Pain With Sex? Pelvic Physical Therapy Can Help!

Authored by The Bodyful PT and Wellness Team.

Have you had pain with sex for more than 2 months, without an identifiable cause? Do you struggle to understand why you have pain with sex?

Do you also have vulvar pain, difficulty wearing tight clothes, and it feels like your vulva burns, is itchy, and dry? 

Pelvic floor therapy can help!

The first question you may ask is “what is the pelvic floor?” The pelvic floor is a bowl of muscles that support your pelvic organs, prevent you from peeing on yourself when you sneeze, they stretch to push poop or a baby out, and they function for orgasming. 

Also, whether you are penis-bodied, vulva-bodied, or any body in between and beyond, all bodies have this important group of muscles and all bodies can benefit from treatment and education when symptoms present.

If you are experiencing pain with sex, and it is not caused by an acute injury or an infection, then it is likely caused by “pelvic floor dysfunction.”

“Pelvic floor dysfunction” means your pelvic floor muscles may not relax when you need them to relax, or tense when you want them to tense. In other words, they may benefit from coordination training and application to movements and activities. 

If you have pain with sex, you may have tense muscles that are also tight. Tight pelvic floor muscles, along with fear of pain, can be the cause of “vaginismus.” Vaginismus is diagnosed when any vaginal penetration is impossible or extremely difficult. You may be wondering, “why does my tampon hurt when I take it out?”

Pelvic floor physical therapy can help you to navigate your fears, gradually stretch your pelvic floor muscles gently to re-train your brain’s relationship to your pain, and educate you on what is happening so that you can trust yourself more. Contact us to learn more! 

If your pelvic floor muscles are too tight, you will also likely benefit from hip and low back stretches, breathing practices, and pelvic floor awareness training so you can consciously relax your pelvic floor muscles to tolerate the beginning of vaginal penetration.

If you have pain in your vulva during penetrative sex, it could be caused by the irritated pelvic nerves being stretched and compressed. Pelvic floor physical therapy can help with teaching you to release and move the soft tissues, blood vessels and nerves in your pelvis.

If you are postpartum, perimenopausal, or on birth control, and you also feel dry and itchy, you may be experiencing hormonal changes to your vulva that are causing irritation in your tissues during penetrative sex. Your pelvic floor therapist can inspect your vulva and refer you to the appropriate provider or over-the-counter vulvar moisturizers, like Revaree. 

Do you have pain with deeper vaginal penetration? Do you avoid certain positions during sex? Do you also get low back pain or hip pain and stiffness? Do you get a burning sensation during and after sex? 

If you answered yes to any of the above questions, your pelvic floor “bowl” muscles, closer to your pelvic organs, hip joint, and sacroiliac joints, may be tense, tight, or weak. As a result, your nerves may not be getting the necessary blood flow they need and the threat of this is painful. 

Pelvic floor therapy can help with the hip and low back flexibility and strength, as well as core support and pelvic floor movement needed to improve symptoms during deeper penetration. 

How do the pelvic floor muscles contribute to sexual pleasure?

For all bodies, the pelvic floor muscles contract or tense during arousal. 

If you experience clitoral pain or hard flaccid symptoms, for example, your pelvic floor muscles near your arousal organs may be involuntarily tensing and causing discomfort. 

If you have difficulty experiencing orgasm, and you must tense your whole body or hold your breath to orgasm, then your pelvic floor muscles are likely too tense to get the range of motion required to experience a clitoral or penile erection and the release for the orgasm. 

For some, orgasm may be painful if the muscles are too tense.  The blood flow required to bathe the nerves in your pelvic floor may be too restricted and it can be painful. 

Pelvic floor therapy can help with mobility, soft tissue flexibility, breathing and relaxation exercises, specific restorative poses to release your pelvic floor, and coordination training so that you can consciously use your muscles and understand when to relax and when to activate. 

For people with penises, overactive, tense, tight pelvic floor muscles can often present as:

• Erectile dysfunction - may be caused by restricted blood flow to the pelvic floor muscles.

• Premature ejaculation - may be caused by pelvic floor coordination and breathing pattern challenges.

• Burning after ejaculation, no STD - your pelvic nerves may be compressed from tight muscles in your abdomen, pelvis, and hips, and you may be experiencing “trigger points” in your pelvic floor that cause this symptom. 

• Penile and/or testicular pain - restricted blood flow to the nerves that travel from the abdomen to the pelvis and tense muscles. Do these symptoms change when you are lifting, sitting for a long time, when you are stressed, and do they get worse after sex or masturbation? 

• Rectal pain and pressure - do you also experience straining for bowel movements? You may be tensing your muscles when they need to be relaxed and stretched. 

• Pain with rectal penetration - are your hips and back also stiff and tight? Do you strain for bowel movements? 

If you are a trans-human, pelvic PT can help you rehabilitate after gender affirming surgeries. For example, dilators can also be an important tool after gender affirming surgeries such as a vaginoplasty and pelvic floor physical therapy can help immensely in the recovery from that procedure.

Do you want to know more about what pelvic floor physical therapy and an internal assessment and treatment could be like? Read our blog about internal therapy here. 

Do you want to know more about what pelvic floor physical therapy is? Read our blog here. 

During your first visit with a pelvic floor therapist, you will share your intentions and goals for PT. What answers are you looking for and how do you want to feel better? 

Once a thorough PT examination has been completed, either online or in person, your pelvic therapist will tell you your PT diagnosis, how long it will take for your symptoms to change, and the plan to reach your goals. This will include the number of visits recommended, the duration of treatment, and how you can get started with lifestyle changes and movement resources at home. 

Your PT can also work as part of your health care team, consulting with your other providers as needed and with your consent, and referring you to specialists to improve your prognosis and get you the correct diagnoses and care you deserve. 

For integrative care and support, you may consider working with a psychotherapist who is informed in sex therapy treatment practices while working with a pelvic physical therapist. 

Your body is expressive and cannot be separated from emotions and historical stories and meaning making. 

If you’d like to learn more about receiving pelvic floor therapy services, you can reach out to Bodyful Physical Therapy and Wellness where you will see options for online consults and education as well as in person therapy visits at our office in Oakland, CA.