Pittsburgh Sexual Intimacy

Pain or Discomfort

Painful intercourse, or dyspareunia, is defined as pain with vaginal penetration and it’s more prevalent than you may have guessed, especially after birth. One study found that 23% of women – that’s more than 1 in 5 women – still experienced pain at 18 months postpartum. And having a c-section is actually a greater indicator that you may develop pain with intercourse, as c-section moms are actually more likely to experience intense pain with intercourse at 6 months postpartum compared to women who delivered vaginally. 

Some factors that contribute to discomfort or pain with intercourse include tight or tender pelvic floor muscles, hormonal changes that lead to thinning and poor lubrication of the vaginal tissues, and scarring from perineal stitching after birth or from a c-section scar.

Common symptoms:

• Pain or discomfort at perineum
• Pain with shallow or deep vaginal penetration
• Pain with speculum exams with gynecologist
• Throbbing pain following intercourse
• Lower abdominal discomfort following intercourse
• Difficulty or pain inserting tampons

Treatment techniques that we use to help you get better:

1. Pelvic floor muscle neuro re-education (slowly teaching your muscles to be able to tolerate penetration again) – may use a dilator or pelvic wand such as this
2. Behavioral modification – recommendations for better lubricant and vaginal moisturizers, discussion of habits and emotions related to intercourse (ex – retraining your thoughts and habits leading up to intercourse to promote increased relaxation and better preparation for intercourse), use of external device such as Ohnut for reduced depth of penetration as warranted
3. Relaxation training including pelvic floor muscles as well as supporting muscles and breathing for facilitating relaxation fo pelvic floro muscles
4. Manual therapy including trigger point release of internal pelvic floor muscles for tightness or tenderness, fascia release of external pelvic area and abdominals/back muscles
5. Tailored home exercise program to target your areas of weakness, including Kegel exercises as indicated