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Is Pain with Sex Normal?

Pain with sex can be so frustrating and embarrassing. It may even affect your relationship with your partner! While sometimes pain with sex can have a medical cause, it’s also a big red flag of pelvic floor dysfunction (which is very fixable!). Let’s answer the question you may be afraid to ask out loud… why do I have pain with sex?

The Role of our Pelvic Floor

Our pelvic floor muscles lie like a hammock in the bottom of our pelvis and form the bottom of our core. These muscles have a few very important roles: supporting our internal organs, providing stability to our back and hip region, and providing sphincter control around all of our openings. Because these muscles surround the vagina, they play a large role in sexual function.

pain with sex

Pelvic Floor Tightness

Pain with intercourse often indicates an issue with the pelvic floor muscles. (It’s actually a screening question I ask everyone who comes to see me for pelvic floor issues!) If the pelvic floor muscles surrounding your vagina are tight and you have difficulty relaxing them, sex may be difficult, uncomfortable, or painful.

How do I know if I have pelvic floor tightness? The only way to truly know if you have pelvic floor tightness is through an exam by a pelvic floor physical therapist. However, here are some other common symptoms of pelvic floor tightness that MAY OR MAY NOT be present:

  • Current or a history of back, hip, glute, or tailbone pain
  • Chronic constipation
  • Difficulty relaxing to urinate
  • Incomplete emptying of bladder or bowels
  • Leaking with jumping, running, lifting, coughing, sneezing, or laughing
  • Urinary urgency or frequency

Low Estrogen

Our estrogen level also plays a role in comfort with intercourse. If you have low estrogen, you may experience vaginal dryness, which may also contribute to pain with sex. