Painful Intercourse - Symptoms and Treatment Options
Many people are uncomfortable talking about sex in general, but when it's painful and you have no idea why, then it can be even harder to discuss. Sure, you may dance around the topic with your girlfriends during a girls-night-out, or with your partner after you suffer through intercourse, but most people avoid the topic like the plague. Sex and intercourse are vital parts of our lives - not only does our population depend on it, but it should be pleasurable and fun! When it hurts we often avoid it which can lead to many other issues in our personal lives and relationships. Thats why it's important to get it all out there, talk about it and figure out what you can do to get your groove back!
Pain during intercourse is called Dyspareunia and often refers to pain in a woman's labia, vagina, and/or pelvic areas during penetration. Many women report having pain during their very first episode of vaginal intercourse. Recent studies show that women continue to have recurrent pain with intercourse but fail to report this to their doctors - and often the doctors are not even asking about it. Patients often describe this as deep aching pain, sharp and stabbing or a burning sensation. So, what causes dyspareunia?
Well, many things! Changes in sexual activity, infections, skin conditions that affect the genitals, thinning and dryness of the vaginal wall (often during menopause), sexual trauma and pelvic muscle tightness are just a few. Most women report that the pain is on initial penetration, where others report muscle spasm, cramping or tightness during intercourse. The good news? Pelvic Floor Physical Therapy can typically help decrease symptoms - if not remove them all together!
It is important to note that women should seek medical care whenever they experience new or worsening pain, discharge or bleeding after intercourse. A gynecologist is often the first line of defense to discuss your concerns with. Additionally, urologists and urogynecologists may be consulted as part of the care team depending on the underlying conditions. Pelvic Health Physical Therapists are often the first provider that a woman may see when she has these concerns. In concert with the other medical professionals, PTs can develop an appropriate plan of care to address the symptoms or underlying dysfunction to help reduce pain and get back to the pleasure you deserve!
Treatments vary depending on the cause of the pain, and once a woman is seen by her provider a plan of care can be decided. Frequently small changes can make a big difference! Addressing an underlying infection with antibiotics, determining the appropriate lubrication (depending on the reason behind the vaginal dryness), or assisting with passive vaginal dilation can often be the first steps taken. However, if the driver of the pain is due to a condition such as Interstitial Cystitis (inflammation of the bladder with no known cause), Endometriosis, or pelvic adhesions following surgery then a more involved course of treatment may be necessary. The big take-home here is: YOU DONT HAVE TO JUST LIVE WITH IT!! There is always something we can try to help you get your mo-jo back.
Speaking of helping, there are some things that women can do in an attempt to prevent painful intercourse. (Yay!) It is suggested that women avoid or discontinue using scented soaps, douching, scented toilet paper, panty liners or tight synthetic undergarments that could irritate the area. Ladies - the vagina is self-cleaning! You don't need special cleaners or sprays or perfumes to keep things healthy "down there!" Besides, have you ever noticed that the people that tell you that you "need" these products are also the ones that sell them?? Good ole fashioned mild soap and water - on the exterior of the vagina - is really all you need to keep things clean and healthy.
The bottom line is while pelvic pain is very common, it isn't normal nor is it something you need to "just live with." The important thing is to find what is causing the pain and then start addressing it. I encourage all women to feel comfortable speaking to their primary care provider, OB or PT about these symptoms and concerns. Have questions about this? Contact me! Our ultimate goal is helping patients achieve wellness - and that includes sexual wellness. That sounds like a pretty good destination to me!
In good health,
Wherever you look, this month especially, people are talking about the things they want to improve in their lives. Some want to eat healthier, lose weight, gain muscle, increase their water intake, be more present with their families...the list goes on. The New Year tends to have us thinking about the things in our lives that we want to reset, recharge or recover. While I think it is very healthy to look at the things we want to improve, I firmly believe the place we need to begin is in a space of self-acceptance.
