There is a big myth amongst women that pain with sex is normal. It’s something we all go through at some stage or another, whether it be an ongoing issue that occurs with every encounter or something that happens unexpectedly, having previously not experienced pain with sex at all.
Whilst sometimes the issue can be explained by a pathology of some sort such as a rash, infection, thrush or a sexually transmitted disease; other times the cause of pain can be more frustrating as it is not something that can be treated with a pill or cream. Ask any woman you know if they have ever experienced pain with sex and I guarantee that most of them will say yes. Which means this is a problem which affects roughly half the population and yet is rarely talked about. Talk about a silent epidemic!
Luckily, there has been more talk in recent years around pain with sex and the causes surrounding this issue, one of which is something called vaginismus. Vaginismus can be defined as the involuntary contraction of the superficial pelvic floor muscles during the act of penetration (whether it be intercourse, tampon insertion or gynaecological examination) that results in pain. If you have vaginismus, a scan a blood test won’t show up with any issues, nor will there be any visual indication that there is anything wrong at all – which can cause frustration and hopelessness as you deal with ongoing pain that can go undiagnosed.
So what causes vaginismus? Well, vaginismus is tricky in that it can pop up at any time. Some women have vaginismus from the word go and have never had a sexual encounter without pain or discomfort of some degree – these are the women who have likely never been able to insert a tampon as a teenager or tolerate an internal examination. Whereas there are other women who have managed to go years without any issues and then one day sex starts to become painful. This is usually a problem that gradually develops over time but can be preceded by childbirth. What a lot of women don’t really grasp is how traumatic childbirth can be on the body even if everything went perfectly, so it’s not surprising that following something as traumatic as this our vagina decides to recoil in fear of any future penetration!
Is it always caused by childbirth?
Unfortunately, it’s not just childbirth that can cause the tightening of these muscles. Trauma of any kind can cause the muscles to go into spasm or a contracted state including sexual abuse, PTSD or significant injury. The mental state of the person experiencing vaginismus can also be a significant factor as women can experience it during times of heightened stress, marriage or relationship breakdown or simply not being in the mood. Women can experience vaginismus in times of stress much the same as when you get tight shoulders in stressful times- your pelvic floor can tighten up too! The unfortunate thing about this is even if the woman really wants to be able to have normal sex, the stress surrounding the issue can cause the issue to escalate, resulting in a vicious cycle.
How can physiotherapy help?
Thankfully, physiotherapy is something that can help in this situation. A physiotherapist can assess your pelvic floor for muscle tension and help provide you with techniques and feedback to help relax your pelvic floor. Treatment can also involve manual release work, which is exactly as it sounds: an internal massage of your pelvic floor muscles, and the use of dilators. Dilators are a series of penis shaped devices that increase gradually in length and girth to help stretch the pelvic floor muscles. Dilators are usually something that is taken home to use daily, incorporated with your home exercise program. It’s also usually a good idea to consult with a psychologist in cases where there are mental factors involved in the issue although these aren’t always immediately apparent.
If this sounds like you at all you do not need a referral to get an appointment with a women’s health physio to assess your pelvic floor, however it is always important to rule out any pathology that may be causing the issue with your doctor if you are unsure.
Please give Cairns Pelvic Health Clinic a call if you think we may be able to assist you with this all too common problem.