Pain during sexual intercourse: let's break the taboo | PhysioExtra

Did you know that about 20% of young women report experiencing persistent pain during sexual intercourse? These discomforts, which are also common among older women and during the postpartum period, can not only affect their sex life but also lead to deep distress and isolation. Fortunately, solutions exist. Perineal and pelvic rehabilitation is an effective physiotherapy approach to relieve this pain and regain optimal quality of life.

Understanding the Causes of Sexual Pain

Dyspareunia, or pain during sexual intercourse, can present in two forms:

• Superficial dyspareunia: Pain located at the vaginal entrance or in the vulvar region, sometimes making penetration difficult or impossible.
• Deep dyspareunia: Pain felt in the middle or deep vaginal area, sometimes extending to the abdominal and pelvic regions.

These pains can be caused by various factors, such as:

• Recurrent urinary or vaginal infections.
• Physical (pelvic fracture) or psychological trauma.
• Hormonal changes (pregnancy, menopause).
• Childbirth, with or without episiotomy.
• Pelvic surgeries or medical conditions such as endometriosis.

These events can lead to pelvic floor muscle dysfunction, causing muscle tension, spasms, or neural pain. Sexual pain can also occur without an identifiable cause. Common diagnoses include provoked vestibulodynia and vaginismus, particularly in young women (Psst... Men can also experience sexual pain!).

Breaking the Silence: The First Step to Relief

Although these issues are common, many women hesitate to discuss them with their doctor or a healthcare professional. However, talking about your symptoms is essential to starting the healing process. Your doctor can identify the source of your pain and, if necessary, refer you to a physiotherapist specializing in perineal and pelvic rehabilitation. You can also consult a physiotherapist directly without a medical prescription.

What is Perineal and Pelvic Rehabilitation?

Perineal and pelvic rehabilitation focuses on the pelvic floor muscles, located at the base of the pelvis and playing a key role in sexual function. This physiotherapy approach also targets abdominal muscles and the diaphragm, as they significantly impact pelvic floor muscles. By working on these areas, perineal rehabilitation can reduce or even eliminate pain. Here’s how it helps:

• Personalized assessment: Your first session includes a detailed discussion and physical examination by a physiotherapist, who will then develop a tailored treatment plan.
• Pain relief techniques: Stretching of the abdominal and pelvic muscles, guidance on lubricants and sexual positions, and the use of dilators to improve vaginal flexibility.
• Targeted exercises: Pelvic floor muscle relaxation, pelvic and spinal mobility exercises, and breathing techniques.

A Multidisciplinary Approach

In some cases, collaboration with psychologists or sexologists may be necessary to optimize results. Together, these professionals can help you regain a fulfilling sex life.

Breathing Exercises

A simple breathing exercise can help relax the pelvic floor muscles. Practice slow, deep breathing regularly:

1. Lie on your back with your knees bent and your spine in a neutral position (slightly arched).
2. Place your hands on your belly and focus on your breathing.
3. Inhale by gently expanding your belly and letting your ribcage open like an umbrella (forward, backward, and to the sides).
4. Exhale without forcing.

There should be a brief pause after each breath before inhaling again.

Don’t Endure the Pain—Take Action!

Pain during intercourse should not be something you simply endure. Speak to your healthcare provider or consult a physiotherapist specializing in perineal and pelvic rehabilitation. It’s never too late to take care of yourself.

Article written by Sabrina Boucher, physiotherapist with expertise in perineal and pelvic rehabilitation.