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Pain With Sex Isn’t Sexy

Pain with sex isn’t sexy, and while this is really common amongst women postpartum (PP), not enough people are openly talking about it. The lack of talking about sex in our society, in general, makes this problematic leaving many women to think, “it must just be me…” This creates additional feelings of shame, depression, anxiety, isolation, and decreased levels of connection with partners. All of which further add to the challenges of motherhood with adjusting to new roles and the pressures around “bouncing back” which includes intimacy. For this week’s Real Talk I’m choosing to share about this important topic in hopes of normalizing this pain, explaining the why behind it, and most importantly sharing that there are solutions! Just because this is common, doesn’t mean it has to be your forever. Read that one more time, xoxo

On average, the research is finding:

  • 41-85% of women experience pain with sex at 2-3months PP
  • 25-38% are still experiencing this discomfort at 6-12mo PP
  • 24% are still experiencing this at 18mo PP

I share these stats to say, Mama, you are soooo not alone. This pain is not in your head, no you don’t need to have an extra glass of wine to relax beforehand, and no you don’t need to just try harder and through the pain to get past it. That last one especially, is NOT helpful. I can’t tell you the number of times I hear these comments from my patients, and how many of them have been told that those are the only solutions from other medical providers. Those recommendations are so hurtful and minimizing on so many levels, not to mention the fact that they are NOT solutions. Pain is the body’s way of telling us it needs help vs keep pushing through. The good news is, pain with sex is totally treatable and SO much can be helped by connecting with a pelvic floor physical therapist to help you unpack the WHY behind your pain. We help with bringin’ sexy back, because girlfriend, you deserve to experience intimate moments with yourself and your partner pain free!!

Common reasons for WHY pain can happen during sex:

  1. Scar tissue: scar tissue is a type of connective tissue made in the body out of cells and collagen fibers. It is used to reinforce an area of the body that has undergone an injury or surgical repair. Examples include: cesarean section scar, vaginal tearing and/or episiotomy incision, hysterectomy, radiation and chemotherapy to pelvic organs, cyst removal, endometriosis, and abdominal surgeries. Scar tissue can develop sensitivity, making it painful at rest, to touch, during movement, and/or when stretched.
  2. Pelvic floor muscle tightness: The pelvic floor is a muscular sling that supports the internal organs of the pelvis, controls bowel/bladder/sexual functions, and is the foundation of our core system. The pelvic floor can develop muscle knots (aka trigger points) or spasms which can create pelvic pain internally or externally, and/or make penetration significantly uncomfortable. This tightness can be due to pelvic floor weakness or overactivity, coordination challenges with abdominal muscles, pregnancy and delivery injuries, scar tissue, and past pelvic trauma.
  3. Pelvic Organ Prolapse (POP): POP is a condition where one or more of the pelvic organs has descended from their normal position. This is often caused by injury to the muscles or tissues that support the pelvic organs. The main cause of POP is usually from pregnancy and childbirth, especially vaginal childbirth.The descent of one or more of the pelvic organs can make different depths of penetration uncomfortable and/or affect the depth of penetration that’s possible.
  4. Lower Estrogen levels: Estrogen is responsible for hydrating vulvar and vaginal tissues, as well as, providing the female body with its source of natural lubrication within the vaginal canal. Thinning of the vulvar and vaginal tissues, as well as, decreased lubrication can contribute to sensitivity externally and/or with penetration. Examples where lower estrogen levels occur can include the following:
    1. Breastfeeding
    1. Adrenal fatigue
    1. During perimenopause/postmenopause
    1. Irregular/absent menstrual cycles
  5. Nerve injury: Nerves are the relay channels that help the muscles of our bodies communicate with our brain. There are specific nerves that branch from our spine to the muscles in our pelvic floor that help to coordinate all the important events that happen down there: core activation, bowel/bladder/sexual functions, and lengthening of the tissues to bring babies into the world. Delivery is a beautiful yet challenging event on a woman’s body. It’s common for injuries to occur to the surrounding structures and tissues of the pelvic floor and vaginal canal during this process. In come cases, this can include a nerve injury which can cause pain internally or externally to the vulva and/or vaginal canal.

Good news! Pelvic Floor Physical Therapist are trained to support you through all of these challenges. You don’t have to “just deal with it,” or accept this as your forever. If you need help overcoming pain with intimacy, I would be honored to help you on your healing journey.