At conferences of the International Society for the Study of Women's Sexual Health (www.isswsh.org), there are many presentations about female sexual function.
We learn that women with "hypoarousal disorder" (little or no sex drive) can regain healthy arousal. (Yes, please!)
Hormone replacement therapy can balance the 70% loss of estrogen that happens during perimenopause (and keep us cool!)
Women over 60 can enjoy a healthy sex life. (What??)
And women can regain penetrative sex without vaginal pain. (Tell me more!)
Women describe their distressful sensations during or following penetration as burning, itching, dryness, stabbing, and/or deep internal pressure.
Many women think that it's normal to experience some pain with intercourse. Having constant pain during most sexual encounters is not normal. Continuing to experience distressful symptoms can lead to feeling shame, guilt, and avoidance of intimacy altogether. Some women are too embarrassed to tell their doctors about their "private" issues, not even their closest friends!
Females (and those who define themselves as such) who are in relationships may be concerned that their partner may leave if there isn’t any intercourse. So they continue to endure painful sex to keep the relationship intact. Over time though, pain can spill over into sitting pain, lower back pain, or disrupt bladder and bowel function.
What's Going On?
If you've seen a sexual medicine doctor and continue to feel pain with penetrative sex following their good diagnosis and treatments, here's what could be happening:
You’ve developed a cycle that involves fear of pain which results in the nervous system sending threat messages to the brain. If there are too many threat messages sent to the brain, it sends your body pain and signals your pelvic muscles to tighten and guard as protection.
With repetition of this pattern, your nervous system becomes more sensitive to attempts of intimacy, even reacting to your thoughts of sex as a threat. It communicates these potential or actual danger messages to the brain.
When the brain receives too many potential or actual threat messages, it wants to do a better job of protecting you, so sends more pain or other pelvic distress symptoms.
Pain is the brain's most potent way to tell you something's wrong and to take action. A common reaction is to avoid the triggering activity, so we stop engaging in sexual intercourse. While this makes sense short-term, it's not a great long-term solution for your emotional, physical well-being and for a healthy intimate relationship.
Overactive Pelvic Floor
Chronically tight pelvic floor muscles are a major underlying cause of vaginal pain. Along with feeling pain, many women say they feel tense within their pelvis, inner thighs, hips, and lower back muscles. As the brain receives lots of threat signals, it tells muscles to guard - day and night - as a form of protection.
Maybe you’re noticing when you stand up from sitting, you feel creaky and hobble a few steps, or noticing that you’re walking at a slower pace. Perhaps sitting cross-legged is not on the table anymore. The brain has signaled these areas to be more rigid, so coordination of movement is not as smooth.
Having chronically tight pelvic floor muscles can also lead to symptoms of urinary frequency, urgency, frequent UTIs, constipation, and abdominal bloating. So if you're experiencing other distressful pelvic issues on top of vaginal pain during sex, there's a relationship.
Reducing tension in the pelvic floor, lowering fear responses, and sending soothing to your nervous system can help heal vaginal pain.
Begin your healing journey
Vaginal pain can be effectively treated with pelvic physical therapy.
Evelyn Hecht is a Master Clinician of Pelvic Physical Therapy and a certified biopsychosocial chronic pain rehab practitioner. She deeply understands pain, pelvic issues and can guide you to regain optimum pelvic function - such as pain-free sex.
In her 25 years as a pelvic physical therapist, she’s helped fifteen thousand patients recover. She offers many options for care, whether it is in-person, telehealth or virtual pelvic coaching.
Treatment for painful sex includes education in pain neuroscience, self-care healing techniques, and gentle manual & movement therapies. All to help reduce fear and muscle tension of the vaginal region, inner thighs, and hips.
You'll learn how to do breathing techniques, soften the pelvic floor and activate your parasympathetic, our “rest, digest, and sex” nervous system. You’ll practice mind exercises to feel calm.
Therapies may also include biofeedback and dilator training.
Contact Evelyn today by email firstname.lastname@example.org to start your healing.