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Why Does Sex Hurt?

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By: Kellie Dushner PT, DPT 

There are many reasons why someone may have pain with intercourse (dyspareunia). For example, think of a young girl who grew up in a  home where she had been told that sex was bad if you do not wait until marriage. When this young girl grows into a woman and eventually does marry, do you think she will have a healthy sexual relationship with her new husband? Perhaps she will, or perhaps those ideals which she grew up with still ring true in her head, causing her anxiety and stress to increase when having sex, ultimately resulting in dyspareunia.

In this article, we will review a few of the more common reasons why men and women experience pain with intercourse.

High levels of stress and anxiety

Just like some people tend to carry stress and tension in their neck, some people tend to carry their stress in their pelvis. When muscles in the pelvic floor become tight and irritated, it can make sexual intercourse extremely uncomfortable.

Injury or Trauma

An injury to areas such as the low back, pelvic girdle, and hip can also result in dyspareunia. When a disruption occurs within your body’s bony alignment, the muscles which attach to those bones and joints are often affected. Due to this disruption in the optimal length/tension ratio, over time muscles may become overactive, underactive, and/or painful with daily activities.

Childbirth

Most women who have been through childbirth understand that the body goes through many structural and hormonal changes before and after giving birth. Many women who have never experienced painful intercourse are surprised when they start experiencing pain in the postpartum period. While childbirth is common and therefore often seen as “no big deal,” it still involves a major trauma to the pelvic floor. This along with any tearing or episiotomy which occurred can all translate to pain with intercourse.

History of Sexual Abuse

Any history of sexual abuse, despite the severity or how long ago it occurred, should never be easily dismissed. Past abuse and trauma has a way of hanging around and affecting every aspect of our daily life. It is important that men and women seek the appropriate help needed in order to address these deep-rooted issues.

Menopause

A drop in estrogen levels associated with menopause, can lead to atrophy within the pelvic floor, a decrease in natural lubrication, and a decreased sex drive. All of these factors can contribute to the development of dyspareunia. However, this does not mean that women can no longer engage in healthy and pleasurable intercourse after menopause. There are many treatments and medications available to address these secondary effects, which can be discussed with your physician and physical therapist.

Prostatitis

Prostatitis is inflammation within the prostate. This can result in painful urination, difficulty urinating, and frequent urination. It can also result in pain within the abdomen, groin, and genitals, which can lead to painful ejaculation. Treated in conjunction with prescribed medications and procedures, physical therapy can provide significant relief for men experiencing these symptoms.

Constipation

Many people do not often realize that when our bowels are not moving appropriately, it can lead to disruptions throughout the entire pelvic floor. Increased straining and pressure within the rectum can create overactivity within the pelvic muscles. When these muscles are overactive and forget how to appropriately lengthen and relax, sexual intercourse can begin to feel painful. It is also possible that the presence of dyspareunia may have resulted in constipation as they are very closely tied in together.

Sex is a beautiful and natural life experience that should never be associated with fear, anxiety, or pain. Many believe that by simply having intercourse repeatedly, it will eventually get better, when in fact, it may worsen the dyspareunia. If you or someone you know is experiencing any of the above listed symptoms associated with dyspareunia, reach out to your local pelvic floor PT to see if physical therapy is right for you.

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