These ARE My Definitions of Painful Sex
Let’s talk about dyspareunia (dyspareunia = painful sex) without vaginismus (vaginismus = spasming of muscles that don’t allow any penetration") or vestibulodynia (vestibulodynia = pain at the opening of the vagina).
You see, ideally, if you are a woman, your pelvic floor muscles should relax during sexual activity. Whether or not we are talking about penile penetration, finger penetration, dildo penetration, it doesn’t matter, the female body thinks that this is another opportunity to reproduce. The pelvic floor muscles will relax and the cervix will even ascend to allow more room for penetration.
If you have painful sex, it is very possible that the pelvic floor muscles are too tight which is creating a situation where penetration of any kind is uncomfortable and the typical relaxation component of sex does not happen. This could be why some women feel that their partner is hitting a wall with thrusting. In addition to overactive pelvic floor muscles, some women are not able to lubricate enough naturally in order to ease the penetration and thrusting. In this case, it is a good idea to use a lubricant such as Slippery Stuff, coconut oil or olive oil (FYI - oils can break down a condom). There is no shame in using extra lubrication. If one partner cannot enjoy the experience, then it effects the other partner as well. Lack of lubrication doesn’t mean that you are not into the situation, this could be stemming from a variety of reasons.
There is a lot that can be done to relieve the simple form of painful intercourse (dyspareunia) – tight muscles and not enough lubrication. Pelvic floor physical therapy can certainly help.
If you have tight muscles in the abdomen, inner thighs, buttocks, hamstring and pelvic floor, it’s important to stretch these muscles daily. If the abdomen, inner thighs, buttocks or hamstring are tight, it’s very, very likely that your pelvic floor muscles may be tight too. The most recent research I’ve read determines that a 30 second stretch (in real time, no counting in your head!) is the most effective way to get a lasting result from your stretch. No bouncing, no repetition necessary. Just a 30 second stretch once a day. Determining how to stretch these muscles correctly may be a little tricky and this is where a therapist comes in pretty handy. Sure, you can google search a certain stretch and, if you have no other issues, this should be okay. However, if this increases your pain or creates new symptoms, stop immediately and I legally need to say: consult your healthcare provider. Call them and say “I stretched and now I hurt.” Can you imagine?
Guess what. Most of the time, my patients feel like their muscles are tight, but they actually are not tight. The fascia is tight. Their hamstrings can have normal length, which means they aren’t “tight” and don’t need to be stretched daily. They only feel tight. Being tight and feeling tight are two very different things.
I have patients stretch their pelvic floor muscles by doing diaphragmatic breathing. This is an active…activity.
Next, you’ve got to address the overactivity in the pelvic floor. This means that getting the vaginal muscles assessed by a pelvic floor physical therapist could be really valuable. Releasing trigger points and lengthening shortened muscles is vital to learning to relax these muscles during intercourse. If you cannot get a therapist to assess and treat you, many people have done well with self trigger point release in the vagina or with using items such as a pelvic wand. These are tools that you can use at home to gently work on trigger points. Just – be careful. You can get into some awkward positions trying to use your finger or a wand, so if you feel more pain or you flare after each attempt at using your finger or a wand – stop. Just. Stop. And call your healthcare provider. Call and say “I was trying to release a trigger point in my vagina and now I’m hurting.” See what happens.
Another huge component of getting to pain-free intercourse is a dilator program. I have a lot to say about this. First off, a lot of physicians are familiar with dilator programs and will recommend them to patients. However, I don’t think that you can just give a dilator to someone and tell them to use it and they’ll get better. There’s a lot of anxiety, emotion and physical pain around penetration for someone who has painful sex. So, to give someone a dilator without instruction is not taking care of the whole picture. I believe that an explanation behind why a dilator program is helpful and how to use it correctly is a huge part of rehabilitation.
Your doctor can also prescribe you vaginal suppositories to help relax the pelvic floor muscles. Some people ask me if this is just kind of a band-aid effect. They worry that using a suppository before sex doesn’t fix the problem, just masks it. I don’t think that it is just covering up the problem. If your muscles are encouraged into a relaxed state on a regular basis, then they will slowly begin to re-learn how to actually relax because they will be out of a tensioned state. I consider this muscle re-training. Your muscles are then worked on by your stretches, dilator program and physical therapy. I think that a suppository is a nice adjunct to everything else that you are doing and it speeds up the rehab process. That is, if the suppository is used on a daily basis. If it is used only before sex, I do still think there is a positive change taking place, but it might not be as powerful or as rehabilitative as daily use. This is something to discuss with your physician.
Lastly, if you can, talk to your partner. Don’t leave them in the dark. Typically they want you to enjoy the sexual experience so clue them in as to what’s going on and clue them in on your progress. I hear from a lot of women that once they have pain with sex, their partners are afraid to have sex with them because they don’t want to hurt them. Communication can help with this. So, please, keep your partner in the loop.
These are the three categories I separate painful sex into. If your therapist classifies things differently, that’s fine, but this is how I operate. Mind you, this is not textbook information, this is my casual information based on my experiences in treating painful sex:
Pain with entry: Like a fat man going through a skinny door.
Thrusting pain: The friction of the back and forth is like sandpaper.
Deep pain: You try to control the depth of the penetration because hitting the back of the vagina doesn’t feel good and can even take your breath away - in a bad way. Not a romantic way.