Ways Pelvic Physical Therapy Can Get You Back to Pain Free Intercourse

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Dr. Nicole Freitas, PT

Did you know that many individuals experience pain with sexual intercourse? In fact, at one point within your lifetime, 40% of women will suffer from painful intercourse. Some contributing factors to dyspareunia (painful intercourse) may be postmenopause, postpartum, endometriosis, interstitial cystitis, change in sexual behavior, sexual trauma, frequent infections, abdominal surgery, hysterectomy, constipation, hip pain, etc.

Many individuals think there is nothing that can be done to mitigate the effects of painful intercourse, however, that is a common misconception.

If you are someone that cannot enjoy intercourse without feeling discomfort, ultimately leading to fear, embarrassment or anger, then pelvic physical therapy is for you!

Just like any other muscle in the body, the muscles surrounding your vaginal canal can become aggravated, leading to tightness and pain. The muscles in this region are called your pelvic floor muscles. At times, they can require specialized care to decrease pain just like your shoulder or neck muscles. Although the pelvic floor may seem of primary concern, many hip muscles attach to the pelvis, contributing to pain and tightness of the pelvic floor as well. There is even a hip muscle that attaches internally, alongside the pelvic floor muscles, and when this muscle is restricted it refers pain to the pelvic region.

Benefits of Pelvic Physical Therapy

  • A pelvic physical therapist specializes in the evaluation and treatment of these muscles and can come up with a treatment plan directed towards your individual needs.

  • Every patient is different, however treatment to resolve your painful intercourse will be tailored around:

  1. Soft tissue mobilization: Targets those aggravated pelvic and hip muscles, bring blood flow to the area, and send signals to your nervous system that these muscles should not be pain provoking

  2. Relaxation techniques: Benefits the pelvic muscles and your entire nervous system

  3. Strengthening: Restore the optimal function of the pelvic floor muscles, and possibly hip muscles that are contributing to your pain

  4. Evaluation of the hip muscles: Unhappy hip musculature can contribute to pelvic pain, especially with intercourse

    • Sometimes pelvic pain stems simply from hip dysfunction and relaxing the hip musculature can contribute to decreased pain with intercourse

  5. Soft tissue health and lubrication usage: Assists with recovering and avoiding further aggravation of the pelvic floor muscles

    • With aging, the elasticity of the vaginal tissue changes. Just like moisturizing your face is of utmost importance, the vaginal tissue should be lubricated to maintain the pliability.

  6. Use of equipment:  Examples include dilators, biofeedback and e-stim for relaxation or strengthening assistance

  7. Sexual positioning suggestions: Optimizing the positioning of the pelvic floor aids in relaxation of the muscles involved with intercourse

What You Can Do Right Now to Decrease Your Pelvic Pain

  • Reverse Kegels: Many individuals hear about performing kegel exercises to strengthen their pelvic floor musculature. However, they are not always the answer. Sometimes your pelvic floor muscles may be too tight or shortened and that can be causing pressure, pain or discomfort in your pelvic region, especially with intercourse. In order to increase blood flow and healing, reverse kegels can be performed to elongate the already tight pelvic floor muscles. Here’s how to perform a reverse kegel:

    • Lay down in a comfortable position.

    • Inhale through your nose allowing your abdomen to rise and your diaphragm and pelvic floor to expand. Think of your pelvic floor muscles lengthening and widening with each inhalation.

    • Breathe out through your mouth and allow the pelvic floor to return to its resting state.

    • Practice this exercise 3 times per day for 3 to 4 minutes at a time.

    • Avoid pushing outward as your perform the exercise.

  • Stretches for pelvic pain: Pain with intercourse can be caused by tightness of the pelvic floor muscles. Try these simple stretches to improve pelvic tightness!

    • Happy baby pose

      • This stretch targets and lengthens the pelvic floor and hip muscles to relieve tension in the target area.

    • Piriformis stretch (lying on your back or sitting upright)

      • The piriformis is an important pelvic stabilizer, attaching to the front of the sacrum and inserting at the femur. Commonly, a tight piriformis causes pelvic pain.

    • 3 way leg stretch

      • The hamstrings, adductors and abductors of the hip attach to the pelvis. Not only are the pelvic muscles important to lengthen to improve pelvic pain, but relieving tension in these muscles are essential as well.

    • Deep squat stretch

      • Similar to the happy baby pose, a deep squat stretch improves pelvic pain by stretching pelvic pain and allowing for relaxation.

    • Adductor stretch

      • The adductors run along the medial thigh and attach to the pelvis. Targeting this area relieves unnecessary stress on the pelvis.

    • Lacrosse ball release to target the deep hip rotators

      • The deep hip rotators attach from the sacrum to the lateral hip and are commonly a cause of pain due to its close proximity of the pelvis. Using a lacrosse ball to target tension in these muscles, you can apply mild to moderate pressure to the area to communicate to your nervous system to relax.

Feel free to contact Inner Dynamics Ocean at (732)508-9926 or Inner Dynamics Toms River at (732)506-3471 to hear about the ways IDPT can get you back to pain free intercourse.

Tamra Wroblesky