This week we hand over the blog to our friends from Women’s and Men’s Health Physiotherapy. Pelvic health and associated problems can be difficult to discuss no matter your age or gender but it is important to address issues before they become major problems. The team at Women’s and Men’s Health are experts in this field and have shared the following information on an important topic….

One in five women experience pain with sex, but most are too embarrassed to talk with their doctor, or confide in a friend. But want to know the good news? Painful sex is very treatable!

There are many different reasons why sex can hurt, including:

• Skin conditions of the vulva

• Not enough vaginal lubrication, which can be caused by hormonal changes with menopause or after childbirth, or by not being ‘turned on’ enough

• Increased tension, or ‘overactivity’ of the pelvic floor muscles

• Increased sensitivity in the nerves in and around the vulva

• Other medical conditions such as Endometriosis and Adenomyosis

• Stress and anxiety

• Sexual trauma

• Sometimes, the cause is unknown.

  .

What is an ‘overactive’ Pelvic Floor?

The pelvic floor muscles are the muscles that fill in the base of your       pelvis and are located in the lower third of the vagina. These muscles play a role in sexual function, support of the pelvic organs above and control the bladder and bowel. You need to be able to relax the pelvic floor to achieve comfortable insertion into the vagina and to empty your bladder and bowel effectively.  The muscles of the pelvic floor often become very protective and have increased resting tension and spasm in those experiencing painful sex.  It is important to understand that this ‘overactivity’ of the pelvic floor is involuntary, and it can be successfully treated. 

Sex, Pain And The Brain

Painful sex can often begin with a physical cause, like a thrush infection, but continues because of changes in the brain.  A vicious cycle can quickly develop from a painful sexual experience. Your brain is constantly on alert, looking out for danger and analysing messages from the body carefully. 

If your brain decides there is a threat or danger, your brain produces pain and muscle spasm to protect you. 

 Ongoing experiences of painful sex further reinforce the brain’s sense of danger, leading to anticipation of pain, increased anxiety and spasm of the pelvic floor muscles. 

 You may have thoughts like “I’m not normal”, “I’m not a good partner”, “I’ll never be able to have a baby”, and “My partner may leave me / find someone else if I can’t have sex”. These thought patterns make the vicious cycle even worse.

Pain: The Passion Killer

If sex causes pain, it’s natural to avoid it and for your libido to drop, meaning you experience reduced or even no desire for sex. You may find it very hard to relax and enjoy any intimacy such as a gentle caress or a simple cuddle on the couch. Despite wanting to remain close, you may find yourself withdrawing from your partner - a figurative “brick wall in the bedroom”. 

 It can be really difficult talking about this with your partner, finding the right words to explain how you feel both physically and emotionally. It’s not uncommon for feelings of guilt, shame, inadequacy, and resentment to surface.
 

Some real truths about vagina’s & sex 

• No two vagina’s look the same.  There is a huge degree of variation in how each vulva (which is the name given to the external parts of the female genitals) looks.  Whilst all the parts that make up the vulva are the same (eg inner and outer labia and clitoris), they can all look quite different in terms of colour, shape and size.

• More than 70% of women will NOT reliably orgasm with penetrative sex, and this is healthy and normal.

• Female lubrication does not a correlate directly with arousal. This term is called arousal non-concordance. The way a woman knows if she is aroused is if she feels in herself that she is.

• Sex should never be painful. If you have pain with sex, there is help!

Who Should I See To Get Help?

Your first port of call should always be a GP. If you are too embarrassed to speak to your regular GP, finding a GP with a special interest in women’s health is a good option.  

Once you have a diagnosis, a team approach to recovery works best. The team may include a doctor, a pelvic floor physiotherapist and a sexual counsellor. Research tells us that this approach to treatment gets the optimal results.
 

How Can A Pelvic Floor Physio Help?

To successfully treat sexual pain, a Physio will treat the tissues of the body (the skin, nerves, and muscles), but must also work with the brain, exploring your thoughts, feelings, and beliefs about sex.  They will help you to relax tight pelvic floor muscles with different relaxation exercises, breathing activities and help you to reduce anticipatory spasm and anxiety associated with intimacy and vaginal penetration.
 

Don’t Put Up With It!

Remember, you are not alone. Sexual pain is very common, and very treatable. Don’t put up with it. Seek help and you will be surprised – sex can be fun and enjoyable!

For more information, visit our website www.wmhp.com.au or this specific page on sexual pain https://www.wmhp.com.au/womens-pelvic-health/vulval-sexual-pain or call us on 8823 8300.

 Women’s and Men’s Health Physiotherapy exists to restore pelvic health, empowering every person to live their best life.  We are invested in your overall wellbeing, and dedicated to supporting your physical, emotional and lifestyle needs.  Our hand-picked team of Physiotherapists have helped thousands of Australian women and men improve their pelvic health for over 25 years.

 All of our Physiotherapists hold post graduate qualifications in pelvic health, and have extensive experience in treating bladder, bowel, prolapse, pelvic pain, sexual problems, and conditions of the childbearing year. 

 We pride ourselves on making sure that you feel comfortable as we understand that talking about pelvic health issues can be difficult.

 We listen to you, and work together to help you live with freedom and confidence.