Symptoms and causes
The symptoms of sexual pain vary and are unique to each woman. Some women may have pain with using tampons, during gynaecological examinations and also with sexual activity.
Some women have difficulty and pain with penetration, and the fear and anxiety that goes with this can cause increased tension of the pelvic floor muscles. Some women have described this as like “hitting a brick wall” and “feeling like a failure”, causing long lasting emotional impacts. The pain experienced may be superficial or deep inside the pelvis, and can be exacerbated by any movement within the vagina.
Around 40% of all women will experience sexual dysfunction during their lifetime, and about one in seven will experience some form of sexual pain.
Women with a history of trauma and sexual abuse can have significant issues with pain and penetration, but some women will develop pain and discomfort without any prior trauma experience. In many cases other contributing psychological factors may play a part in this complex condition.
It may primarily be a pain disorder interfering with sexual function, for example changes to the vaginal lining during menopause, overactive pelvic floor muscles, inadequate lubrication, or a disorder of the urethra or other structures nearby.
How can physio help?
An experienced pelvic health physiotherapist will assess your condition, your individual circumstances and your current level of function. The cause of sexual pain is often a result of several factors, so with your consent your physiotherapist will communicate with your GP or specialist doctor to ensure that all of your needs are met. Sometimes input from a psychologist can be helpful, or medications to manage your pain symptoms.
Your physiotherapist may carry out an assessment of your pelvic floor muscles with your consent and observe closely for any pain symptoms. Your physiotherapist will give you a treatment plan, taking into consideration your sexual goals and lifestyle needs. At all stages of your assessment and treatment, your physiotherapist will proceed only with your informed consent. Privacy and confidentiality are also important.
Treatments for women with sexual pain are varied. There is no one size fits all approach. Physiotherapists understand that in order for you to achieve your best outcome, you need to have the treatment that best suits you. This may include vulvar care strategies, use of lubricants, relaxation techniques, manual therapy and stretching. It may be recommended that you return to sexual activity slowly, and ensure that your psychological needs are addressed.
Having informed, honest discussions with your pelvic health physiotherapist and learning about your condition will help. Physiotherapists have in-depth knowledge of pelvic anatomy and function and are also very skilled in teaching you about pain.
Pelvic floor muscle training is often used and focuses on relaxation. Pelvic floor muscle training done correctly can be safe and effective for this condition. The way you do the exercises prescribed for you is important, and your pelvic health physiotherapist will give you guidance along the way.
Do you live with a chronic health condition?
Our women’s health physiotherapists can help you recover from injury, reduce pain and stiffness, increase mobility and prevent further injury. They listen to your needs to tailor a treatment specific to your condition.
You don’t need a doctor’s referral to see a physiotherapist, but in many cases physiotherapists, doctors and other health professionals will work together to plan and manage treatment for your specific condition.
Some of the many techniques physiotherapists use to treat and help you overcome your condition include exercise programs to improve mobility and strengthen muscles, joint and/or soft tissue manipulation and mobilisation to reduce pain and stiffness and muscle re-education to improve control.