Painful Sex | Form and Function Pelvic Health

Top 3 Reasons Why You May Be Experiencing Pain with Sex

1. Irritated Pelvic Floor Muscles

Your pelvic floor muscles are the bowl of muscles that rest within your pelvis. Their 3 jobs are to provide support to internal organs, elimination bowel and bladder, and sexual intimacy. They can become tight or develop tenderness known as trigger points. Although this can happen at any time, it is especially prevalent in postpartum women. This is due to both the birth process and hormonal changes. These tight muscles can then send pain signals causing irritation throughout the pelvis.

An overwhelming majority of women are found to have both weak and tight pelvic floor muscles, as indicated by this study. This means that the pelvic floor muscles have shortened (become tighter). When we consistently contract our muscles without relaxing them, they are often weak. I know, it sounds counterintuitive. But they are weak from being overworked. Think of if you were to walk around holding a heavy shopping bag halfway up. Your bicep would probably start to feel tired after a minute or so. But then what if I told you you needed to go lift a 20lb weight right after that. When the time comes for the muscles to fully contract it is going to be too tired. Similarly, your pelvic floor muscles are unable to produce the necessary strong contraction if they’re always under stress.

There is evidence that suggests pelvic floor therapy can provide significant relief for women experiencing painful sex!

2. Hormonal Changes

“Why am I crying all the time and all I want to do is sleep?”

I for one can say that I’ve been there so.many.times. Pregnancy is physically draining and emotionally challenging. Giving yourself some grace and extra time to rest can go a long way in caring for yourself. But how do the hormonal changes affect painful intercourse?

The rapid changes in estrogen levels can wreak havoc during pregnancy and postpartum. This can lead to dryness and thinning of vulvar and vaginal tissues. Which causes – you guessed it – pain with intimacy and especially pain with penetration. Breastfeeding is associated with painful intercourse early in the first few months postpartum. Early postpartum, vaginal tissues become thinner. Although they begin to restore by 6-10 weeks postpartum. This restoration is slowed in breastfeeding mothers due to decreased estrogen.

While one study found that although breastfeeding was highly associated with painful intercourse at 6 weeks postpartum, by 6 months postpartum, it was no longer a contributing factor. Meaning that if you’re still experiencing pain with intercourse after the 6 months mark, don’t let that be a reason to quit nursing your baby. Consider that there may be another underlying – but fixable – reason why you’re still experiencing discomfort.

The sleep deprivation and fatigue can play a role in the continuation of painful intercourse. Basic factors that contribute to pain-free intercourse – such as time for arousal, enough lubrication, and balanced emotions – can be a hard thing to find time for. Especially when your main concern is just feeding the baby and trying to get them (and yourself!) to sleep. We know sleep has a large role to play with hormones, so be kind to yourself during this time. It won’t last forever!

3. Perineal Tearing from Childbirth

The degree of perineal tearing at birth can directly impact pain with sex after birth. This study found that at 3 months postpartum, women who had had 2nd degree tears were 80% more likely to experience pain. Those with 3rd-4th degree tears were 270% more likely to experience pain with intercourse as compared to women who had given birth with an intact perineum. The use of vacuum extraction or forceps delivery was significantly associated with painful intercourse.

Another recent study found that among women who had experienced 3rd-4th degree tears more than half were still having painful intercourse at 12 months postpartum. This further emphasizes the importance of reducing perineal trauma during birth and educating women regarding the risk of interventions for birth (such as vacuum extraction or forceps delivery).

Moving Past Painful Intercourse

In the past you may have been told to relax, try a glass of wine, or use more lubricant. Here at Form and Function, we aren’t going to be dismissive. It’s important to know that there is REAL help for women who struggle with painful intercourse! Oftentimes this is accompanied by other pelvic floor symptoms too. This could be leaking pee, low back pain or GI distress. These problems can all stem from the same source. All these symptoms can be related to your pelvic floor muscles.

Taking a Closer Look at the Physical Components

The International Urogynecology Journal specifically studied the effects of pelvic floor rehabilitation on improving painful sex. They found that therapy reduce pain with penetration. Participants also reported satisfaction with other important factors. Including desire, arousal, lubrication and orgasm were also restored.

It’s also critical to rule out any underlying medical problems that may be causing pain during sex. Check with your doctor or midwife if you are concerned about PCOS, endometriosis, vulvodynia, or difficulty healing from a c-section scar or perineal scar from birth.

Changing Your Behaviors Can Be Crucial to Healing

Far from last on the list of tools used to treat painful intercourse is our habits and behaviors. So often we can be our own worst enemy when it comes to our mindset about pain and our previous experiences of pain. Getting to the root of these thoughts and learning to overcome them can be critical in giving women the courage to keep trying. Even if they have experienced months or even years of painful intercourse in the past. Learning change negative thoughts for positive ones can be a great tool.

For example, choosing to reject the downward spiral of thoughts such as:

“Sex will always hurt.”

“I don’t see why things should be better this time.”

And instead choosing thoughts such as:

“It doesn’t have to be perfect, and we can always try again tomorrow.”

“I know that I am valued by my husband and we can always stop if things hurt too much.”

Another example of a behavioral change that can improve pain with intercourse is honest communication. Also, to be especially aware of the amount of time needed to achieve pain-free intercourse. A basic rule for new moms is this: there’s no more quick sex! Trying to squeeze in sex at the end of the night and hurry things along because you’re tired is a recipe for disaster.

Instead, give yourself the time needed to relax and let go of the stresses of the day. It’s important to allow for time for arousal. This improves your natural lubrication. And don’t be afraid or ashamed to supplement this with a healthy lubricant. The pelvic floor muscles must relax and open to allow pain free sex. If the process is hurried along then penetration is more likely to be painful.

Trying a different healthy lubricant can also be a big game changer for many women. Especially if they experience burning or stinging with their current lubricant. I recommend the natural lubricant and vaginal moisturizer made by Chiavaye. It was created by a woman struggling with endometriosis. It has gentle, nonit’s even sold at Walmart!

Getting Started on the Healing Journey with Pelvic Floor Therapy

Even if you’ve been dealing with painful sex for years, healing is possible. We would love to help you begin that journey!

Taking the leap to see a pelvic floor therapist is a great step forward. We are here to help you restore control and provide relief from painful sex. It may take time, but most women begin to see improvements within a few weeks.

If you have questions or concerns about if pelvic floor therapy could be right for you, please don’t hesitate to ask. We’d love to take the time to chat with you about what your experience has been and what you’re looking for. Here’s how you can schedule your free 20-minute phone consultation.

Restoring your pelvic health and regaining strength and control can take time, but we promise that we are here to support you on that journey!

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Getting Started Is Easy

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Step 1 - Book a free 30 minute in-person discovery session

Step 2 - Meet your therapist and see if we would be a good fit for each other!

Step 3 - Schedule your first 90 minute PT session - and get ready to regain control and feel your best again.

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