When Sex Hurts

dys·pa·reu·ni·a, dispəˈro͞onēə/
noun. definition: difficult or painful sexual intercourse.
Source: Google

Dyspareunia- Medical term for painful sex for a woman. Truthfully, it really tells us very little about what is actually happening. The cause of the pain could be related to one or a combination of several things affecting a woman’s ability to have pain-free and enjoyable sex. As a pelvic floor physical therapist, I usually begin by asking my patients to describe how it hurts. Sometimes, the emotion of the pain is so overwhelming that is difficult to “describe”, so I ask questions. Lots of questions. I want to understand the possible causes and that requires really getting into some detail.

Describing the pain

For women dealing with endometriosis, I believe that if you understand what may be asked of you and equally importantly, why we are asking all of these questions, you will be better prepared to seek help and get the most out of your medical care. So, let’s go... here are some of my questions:

• Does it hurt to just touch the outside of the vagina or clitoris?
• Does a finger or tampon hurt?
• Does the opening to the vagina hurt?
• Does it burn? Ache? Shooting pain?
• If you are having penetrative sex with a partner with a penis (or toy), does it hurt immediately or maybe only with movement?
• Does it feel like something is blocking the penetration?
• Is the pain only present with deeper penetration or all of the above?
• Can you change positions to get comfortable?

Just answering some of these questions will help your healthcare provider begin to understand what may be contributing to your pain, even before any type of exam is performed. We can start to think that perhaps there are some skin sensitivities or pelvic floor muscle spasms. Perhaps inflammation from endometriosis is contributing to the pain.

What are pelvic floor muscle spasms?

One very important point for women who experience painful sex and a have diagnosis of endometriosis is that your pain may be coming from the inflammation related to the endo, but there are often other contributing factors such as pelvic floor muscle spasm. Sometimes, this spasm can contribute to skin and nerve sensitivities and discomfort if it goes on long enough. Imagine squeezing your hand in a fist and holding it tight. Squeeze tight and keep holding, now try to let go. Your skin is whitened due to lack of blood flow and your fingers are crampy as you try to move them around. Your pelvic floor may be squeezing all the time, irritating the surrounding nerve and skin tissue.

Guarding against pain

Sadly, if sexual activity is painful, our bodies will often “guard” against that pain subconsciously. This can contribute to pelvic floor muscle spasm. Subconsciously means that it will be very hard (nearly impossible) for you to just “have a glass of wine and relax” it away. Please remember if anyone ever tells you that the pain is somehow under your complete control and you are “not trying hard enough” or that “you don’t love me enough", it is not your fault! In some cases, it may be a partner, spouse, friend saying these things. Or maybe it is you own inner critic wondering why you can’t enjoy this supposedly awesome thing called sex. Maybe you enjoyed it previously and now cannot. Whatever your personal journey with dyspareunia, understand that there are often multiple contributors to this pain.

The good news, there are treatments that can help resolve dyspareunia. I look forward to sharing things you can do for yourself and providing some tips about seeking proper care. Read more from Erin here