Sex is one of the more FUN parts of life. It provides a physical connection and a rush of pleasure and feel good hormones. Sex can reduce your blood pressure and heart attack risk, decrease stress, improve immunity and improve sleep. YAY. A study even found that employees who have more sex tend to take less sick days!
But what happens when sex is more pain and stress than it is satisfaction and joy? A woman said to me recently in my pelvic health physio practice “I spent most of our honeymoon in tears. We had both waited so long to have sex for the first time, but things just didn’t fit as they were meant to”. Sadly she is not alone, up to 75% of women struggle with pain during intercourse at some points in their lives.
But why does it happen? For an act that has been ensuring the continuing of the human race since the beginning of time, the women I treat are often surprised to hear that they are not alone in not enjoying or even dreading intercourse; and there can be a number of contributing factors.
These are the ones I see most commonly:
Vaginal dryness.Our oestregen levels drop after having a baby, when breastfeeding and around menopause. It’s job is to help with blood flow to the vaginal walls to increase lubrication to prepare for sex when our brains are ‘turned on’. Lower oestregen means less lubrication and unsurprisingly more discomfort. Lube is your friend for this, and regardless of whether you feel you are dry or not, I encourage all the ladies I treat who are experiencing discomfort with sex to use lube. I am a big fan of the YES brand, which is organic and exclusive to Matilda’s.
Pelvic floor muscle tightness. In the same way as you can get knots or ‘tightness’ in your neck or back muscles, the muscles around your vagina can tighten up too. There can be numerous causes for these pelvic floor muscles becoming over active. This general tightness and the more specific painful trigger points can cause pain with penetration, during intercourse or difficulty with orgasming. A pelvic health physio can help with this by educating you as to why this may be happening, releasing these trigger points with massage internally and teaching you how to connect to your pelvic floor with your breath to relax. Most of the ladies I treat are surprised to realise that they are constantly tensing these muscles without even realising that they are doing so!
You have had a bad experience in the past. Unsurprisingly, women who have had a past history of sexual trauma to the pelvis or a stressful birth can struggle with painful intercourse afterwards. I encourage women to seek counselling alongside seeing a pelvic health physio as painful past psychological associations can also contribute to an inability to relax the pelvic floor and enjoy sex.
Painful perineal scar tissue from a tear or episiotomy after a vaginal delivery. Scar tissue around the vagina following a vaginal birth can cause discomfort during intercourse. The effect from these on sex can be two fold, as the scar tissue can be sensitive to touch, and the scar can also contribute to tightness in the pelvic floor muscles. Your Dr may prescribe you oestregen cream or a local anaesthetic cream to use to promote healing and help reduce this discomfort and seeing a women’s health physio is also beneficial for scar tissue massage and pelvic floor muscle release.
Your tummy is flat across the top and on the sides, but you have a little pot belly in the front. Constantly pulling in your tummy to look thinner, or over using your upper most tummy muscles when exercising, can make your pelvic floor muscles tighter, which will make sex painful.
Underlying Infection. I encourage all the ladies that I am treating for a new onset of painful sex to have a swab taken by their GP to rule out an underlying infection, as this can also cause pain and discomfort.
You are stressed. I frequently tell the women I treat, that ‘The vagina holds the score’. A study that recorded the activity in women’s neck and shoulder muscles and pelvic floor muscles while watching a scary movie; found that as their neck and shoulders tightened as the film became more tense, so did the muscles around their vaginas. Exercise, meditation, and other stress reduction modalities for the whole body, can reduce the tension in your pelvic floor muscles too.
Establishing and treating the underlying causes of pain during sex requires a holistic overview, and ensuring you are fully relaxing your pelvic floor muscles is essential. The Oh Nut, exclusively available to Matilda’s, can be helpful for tightness in the deeper pelvic floor as it reduces the depth of penetration and you can read my review of it here.
The OhNut Set puts you in perfect control of penetration, allowing you to safely adjust just how deep you play for pain-free partner fun. This set of three comes with an extra ring – and each one acts as a soft, squishy buffer that feels just like skin for a completely natural feel. With this buffer in place, you can make penetration a little more shallow and comfortable – and it can be worn externally at the base of a penetrating partner. Use one or stack as many as you need – sex will quickly become more comfortable for confident intimacy.
The most important thing to know is that it’s NOT all in your head. Pain with sex is multifactorial, and can be improved! As the women who I treated who cried during her honeymoon said to me at her follow up appointment “Wow Lulu, I can’t believe the difference. It’s not even just not sore, it’s AMAZING. I finally get how people can love sex so much!”
Lulu Becker is a Pelvic Health specialist Physiotherapist and yoga teacher, based in La Lucia in Durban. She treats women, men and children who are struggling with urinary and faecal incontinence, bed wetting and pain in the pelvis. You can find her online at www.luluphysio.com or on social media. Facebook: @Lulu Physiotherapy and Instagram: @luluphysio