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Sex is complicated. It’s physical, but there’s so much more to it than that; our state of mind, our emotional needs, our interpersonal relationships, our past experiences, our self-esteem, our preconceived notions — they all play a part in our ability to have and enjoy sex. 

If sex is not working out or, worse yet, if sex is painful, it’s worth considering all the possible explanations for why that may be. Very likely, there is more than one reason why the sex someone is having is not the sex they want to be having. And, more often than not, the pelvic floor is a part of that equation. 

So how are the pelvic floor muscles involved?

The pelvic floor is a group of muscles located at the base of your pelvis (check out the diagram below). They include several layers of muscles that extend from the pubic bone to the tailbone, from sit bone to sit bone, and everywhere in between. They surround the opening of the anus, vagina, and urethra. Many of their functions are automatic, but you can also voluntarily make them contract or relax.

During sex with vaginal penetration, these muscles — specifically, the muscles surrounding the vaginal opening — play a major role. They must be able to contract, release a contraction, maintain a relaxed state, and tolerate stretch. When any of these functions are compromised, penetration can be painful and even impossible.

Pain with sex can feel different for everyone

If the pelvic floor muscles are unable to relax prior to penetration, it can lead to pain. But all pain is not the same. If pain is present when attempting to have sex, that pain can vary from person to person and from one experience to another. Pain can be sharp or dull, raw throughout, or local like a paper cut. It can feel like tearing or throbbing or burning. It can be completely external, just at the opening, or deep within the vagina. 

There are so many different ways to experience pain. While this may be mortifying to learn, in reality, it’s actually good news. Being able to differentiate between the types of pain that a person is experiencing is the first step in finding a way to address it. The type of pain may signal to a medical provider that this person should be working with a dermatologist, neurologist, gastroenterologist, sex therapist, urologist, psychologist, gynecologist, physical therapist, or any combination of these. 

If someone is experiencing pain during sex, multiple factors may be involved and they will likely benefit from a team of medical professionals to restore function. And if part of the problem is that someone’s pelvic floor muscles aren’t functioning properly, then access to a pelvic floor physical therapist will be fundamental in their recovery.  

How pelvic floor muscle training helps with painful sex

Regardless of the type of pain a person may be experiencing with sex, it’s likely that their pelvic floor muscles are not functioning properly. That’s because, when pain is present anywhere in the body, the muscles in that area all tend to react the same way: by guarding. Muscle guarding involves holding muscles in a partially contracted state to prevent or alleviate pain. Over time, this muscle guarding will change the flexibility, range of motion, strength, and overall function of any muscle group, and the pelvic floor is no exception. 

The purpose of pelvic floor muscle training is to restore function to these muscles so that they are no longer contributing to pain experienced during sex. A trained specialist can provide guidance and the tools necessary to restore pelvic floor function by: 

  1. Improving your awareness and coordination of these muscles
  2. Restoring the range of motion, flexibility, and resting tone of these muscles
  3. Increasing tolerance to stretch for pain free penetration

Fully-functioning pelvic floor muscles also provide the best possible foundation for incorporation of additional treatment strategies to reduce pain during sex, such as pharmacology, psychology, or surgical interventions. The important thing to realize is that these muscles are resilient, capable, and can be re-trained. However long you may have been dealing with painful sex, it’s still possible to recondition these muscles and achieve life-changing results. 

Consider reaching out to a physical therapist who specializes in treating the pelvic floor. As a member of your care team, they can assess your current muscle function, provide education for strategies to reduce your symptoms, give clear guidance on how to restore your pelvic floor, and offer you the support you need to start having sex you want and deserve.

Learn more about the pelvic floor and pleasure from Origin provider, Dr. Ashley Rawlins on HerVoice.

  1. Caruso, S., Monaco, C. Dyspareunia in Women: Updates in Mechanisms and Current/Novel Therapies. Curr Sex Health Rep 11, 9–20 (2019). https://doi.org/10.1007/s11930-019-00188-w
  2. Olugbade, Temitayoa; Bianchi-Berthouze, Nadiaa; Williams, Amanda C de C.b,* The relationship between guarding, pain, and emotion, PAIN Reports: July/August 2019 – Volume 4 – Issue 4 – p e770 doi: 10.1097/PR9.0000000000000770
AUTHOR

Celestine Compton, PT, DPT is a doctor of physical therapy specializing in women's health. Dr. Compton is both Herman & Wallace and APTA trained in the areas of pelvic pain and pelvic floor dysfunction, myofascial mobilization, and pregnancy and postnatal care. She has acted as a consultant and content developer for various websites and blogs related to women's health and continues to enjoy writing on the subject. Dr. Compton began exploring her passion for women's healthcare and developing her specialization in women's health physical therapy following her experience in the Women's March of 2017.

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