In order to figure out where we want to go - what our next destination is - we need to know where we are. What got us to this point? I saw a sign the other day that said, "Don't look back - you're not going that way!" It struck me as a motivational saying to help propel us toward our goals and while I love the thought, I do feel we need to figure out what actions got us to where we are in order to determine the path to get to where we want to be. Are we too stressed, too tired, too hurt, too painful? Have we neglected ourselves because we are spending our time caring for others and "will get to ourselves eventually?" Have we been waiting for pain to stop, our children to be older, have more money in the bank or more time in the day?
In waiting, or putting ourselves on hold, this can lead to mentally beating ourselves up. We look back and think, "If I had only started 3 months/3 years/3 decades ago, I'd be closer to where I want to be right now!" This way of thinking may be common, but it isn't helpful unless it launches us into the positive changes we are wishing to make (which it often doesn't!). This pattern of thinking can drive us towards feeling angry - at ourselves or our situation - causing us to lose focus on what we need to do to actually move toward the destination we desire. The more effective way of thinking for many people is recognizing where we currently are, the thing (or things) that got us here, and where we realistically would like to be. This can only begin with the understanding that we all need to start somewhere - and accept that today we are in a place where we have decided to make change!
Once we have let go of all of the "what-ifs" and "If I had (time/money/no pain...)" and we truly accept where our starting point is today, then we can move forward. We can sit down, preferably with someone that will support us in our decisions to be better/do better/improve ourselves, and make a realistic plan to reach our goals. While it is helpful to have a great network of friends and family to support us in reaching our goals, often many people feel alone in their journey and unable to confide in those around them out of fear, shame or a myriad of other resasons. While the internet has provided a space for many people to find support groups, I can not empahsize enough the importance of finding a truly unbiased professional to help you reach your goals. Betty from your online support group for Fibromyalgia may be a great person to commiserate with for tips and tricks about what to do when you have a flare-up, but a healthcare professional that has treated these conditions and understands the medical side of things is an essential person to seek out for receiving medical advice about your condition. If your goal is financial freedom, speaking to a financial advisor that can look at your situation with unbiased eyes may be better than your Uncle Joe (unless Uncle Joe is a Fortune 500 millionaire!). There are professional organizers, psychologists, business coaches and life coaches that can help you work toward a goal of having more time to spend with your family. And if your destination goal is to have better sex, pain-free living or improved wellness then a Physical Therapist is a great person to seek out.
Accepting where we are on our journey is really the first step towards the destination we are aiming for.
In good health,
Every Monday I have gotten into the habit of posting a "Myth" on Facebook and then busting it wide open with the truth. Today, I feel this warrants a little bigger blurb, with some more info. Keep reading!!
Today's: Myth: “It’s been 6 weeks since birthing my beautiful baby! I had my check-up with my provider today and he gave me the green-light to return to having sex with my partner. I guess that means I’m ready!?!"
Truth: Congratulations! You’ve made it 6 weeks which I can imagine had its share of ups and downs. Your OB or Midwife spoke with you in their office and told you that you’ve reached the 6-week point where, if there was any injury to your tissue, it may have healed by now. The truth is the “6-weeks” is actually a pretty arbitrary number!
Many people experience tearing or episiotomies during delivery, and their tissues are still angry and painful. Many mom’s have mild or even severe symptoms of prolapse and can’t even imagine having their partner go anywhere near them yet! While other moms are sore, tired, painful, scared….did I mention tired? There is no magic number of days/weeks to wait for you to return to sex. If you feel great at 6 weeks and you and your partner are ready, then go for it! But, if you are not, for ANY reason, then give yourself some grace and wait until you are both ready. Skip the feeling of "I have to" or "I should" and embrace what you actually are feeling - as messy as that may be. - and TALK to your partner about it. If they have a hard time understanding why you may be hesitating after getting the green-light from your OB, then maybe they can talk to a pelvic health PT with you so they can get a better understanding of what is happening with your body.
Some women are concerned things will feel different or hurt or be strange for their partners. These concerns can lead to more anxiety surrounding the fear, which can increase any pain or discomfort - which is just not how sex should be! So - wait until you are both ready, and give yourself a break.
