What Women Want – To have a pain free and pleasurable sex life…

Author             Jóh-Ann Gouws BPhysT (UP) (NZRP)

Designation     Registered physiotherapist with a special interest in pelvic function

As women, our understanding of intercourse is often shaped by what we see on screen. Movies typically portray it as a sequence of kissing, cuddling and fireworks. However, in reality, the experience can be quite different—and for approximately one in five women, it may also involve pain.

Pain during intercourse is known as dyspareunia. If you experience dyspareunia, it’s important to seek medical advice from a professional trained in sexual health. Those who experience pain during intercourse may benefit from a multidisciplinary approach, which can include a physician, a pelvic floor physiotherapist, a psychologist, and possibly other specialists like a dietitian or occupational therapist.

It’s crucial to understand that pain during intercourse is not imaginary; it often has specific physical causes. To address this issue effectively, it’s best to start with a visit to your doctor, who can help rule out infections or other medical conditions that may require treatment.

Pelvic floor muscles often contribute to issues such as dyspareunia, and this is where physiotherapy can make a significant difference. One specific condition linked to these muscles is vaginismus, now referred to as genito-pelvic pain penetration disorder.

Vaginismus: What Is It?

Vaginismus is characterized by involuntary contractions of the pelvic floor muscles, which increases tension and can lead to various symptoms, including pain during intercourse or gynaecological exams, difficulty achieving penetration, and discomfort when inserting a tampon.

The causes of vaginismus can vary widely. It may be associated with physical issues such as yeast infections or hormonal changes, emotional factors like anxiety or negative perceptions of intercourse, or sometimes the underlying cause remains unidentified. Importantly, the physical manifestations of this condition can be addressed through treatment.

Other conditions that can cause dyspareunia, where pelvic floor muscle involvement is evident, include vulvodynia (pain in the vulva), endometriosis, and pain experienced during intercourse after childbirth. Approximately 41% of women report pain during intercourse three months after giving birth.

These conditions often require a combination of medication, counselling, and targeted physiotherapy for the pelvic floor muscles. Surgical intervention is rarely necessary and can sometimes exacerbate the problem.

Understanding the Pelvic Floor Muscles

The pelvic floor muscles are located in the lower part of the pelvis, extending from the front bones, encircling the three openings in women (urethra, vagina, and anus), and attaching to the tailbone at the back. Due to their position, they influence everything that enters or exits the pelvis.

These muscles play a crucial role in sexual function, bowel and bladder control, and providing support to the back and pelvic organs. Individuals experiencing pain often have these muscles in a state of high tension, rather than being weak or lax. Excessive tension, as seen in vaginismus, can lead to pain and other issues such as constipation and urinary incontinence—similar to how a muscle spasm in the neck or shoulders can cause discomfort.

How Can Physiotherapy Help?

Many people mistakenly believe that the only solution for pelvic floor issues is Kegel exercises, which strengthen the pelvic floor by contracting the muscles. However, for conditions like vaginismus, Kegel exercises can increase tension in already tight muscles, making them ineffective and in some cases worsening the pain.

A physiotherapist trained in pelvic floor therapy will conduct a comprehensive assessment and focus specifically on these muscles in relation to your body. Treatment may involve manual therapy to release tension in the pelvic area, abdomen, and back, along with breathing techniques and training on how to properly contract and relax the pelvic floor muscles. Additional components of treatment can include education on toilet habits, muscle re-education, lifestyle modifications, desensitization strategies, and the use of dilators to increase comfort with penetration.

It’s essential to recognize that pain during intercourse is not a normal experience (unless you enjoy and prefer pain) and adopting a "wait and see" approach is not advisable. Seeking help may feel intimidating, but professionals passionate about this field will listen carefully, investigate the underlying causes, and recommend effective strategies to transition from pain to pleasure.