As a pelvic health specialist, one of the most common conditions I treat is pain with penetration. The medical term for this is dyspareunia and there are several things that can cause it. Many of my patients with this condition report that they are unable to use tampons and have much difficulty with gynecological exams as well. Many times these women have been dismissed by their doctors and told to just relax and have a glass of wine before trying to have sex. Unfortunately, that rarely works. Left untreated, this condition can lead to relationship problems, depression and anxiety.

So what causes this to happen? If there is a sudden onset of pain with a previous ability to tolerate penetration without pain, there could be a yeast or bacterial infection present which can be treated medically. Much more often however, it is related to overactivity of the pelvic floor muscles.

Sometimes, the culprit is a condition called vaginismus which is when the muscles in the vagina (pelvic floor)squeeze or spasm when something is entering it. Primary vaginismus is when a woman has had pain every time anything, including a tampon, has been inserted. Secondary vaginismus is when a woman has had sex in the past without pain, but then it becomes difficult or impossible.

Another condition that can cause pain with intercourse is vulvodynia which is not a condition within itself but rather a medical term for persistent discomfort in the vulva with typical symptoms of burning, rawness, itching and stinging. This is often treated with topical medication, oral medication or nerve blocks. Pelvic floor physical therapy can also help because the pelvic floor muscles often go into spasm as a result of this condition and can be the main driver of the pain.

Other times, a patient may develop pain in the vulvar/vaginal area as a result of childbirth causing scarring which can be treated by a pelvic floor therapist through scar tissue mobilization and treatment of the resulting overactive pelvic floor.

Additionally, the pelvic floor may become overactive due to other musculoskeletal injuries causing the pelvic floor to become tight and painful. For example, a persistent hip or low back injury can cause the pelvic floor to overcompensate.

Regardless of the cause, pelvic floor physical therapy is usually quite effective, sometimes in combination with other therapies, to resolve this issue and restore a woman’s ability to enjoy sexual intercourse. A typical visit to a pelvic floor therapist for this condition would include both internal and external trigger point release, exercises to improve the ability to relax the pelvic floor, and exercises to stretch associated tight muscles in the region. Treatment may also consist of dilator therapy, not as the name implies, to dilate the vagina, but rather, to gradually desensitize the tissues over time. Other treatments would be based on the patient’s individual evaluation findings.

If you suffer from this condition, don’t wait any longer to seek treatment. We can help!

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