If you are having anxiety or concerns about this return to activity, talk to a health care provider! Listen to your body and don’t just brush it off. Maybe you are experiencing symptoms that need to be checked, or maybe you just plain aren’t ready! A pelvic health PT can be a great person to consult with, as we have specialized training for these very topics - and can help you get back into action!! (And feel free to leave this post open somewhere that your partner can read it!) ;)
In good health,
Man, this is a tough one. Patience with self, patience with others, patience with the process. This journey - and lesson - is one I'm no stranger to. Given the current state of the world - from COVID-19 to homeschooling to unemployment to social distancing - I'm betting many others are on this particular journey with me. My aunt would tell me I will keep getting the lesson until I surrender to it and finally learn it. Well, it's high time I learn it.
Some people are born with an innate sense of patience (think Dali Lama) but for the majority of us it's a lesson we start to learn as we're young. We must be patient with mobility - learning to crawl before we walk and training wheels on our bicycle before we can balance on our own. We learn to wait for our turn on the swing at the park, for our birthdays to come each year, and to turn the legal age to get a drivers license. Patience is needed as we learn a new task, learn things about ourselves, and even learn about the world around us. For some, myself included, when things beyond our control happen, our patience is tested. Traffic delays, waiting to meet "the one" that will be our partner in life, conceiving a child, illnesses in our loved ones. This hits home for me right now as my mother is in the hospital, awaiting tests and procedures, and we are unable to be with her due to the COVID-19 pandemic that is currently rocking our world. She has transferred hospitals, been in and out of the ICU, had several nurses/doctors/tests of which we know very little about because we can't be there. As a healthcare worker I've always said, "We know too much" and can be dangerous patients with this knowledge - but I'm finding we are even more "dangerous" daughters because we ask questions, we don't settle for "I don't know" and we lose patience.
This struggle all boils down to things beyond our control, and having patience for the process. No degree of frustration will bring lab results faster, answers from her care team more coherent, consistent or better, or my Mom home sooner. I need to have patience with myself; my knowledge of the human body and how it works has served me during this time, but I need to not beat myself up if I can't answer my Dad's question about what type of anesthesia is used during a certain procedure. I need to have patience with the care team; no doubt they are struggling with patient care, fatigue and fear themselves during this time and I know deep down they are doing the best they can. (Still - no doctor has called us in the last 4 days!!?? But I digress...) And I need to have patience with the process; tests have to be done in certain orders, triage takes place for procedures of those people sicker than my Mom, and new protocols are in place during the pandemic that can really slow things down. Things beyond our control frustrate us and often cause us to lose patience.
My Dad recently has taught me a great lesson about this - one of many actually. We have had a few moments of frustration together during this time that have mainly center around lack of communication from the hospitals. We share the "I cant believe...." and "Did they really do that?" and "Why are they not telling us...." sessions after hanging up the phone on several occasions. We both pace (I get that from him apparently), and throw our hands up and shake our heads. Ultimately, he sighs and says, "What's the important thing here? The important thing here is Mom is sick, she is in a place that will hopefully help her, and we want her to come home better." Sure, it takes me longer to get to that point, but ultimately I reach it too. We just want Mom home and happy and well, and we just have to be patient.
The lesson here on the journey toward patience is this: when you find yourself getting worked up and wanting to tear your hair out because_________ (fill in the blank: your kids aren't homeschooling well, your boss isn't listening to your great idea, you have back pain and can't get answers as to why), then take a breath, and do what my Dad does. Look at what is really important. Are your kids fed/clothed/safe? Do you have a job that helps you pay your bills and brings you at least some satisfaction? Are you healthy? More than likely the answer will be yes, and thats when the patience begins. The things that will come after may not be the answers you think you want - which may lead to the need for more patience - but then you have a choice. You can choose to be frustrated OR you can choose to find answers. You can choose to wait for things to happen to you, OR you can take action. I've never been one to sit and wait around (hence the issue with patience!) so in my case doing research, talking to smart people in the healthcare field that I know, and planning for what my mom will need when she comes home is what I do. While practicing patience and waiting for answers about her care (things I can't control), I'm taking action and cleaning or learning (things I can control) to ultimately get us to the important thing: Mom home safely and well.
In good health,
PS - If you identify with having back pain with no explanation as to why - contact us! We'd love to help you find answers!!