Why is sex painful?

We sat down with Lucy Allen, Clinical Specialist Pelvic Health Physiotherapist to understand more about why women may find sex painful. Our consultants may refer patients to Lucy when they are experiencing pain during sex for further specialist care, if required. Here, Lucy discusses the common causes and misconceptions, what you can try at home and when you should seek medical help.

Sex should be a pleasurable experience, yet around 1 in 10 women in the UK will experience pain during sex. Dyspareunia or painful sex can include pain at the entrance to the vagina and/or deep inside the pelvis and is often described as a tearing sensation, stinging, burning, bruised, stabbing or aching pain.

The common causes of painful sex are:

• Pelvic Floor Dysfunction
• Changes to the body after childbirth or surgery
• Scar tissue
• Vaginal dryness
• Vaginismus
• Vulvodynia
• Infection
• Prolapse
• Psychological – trauma, fear, anxiety, depression, stress
• Dermatology conditions
• Endometriosis/Adenomyosis
• Hormonal changes due to menopause
• Cancer

There are many causes of painful sex that can lead to a tense or non-relaxing pelvic floor muscle. For many women the pelvic floor muscle tensing is a protective mechanism in response to trauma, infection or pain in other areas of the pelvis. However, in some cases the pelvic floor doesn’t regain its full range of movement or can become more sensitised which leads to pain during sex.

Are there any common misconceptions?

There is still a lack of awareness in the treatment and management options for women who experience painful sex, but there is help available!

Pelvic Health Physiotherapy can be very effective in helping women understand the cause of their symptoms and in reducing pain and dysfunction. It is not a case that painful sex is something you have to live with or put up with. In some scenarios we work in collaboration with psychologists and gynaecologists to ensure all causes of pain are addressed. For example, if scar tissue following childbirth was causing pain with sex then a pelvic health physiotherapist would work on helping mobilise the scar tissue, desensitise, whilst regaining pelvic floor movement, a psychologist would help to address any issues following a traumatic birth experience and/or sexual dysfunction and your gynaecologist would address pain relief, investigations to ensure there is no other underlying cause and for more invasive procedures if required such as a Fenton’s procedure.

You will find that most healthcare professionals work alongside each other to ensure that your care is optimised and that there is always someone who can help.

There are some thing you can you try at home to see if this helps ease symptoms:

• Try using a water-based lubricant with foreplay and sex – I recommend YES Organics
• If you think that vaginal dryness may be contributing then a vaginal moisturiser can really help – YES Organics do a great one that also comes with internal applicators. You can also speak to your GP or Gynaecologist about topical Oestrogen
• Don’t rush! Give yourself space and time to enjoy sex, try not to put it on the ‘To Do’ list or feel you have to have sex
• Reduce stress; work out how best to reduce stress levels whether that be through exercises, mindfulness, or a call with a friend
• Pelvic floor stretches;  yoga can be a great way to stretch the pelvic floor without overloading – Happy baby, childs pose and frog positions can really help.
• Diaphragmatic breathing; deep belly breathing helps the pelvic floor to naturally relax. Try doing a 3 second inhale and 3 second exhale for 5 minutes daily whilst lying down and allowing your whole body to switch off.

When should someone seek medical help?

If sex has always been painful or it is now painful and the tips above haven’t helped I would recommend seeking the help of a gynaecologist and Pelvic Health Physiotherapist. Your GP can refer you via the NHS or privately and you can also self-refer to a private Pelvic Health Physiotherapist.

*If you experience any bleeding after sex then I would speak to your GP for further investigation.

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