Let’s Talk About Sex, Baby

Sex. The threeletter word that carries a lot of connotations. It means different things to different people emotionally, mentally and physically. However, when spoken about it pricks a lot of ears. Despite triggering people to listen, many people don’t want to talk about sex with a health professional, or even seek advice regarding their sex lives.   

So, in the wise words of Salt-N-Pepa – “Let’s talk about Sex, baby”. More particularly, let’s talk about females and pain during sexual intercourse; a highly prevalent, distressing and under-treated condition.   

Pain experienced at initial penetration, or during sexual intercourse, can be caused by many things including: 

  • Genital infections; thrush, sexually transmitted infections & bacterial vaginosis. 
  • Vulvar skin conditions.  
  • Genital irritation due to dryness, allergy to latex or washes. 
  • Lack of sexual arousal. 
  • Vestibulodynia – burning pain around the vagina opening. 
  • Vaginismus – involuntary spasm of the pelvic floor muscles causing then to shut tightly, causing sex to be painful or even impossible.  
  • Psychological trauma or distress. 

All the above can be the primary pathology and/or source of pain with sex and can inadvertently trigger a secondary adaptive response – an overactive pelvic floor. The muscles become physically shortened, lack nutrient-rich blood supply and release chemicals that cause pain.  This can intensify the pain experienced by the individual.  

An overactive pelvic floor is rarely the sole/primary cause for painful sex. It is usually a more complex presentation which needs many factors addressed.  However, for the sake of simplicity, let’s chat about how a tight/overactive pelvic floor can be the main source of pain with penetration. 

So, why are pelvic floor muscles overactive in the first place?  

  • Previous pelvic trauma, pelvic surgery, chronic pelvic pain disorder – ie endometriosis. 
  • Psychological trauma, or previous painful sexual encounters, can make you anticipate it to be painful each time you have sex and the pelvic floor muscles contract to protect you. This is a conditioned response.  
  • Overloading the pelvic floor muscles with too many kegel exercises and insufficient relaxation phase. Yes, this can be detrimental to your pelvic floor and sex life! 
  • Too many abdominal strengthening exercises and holding your ‘core’ on all the time can lead to an overactive pelvic floor and painful sex. When you tighten your abdominals, often your pelvic floor tightens too. Thereforegirls and women who are very athletic/sporty, or even women who constantly hold/suck their stomach in, can often have difficulty relaxing their pelvic floor due to such high resting tone in their muscles.  This can predispose them to pain during intercourse if they’re unable to sufficiently relax.  

What can physiotherapy do? 

Physiotherapists who are trained in treating women’s health and pelvic floor conditions can help people who experience pain with sex. Most consultations begin with a thorough discussion about the client’s bladder, bowel, gynaecological and obstetric history. From there, clinically indicated assessment and treatment is administered. This can include education on the role of the pelvic floor, graded exposure, tips and tricks, pelvic floor muscle down-training, manual therapy, dilators and electrical stimulation.   

Take home messages: 

  • Pain with sex is not normal, no matter your age. 
  • Please seek medical advice if you are experiencing painful sex as it can be treated. 
  • Don’t suck your stomach in/tense your abdominals all day long like those Instagram models – it’s bad for your pelvic floor.  
  • You can over-work your pelvic floor muscles. 

About the Author:

Chloe Medwin is a Physiotherapist at Physiotas on the North West Coast.

Chloe completed a Bachelor of Health Science and a Masters of Physiotherapy Practice at La Trobe University’s Melbourne Campus in 2016 and started working at Physiotas in early 2017. Chloe enjoys the diversity of ages and conditions that private practice physiotherapy offers.

Chloe is qualified in DMA Clinical Pilates, and takes classes in both the Ulverstone and Devonport clinics. Chloe has also completed her certificate in Dry Needling for sports and spinal conditions, and regularly implements this into her practice.

Chloe has a specific interest in women’s health, and has completed additional training in urinary incontinence, prolapse management, pelvic pain, pregnancy and post-natal physiotherapy.

A self-confessed ‘foodie’, Chloe likes to visit local cafes and bake desserts in her spare time.