If you have ever experienced pain before, during, or after sexual intercourse, you are far from being alone. According to the American College of Obstetricians and Gynecologists (ACOG), as many as 3 out of 4 women will experience painful sex in their lifetimes (ACOG, 2018).
For some women, this painful intercourse, which is called dyspareunia, is a temporary ailment. For others, it can persist over time and can take a toll on sexual health, relationships, and quality of life.
Fortunately, dyspareunia does not have to be a life-long condition and many at-home treatment options exist for women.
As mentioned, dyspareunia describes pain in the pelvic or genital area with sexual intercourse and can occur before, during, or after intercourse. Some women experience pain with any penetration of the vagina, including when using a tampon or undergoing a pelvic exam with a speculum.
The pelvic floor muscles, which form a sling-like structure in the lower pelvis, support the pelvic organs and surround the vaginal wall. As with other muscles, these muscles can become tight and develop painful knots, known as trigger points.
Pelvic floor tightness can have physical causes such as injury or poor posture, but it can also be caused by emotional issues such as stress, poor self-image, fear of intimacy, or sexual abuse. These factors can cause unconscious tensing and clenching of the pelvic floor, leading to difficult and painful intercourse.
In most cases, dyspareunia can be treated with consistent use of at-home treatment options. A pelvic floor physical therapist can also help you get started with some of these techniques. Often, it is a combination of the strategies below that provide the best results.
When vaginal dryness is a cause of painful sex, using a lubricant can be extremely helpful. If you are using a condom, water-soluble or silicone-based lubricants are the best choice, since they will not break down the condom.
For pelvic floor tightness, vaginal dilators are specific tools in a variety of sizes that allow you to gradually stretch and release the pelvic floor muscles and are best used with the guidance of a pelvic physical therapist.
Dilators, which are often made out of silicone for comfort, are a gentle way to train the brain and the muscles of the pelvic floor to relax during insertion. Dilator therapy is best performed in combination with relaxed breathing, which encourages the muscles of the pelvic floor to open up and relax.
It can also be helpful to use visualization while using the dilator, picturing the pelvic floor opening up like a flower.
Trigger points in the muscles of the pelvic floor can cause pain at rest, in addition to during sex. To release these tight knots, a specially designed trigger point release wand can be used either vaginally or rectally to access these hard-to-reach muscles.
When you move the wand around the pelvic floor, trigger points can be identified as particularly painful spots. By applying gentle pressure to these spots for 1-2 minutes, the trigger point will release. This should be done on a daily basis.
Because of the structure of the abdominal wall, the muscles of the pelvic floor can be influenced by our breathing patterns. By practicing relaxed breathing in a quiet place, preferably laying down, the pelvic floor can be gently mobilized and stretched.
With each inhale, the pelvic floor drops slightly, providing a gentle stretch to the muscles. With each exhale, the pelvic floor returns to its resting position. It can be helpful to place your hand along the perineum to help feel the slight drop of the pelvic floor with inhalation, providing additional feedback to the brain.
The muscles of the pelvic floor can be stretched gently with exercises that open up the hip, many of which are common yoga poses. Combined with relaxed breathing, these exercises can help you learn to consciously release the pelvic floor muscles and retrain your body to let go of unconscious tension.
With the right tools and consistent practice, sex can become pain-free and enjoyable once again.
American College of Obstetricians and Gynecologists. (2018). When Sex is Painful. https://www.acog.org/womens-health/faqs/when-sex-is-painful?utm_source=redirect&utm_medium=web&utm_campaign=otn