For women, pelvic pain during sex is a very common problem.

According to research by the American College of Obstetricians and Gynecologists, as many as 75% of women will experience pain during sex at some point in their lifetime.

From a Women’s Pelvic Health and Physiotherapy perspective, there are many simple tips and treatment approaches we provide on a regular basis to help our patients with this common problem.

In this blog post – we talk about the common causes of pain during sex and some simple things women can do to improve their symptoms during and after intercourse.

What causes pain during sex in women?

Dyspareunia is the medical name for painful intercourse and is defined as persistent or recurrent genital pain that occurs just before, during or after sex (or a combination of 1 or more of these). Let’s talk about when pain occurs and how that can help determine the most likely cause of pain.

Pain just before sex (entry pain)

If pain occurs during entry (or pain during penetration) this could commonly be caused by:

Decreased lubrication – this could be a result of hormonal change (e.g. during menopause or breastfeeding), not enough foreplay/arousal or usage of medications which affect arousal
Muscle tightness or spasm (vaginismus)
Injury or trauma (e.g. pelvic surgery, childbirth, episiotomy)
Inflammation, irritation or skin disorder (e.g. urinary tract infection (UTI) or eczema)

Pain during sex (deep pain)

This pain can be caused during deep penetration and may be worse in certain positions. This can commonly be caused by:

**Illnesses or conditions affecting the pelvis **(e.g. pelvic organ prolapse, endometriosis, pelvic inflammatory disease, pelvic floor dysfunction)
**Post surgery or medical treatment **– this could include scarring from pelvic surgery such as hysterectomy or side effects from radiotherapy/chemotherapy

How can pain during sex be improved? A physiotherapy perspective

In most cases of painful sex, there are many treatment approaches and management techniques that can be used to significantly improve or completely resolve symptoms. Physiotherapists with experience in the field of Women’s Pelvic Health can help patients manage Dyspareunia in a variety of ways.

How to improve pain just before sex when it is caused by muscles (vaginismus)

Yes the muscles inside your vagina can get sore, tight or weak just like any other muscle in the body!

Like other muscles you can massage your pelvic floor muscles internally if they are too tight, just like you would massage any other tight muscle in the body. You can also exercise these muscles to improve endurance, strength and control just like any other muscle.

A pelvic floor physio can help:

Provide muscular release techniques to reduce tightness and muscle spasm
Teach you how to release these muscles yourself with internal massage
Show you exercises to help with control – this can sometimes involve pelvic floor exercises but may also involve breathing and relaxation techniques to help with decreasing pelvic floor muscle spasm

How to improve pain just before sex when it is caused by surgery, injury and trauma

After surgery, injury or trauma there may be increased pain sensitivity in various structures inside the vagina. In some cases there may be some formation of scar tissue.

A pelvic floor physio can help in these cases by:

Providing education and re-assurance around the natural healing process
Gradual exposure to different sensations e.g. pressure, muscle activation, touch
Exercises to gradually strengthen and improve tissue healing

How to improve pain during sex (deep pain) when it is caused by illnesses or conditions affecting the pelvis

Management depends very much on the condition and the individual person. But for conditions like endometriosis, pelvic organ prolapse and pelvic floor dysfunction, a pelvic floor physio can help improve pain during intercourse by:

Providing advice on positions which may be more comfortable depending on the condition
Providing management for pelvic organ prolapse such as pessarys, exercises and advice on load management
Providing education and support to women (and their partner(s) if appropriate) to help manage both the physical and emotional side of this condition with ability to refer on for further support as appropriate

Next steps if you have pain during sex

The main thing to know is that pain during sex is something you can definitely do something about and in many cases there are very simple tips/treatment options available to improve symptoms.

We recommend consulting with a physiotherapist in the field of women’s pelvic health to get the most up to date, evidence based options available to help manage symptoms.