If you are experiencing pain during sex, or sexual dysfunction, you’re not alone. In fact, one in five cis-hetero women and one in 10 cis-hetero men report experiencing it. Though there isn’t a ton of research on people who aren’t cisgender (yet!), it’s clear the population as a whole grapples with this issue.
In this stream, pelvic health physical therapist Dr. Uchenna Ossai, aka Dr. UC, talks to us about why we might feel pain during sex and how to manage it. And while there’s no one-size-fits-all solution, physical therapy can help.
There are many reasons you might be experiencing pain during sex — it could be hormonal, musculskeletal, a misalignment of joints and muscles, menstral pain, a prolapse, endometriosis, etc. First, identify where you’re feeling the pain, what influences it, and if it’s acute or chronic. Then think about your goals for how you want to adjust the pain — do you want pain-free sex, do you want pleasurable sex, both? Communicate these things to your doctor and/or partner(s) to begin the healing process.
There are a few different common pain types, such as dyspareunia, vulvodynia, and vaginismus.
Dyspareunia is pain during deep penetration and is common for vagina and uterus-owners. It can be managed in physical therapy by strengthening your pelvic floor, lower back, and hips. Dr. UC recommends practicing child’s post or quadruped rocking.
Vulvodynia is a condition where the vulva feels like it’s on fire, Dr. UC recommends working toward managing the pain with oral medication, but also having pain acceptance — accept the pain alongside the pleasure, but prioritize the pleasure. It’s important to find things that feel good that may not involve the genitals.
Vaginismus is when your vagina tenses up or closes down when something tries to enter. There are a few ways to treat this. Dr. UC explains how to use dilators, for example, and why they can be helpful.
In general, if you feel raw or burning sensations before or after sex, you can try something like Private Packs, a pack which can be frozen and placed on the perineum between your legs. For other issues, your healthcare provider may recommend pain management medications, such as estrogen, vaginal Valium, and rectal Valium.
Every kind of pain needs a tailored approach, and just being able to identify the pain and your goal for getting better can be your first step toward pain management. Talk to your healthcare provider or physical therapist to find solutions that might work for you.