Why does sex hurt?


We're all familiar with the idea of awesome, euphoric sex. It's everywhere. It's present in all forms of media, like with Daphne and Simon of Bridgerton (don't get me started on the foreplay issue).

For some of you reading this, you can think of a time you experienced it yourself. Some of you haven't. And some of you have, but are worried that you never can again. Maybe sex felt great, and now it feels terrible. Maybe it never felt great and you're wondering what's wrong with you.

Nothing is wrong with you. This is temporary.

There are so many factors to consider when we're talking about painful sex, or dyspareunia.

  • Hormonal changes
  • Pregnancy/postpartum
  • Perimenopause/menopause
  • Stress
  • Nervous system upregulation
  • Activity levels
  • Muscle strength and imbalance
  • Blood flow
  • Lubricant choice
  • Foreplay
  • Fascial mobility surrounding the pelvic floor and pelvic organs
  • Breathing pattern
  • Medications
  • Scar tissue
  • and more

*So* many factors. Not only this, but everyone's journey with painful sex is different. Maybe it's painful some of the time, but not all of the time. Maybe it didn't hurt a year ago but has progressively gotten worse over the past year. Maybe it has always hurt. In this post, I will focus on the pelvic floor's role in contributing to painful sex. In future posts I will cover the role of hormones, breathing, stress etc.

If you're unclear about what the pelvic floor is, you can learn about it here.  

When you experience pain with sex, do you know where you're experiencing it? Is it at the opening, or does it feel deeper? Is it a burning sensation? Does it feel like stabbing? Is it a sharp or intense pain with penetration? Are you experiencing achiness or pain during or after orgasm? Are only some positions painful, while others feel fine? These are all signs of pelvic floor dysfunction, and more specifically pelvic floor hypertonicity. This means the pelvic floor muscles are too active and are therefore sensitive.

Pelvic floor hypertonicity, like painful sex, may be due to a combination of many, many factors. You can read about those here.  

A hypertonic pelvic floor is one that cannot relax, cannot let go, and cannot lengthen. This can lead to a lot of symptoms, namely pain with sex. Jaw clenchers I'm looking at you.

What can you do about it? SO MUCH!

  • Desensitization
  • Perineal stretching
  • Deep diaphragmatic breathing
  • Happy baby stretch
  • Deep goddess squats
  • Myofascial trigger point release
  • Strengthening the transverse abdominis and glutes

The purpose of this post isn't to go into depth with each of these methods, however one of the more immediately beneficial treatments for your pain is going to be desensitization. If you experience pain, burning, numbness, tingling etc at the vaginal opening, you have to desensitize. There are a many approaches to this and every person is different in the approach they need. I say, keep it simple.

  1. Wash your hands and cover a finger with lube or liquid coconut oil.
  2. Gently rub the lube around the vaginal opening, approximately 1 finger tip depth if possible.
  3. Imagine your vaginal opening is a clock. Gently apply light pressure to 3 o'clock (it does not matter what your clock orientation is). If this burns, just maintain pressure.
  4. As you hold (up to 3 minutes!), pay attention and see if the sensation is increasing or decreasing in intensity.
  5. If it is decreasing, once it's at a tolerable level you can apply a little more pressure.
  6. If it is increasing, maintain at a light touch level of pressure. Don't release and don't press harder. Maintain for up to 3 minutes. If it continues to increase it's a sign of significant sensitivity, but the more you do this the more tolerable it will become.
  7. You can move on to 4-5 o'clock after you feel an improvement in sensation intensity, an increased tolerance to pressure, or after 3 minutes of pressure, whichever comes first.
  8. Repeat this process from 3 o'clock to 9 o'clock.

Do this *prior* to sex as a warm up. Just like we warm up for a run or a workout, we should be warming up our muscles for sex as well. Cold muscles don't adapt to activity as quickly as warm ones do! You can do this daily as well to continue to desensitize the superficial muscles and surrounding nerves.

Disclaimer: while you can do everything listed above, it will not be as effective or efficient as seeing a pelvic floor physical therapist. If you do not notice improvement or if you notice improvement, but the pain doesn't go away, seek help from a professional.

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