Understanding and Managing Sexually Related Pain: A Pelvic Floor Physiotherapist’s Perspective
Sexual penetrative pain, also known as dyspareunia, is a common issue that affects up to 35% of people in Australia (these numbers increase to up to 50% after menopause). Often seen as a taboo subject, this can be a source of high distress, impacting one’s quality of life and relationships.
As a pelvic floor physiotherapist, I often encounter patients who have struggled for years, only to read about pelvic floor physiotherapy in a news article, a social media post, or, if they are lucky enough, referred by their GP, specialist, or allied health practitioner. Admittedly, this isn’t a commonly known area of physiotherapy, and not many know that there are physiotherapists that specialize in this area. Therefore, if this is the first time you are reading about pelvic floor physiotherapy and what it can do for your sexual penetrative pain, don’t be surprised. It is, however, surprising to highlight that although pelvic floor physiotherapy has level 1 evidence and a Grade A recommendation (highly supported by evidence), it is still not widely known that it should be first line therapy for sexual penetrative pain. But I digress. In this blog post, we will delve into two specific conditions related to sexual pain: provoked vestibulodynia and vaginismus, and discuss five strategies that can help manage sexual penetrative pain.
Provoked vestibulodynia, previously known as vulvar vestibulitis, is a condition characterized by pain in the vestibule area of the vulva, which is the area surrounding the entrance to the vaginal canal. The pain is usually provoked by touch or pressure, such as during sexual intercourse, tampon insertion, or even wearing tight clothing. The exact cause of vestibulodynia is unknown, but it is thought to involve a combination of genetic, muscle, nerve, skin, hormonal, and environmental factors.
Vaginismus, on the other hand, is a condition where there is “strong contraction” of the pelvic floor muscles around the vagina. This muscle tension can make any form of penetration painful or almost impossible. Vaginismus can be triggered by physical factors like infection or trauma, but it can also be related to cultural and emotional factors such as fear or anxiety.
According to the new DSM, these conditions are all under the same umbrella name: genito penetrative pelvic pain disorders (GPPPD).
Although these conditions can all share similar features, there are slightly different and can present in many different form in different people. However, there are some things you can do that can help you better manage your pain so here are my top 5 recommendations to manage sexual penetrative pain:
Pelvic Floor Physiotherapy: This involves working with a trained physiotherapist (please always assure that they are trained in sexual health and pelvic floor physiotherapy) who can guide you through exercises to improve your coordination, relax, and control your pelvic floor muscles. This can help reduce pain during penetration and give you back control.
Sexual Counselling or Therapy: Sexual pain is more than just pain on a muscle. Sexual pain is special in itself because it often depends on a certain context. Working with a therapist can help address any emotional or psychological factors contributing to sexual pain. This can be done individually or with a partner, and it is a highly valuable therapy to complement pelvic floor physiotherapy.
Use of Lubricants: Lubricants can reduce friction and make penetration more comfortable. Water-based lubricants are generally recommended as they are less likely to cause irritation; however, they may not be the best for everyone. Talk with your healthcare provider about the best options and alternatives.
Breathing exercises and body awareness exercises can play a crucial role in managing dyspareunia. Deep, controlled breathing can help relax the pelvic floor muscles, reducing tension and potentially alleviating pain during intercourse. It can also divert focus away from the pain, improving awareness of their body and the sensations they are experiencing. This mindfulness approach, often used in conjunction with other treatments like physiotherapy or sexual therapy, can be a valuable tool for managing and reducing sexual pain.
Pain Management Techniques: This can include methods like warm baths, doing yoga or mindfulness, the use of heat packs, and over-the-counter pain relievers. It’s important to discuss these options with a healthcare provider to ensure they are safe and effective for you.
Sexual pain is a complex issue that can have physical and psychological components, and it is widely undertreated. Understanding your pain and how you can manage it according to your individual symptoms is the first step towards managing symptoms. With the right strategies and professional guidance, it is possible to navigate this challenge and improve your sexual health and well-being.
Remember, it’s important to consult with a healthcare provider if you’re experiencing sexual pain. Although it can feel daunting, they can assess you, provide a proper diagnosis, and guide you towards appropriate treatment options.
You’re not alone in your pain, and help is available.
*If you have a history of trauma or abuse or simply don’t want to go through an internal vaginal assessment, know that your pelvic floor physiotherapist can have other ways to assess you. (Please inform them of your preferences at the initial appointment.)
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