Dyspareunia (Painful Intercourse)
Physical Therapy can effectively treat painful intercourse.
Pain during intercourse, also known as dysparuenia, is very common. Nearly 75% of women have had pain during intercourse at some time during their lives. For some, the pain is only temporary; for others, it is a long-term problem. For many women, the search for a cure for painful intercourse can be a frustrating and unproductive journey of referrals from one doctor to another (gynecologist, urologist, pain specialist). Adding to the frustration, many are told to consult a psychologist or psychiatrist because the pain “must be in your head.” But their pain persists because it actually occurs in the pelvis, precisely where they feel it. The fact is that more often than not, pain with intercourse can have a very real physiological source.
Other possible medical diagnoses that can result in painful intercourse can include: vestibulodynia (vulvar vestibulitis) or vulvodynia, interstitial cystitis, painful episiotomy, vaginal dryness, pelvic floor muscle spasm, endometriosis, adhesions/scar tissue after pelvic surgery, and slip/fall related trauma to the pelvis, all setting the stage for pelvic floor muscle spasm. Once evaluated by a physician to rule out other medical conditions or diseases, the musculoskeletal causes of dyspareunia need to be addressed.
When a patient experiences any of the causes listed above, she almost always has pain with intercourse related to muscle spasm of the pelvic floor. Often in the literature, the term vaginismus is used interchangeably. Contrary to popular belief, it is unlikely that these patients' muscle dysfunction will self-correct and they are unable to “just relax” to make the pain go away. They require the help of a pelvic floor Physical Therapist to elongate the muscles, eradicate trigger points, and make both the fascial and muscular systems healthy again.
Patients with the following symptoms should be assessed by a Pelvic Floor Physical Therapist:
- Pain with penetration
- Inability to insert a finger or tampon
- Abnormal pain with gynecological exam
- Pain with orgasm
- Vulvar burning
How does Pelvic Floor Physical Therapy Help?
The initial evaluation will include a detailed history, which will determine the patient’s major complaint in addition to linking the sexual problem with other systems, such as urinary function problems, or even low back pain. The therapist will then assess the patient's posture, mobility, and strength, as well as her movements and breathing, in order to get a sense of how she uses her body. The spine, sacrum and pelvis are checked for alignment and mobility. The muscles of the pelvis, abdominals, gluteals, low back and legs are assessed for length, strength, and presence of trigger points. Often trigger points are found in the pelvic floor, internal muscles of the vagina, inner thighs, buttocks, and hips. Next the therapist will assess the vulva and pelvic floor. The therapist will do a full viseral and manual exam of the vulva, perinum, and vaginal wall, and the pelvic floor muscles are palpated to note areas of tenderness. In the case of women who have given birth or had surgery, areas of tenderness caused by scar tissue from surgical or episiotomy stitches are identified. The internal exam allows the therapist to assess pelvic floor muscle tension and tightness, tone, range of motion, and muscle strength.
This thorough evaluation allows the therapist to design a treatment program specific to musculoskeletal causes of dyspareunia. This will include one on one treatment with the therapist as well as teaching a home program of self-treatment of the pelvic floor, stretching exercises, and deep breathing with behavioral techniques. Internal self treatment may require the use of vaginal dilators. Typically, dilators of increasing width are gradually introduced and the patient continues to work with them at home until the largest dilator can be inserted without pain. In many cases, if the pain is severe, we will work with the referring physician and ask for a muscle relaxant suppository to be prescribed and used prior to self-treatment, physical therapy, or intercourse attempts. To ensure the best possible results, the therapists at Sarton Physical Therapy always spend an hour with each patient during every appointment.
Let our expert Physical Therapists with advanced board certification in pelvic floor physical therapy help. Please contact Sarton Physical Therapy with any questions or to have your patients schedule an appointment.