A few years ago, I participated in a Women’s Health Fair with my pelvic health team from Greenville, SC:
If you notice in the photo, we had a “Test Your Women’s Health IQ” game at our booth. The premise: 10 True/False questions… with an awesome prize if you get them all right. So, we had a group of about 4 or 5 guys (mid 20s-30s, all working for some tech company, I believe) come up to our booth, and confidently ask to take our test. The test was going pretty smoothly, and they were actually doing surprisingly well….until we reached this question:
True or False. It is normal for women to have discomfort/pain during sexual intercourse.
The guys chatted among themselves briefly, then confidently said, “Yeah, that one’s true… not always, but sometimes, yeah.”
Seriously guys?? In that moment, I felt a mixture of annoyance that there really are so many people out there who believe that women should have pain during sex, and also a whole lot of compassion for the poor women who may or may not have these guys as sexual partners.
Unfortunately, I hear this misconception frequently. Pain during sexual activity is fairly common (up to 1 in 5 women have pain during sex!), and somehow, women became convinced that this is “normal” and they just have to “deal with it.” But, I’m hear today to tell you that is not true!! There really are so many things that can cause pain or discomfort during sexual activity, and there are so many things that you can start today to help!
First things first, if you or your partner is having discomfort or pain during sexual activity, it is very important to be medically evaluated. Pain can be caused from urinary tract or vaginal infections, STDs, ovarian cysts, low estrogen, endometriosis, vulvodynia/vestibulitis, overactive, tender pelvic floor muscles**, abdominal scar immobility (yes, that c-section can play a role!)…and many other things! So, your first step is to call your medical doctor and get evaluated. I know that for some people, talking with a health care provider (HCP) about sexual problems can be very uncomfortable–but just remember, we’re professionals. We hear these things every day, and guess what? It’s very very unlikely that you will surprise or shock us by what you say. So, try to get past the embarrassment you may feel, and talk with your HCP. I think you’ll be very very happy you did.
**See note at the bottom of this post
Once you have been evaluated , here are 5 tips to help to improve pain during sexual intercourse!
1.Communication is Key. Yes, between you and your health care provider–but more importantly, between you and your sexual partner. I often treat men and women who will tell me that their partners have no idea that they are having discomfort during sex. It’s easy for people to see sexual pain as a “me” problem–but if you are having pain with sexual activity with a partner–it really is an “us” problem. Approaching the problem together can be so so helpful! It tends to be much less isolating, and often, people will find that they can have more enjoyable sex with better intimacy in the process.
2.Lubrication. Lubrication. Lubrication. There is absolutely no shame in using lubricant during sex. In fact, I recommend it for everyone! Using a quality lubricant can reduce pain significantly! Typically, I recommend a water-based lubricant like Slippery Stuff or Sliquid–but I have had good success with my clients using Coconut Oil or even Olive Oil (be careful if using condoms though or if you are prone to infection). Several gynecologists I know especially recommend a natural oil for women who have vulvodynia or vestibulitis/vestibulodynia.
3.If At First You Don’t Succeed…Try A Different Position. Seems pretty basic, right? But many couples will get in habits of using the same positions, and sometimes, position alone can make all the difference in the world. A different position changes how anatomy interacts, so depending on why you are having pain, a new position may be much more comfortable. If you’re having pain while on top, try switching to the bottom or on your side. And, pillows are your friend. Use them to support your legs or back to help you be more comfortable.
4.Foreplay. Pain can really impact the mood. Many times, couples who are struggling with pain during sex will find that sexual desire and arousal become significantly impacted. Setting the mood, and making time for romance and foreplay can help to improve arousal. Arousal is really so important as there will be more natural lubrication and overall body relaxation which should help to improve the experience.
5.Don’t be afraid to ask for help! These little tips are meant to be helpful suggestions–but they won’t necessarily be a fix for many people who are having pain! If you or someone you know are struggling with pain during sexual activity, it really is important to get some help! Pain during sexual intercourse should not be something you have to “just deal with.” I don’t care if you’ve 1) had a baby 2)have a partner who happens to be larger 3) have some dryness as you’ve gotten older 4) have any other excuse for why YOU having pain is normal. Pain is NOT normal. Take the first step–do something about it today!
There are so many wonderful resources out there for people who are experiencing pain during sexual intercourse! Here are a few books I recommend:
Sex Without Pain, by Heather Jeffcoat, PT
Excellent resource by Heather–who happens to be a Duke alum! This book is a self-treatment guide for those experiencing pain with sexual activity.
To Bed Or Not To Bed, by Steve and Vera Bodansky
This book is one I often recommend for those struggling to experience pleasure with sexual activity. Although explicit (**warning), this book does provide step-by-step recommendations to make sex more pleasurable– and also covers other information on romance, foreplay, etc.
Reviving Your Sex Life After Childirth by Kathe Wallace, PT,
This book recently came out about a year ago, and is based on tons of wonderful research by my friend and colleague Kathe Wallace. Kathe has taught pelvic floor education for professionals for years, and this book is awesome!
As this is my first post dedicated to sexual dysfunction, this post is just scratching the surface of a HUGE topic! What else should we learn about? Let me know in the comments below!
**Yes, tender pelvic floor muscles can significantly contribute to pain or discomfort during sexual activity. Remember, the pelvic floor muscles stretch to allow for penetration and contract to provide pleasure. If the muscles are tender, hypervigilant, or overactive, they can contribute to pain or discomfort. If you believe your muscles may be a factor in the pain you are experiencing, it is definitely worth your while to seek out evaluation and treatment by a physical therapist trained in treating pelvic floor muscle problems. Give me a call if you live in the Atlanta area, or feel free to shoot me a message if you need help finding someone near you!