have painless penetrative sex.
c/o giphy: pelvic thrust
Our team of Chicago sex therapists specialize in helping you resolve symptoms of painful sex. If you’d like to work on your sexual pain symptoms in a supportive, safe environment, we’re here to help. You can contact our practice for a free 30-minute consultation here.
~ Allison Colaianni, ALMFT
