Pain with intercourse, or dyspareunia, is a common issue that affects anywhere from 10-50% of women. Dyspareunia is defined as genital pain that occurs just before, during, or after sexual intercourse. Although it can be brought on by emotional or physical trauma, pregnancy and childbirth, or pelvic surgeries, sometimes dyspareunia has no obvious or known cause.
Pain with intercourse can be associated with many different conditions including vaginismus, atrophic vaginitis, pelvic congestion, endometriosis, vulvodynia, vulvar vestibulitis, and interstitial cystitis. Dyspareunia has historically been viewed as a psychological issue but has more recently been redefined with a biopsychosocial approach – integrating the physical and emotional components of pain.
Dyspareunia is diagnosed by taking a thorough history, including questions regarding timing, duration, location, and intensity of pain. Then a physical exam is performed, paying special attention to the visible vaginal tissue. This is to determine if the source of pain is due to a physical change or anomaly in the tissue such as atrophy of the vaginal wall which can occur as a woman ages. The doctor then performs a pelvic exam to check the tenderness of the tissues, flexibility of the introitus or vaginal opening, and tone and symmetry of the pelvic floor. The doctor will take note if there are any abnormalities or masses that need to be treated surgically or with medication. If treatable medical conditions are ruled out, the patient may be referred to a Physical Therapist that specializes in pelvic floor rehabilitation.
Physical therapy can provide significant relief when it comes to dyspareunia or painful intercourse. Here at Anderson Physical Therapy Associates, our therapists specialize in disorders that affect the pelvic floor. If referred for this issue, one of our physical therapists will perform a pelvic exam, paying special attention to the integrity and symmetry of the muscles, fascia, tendons, ligaments, and nerves in and around the pelvis. If dysfunction is found within these tissues, the PT can provide manual treatment to relieve the tension and therefore eliminate pain. The PT will also prescribe exercises and stretches to help the patient learn how to contract and fully relax the pelvic floor and surrounding tissue. If appropriate, the PT can lead the patient through some relaxation exercises to address the psychosocial aspect of dyspareunia, while addressing the physical restrictions.
Our Physical therapists can also work with a couple to teach the partner about the patients condition and how to accommodate or help to alleviate the discomfort during and after sexual intercourse. Most times in PT, patients find significant relief and can return to regular sexual activity and restore intimacy with their partner.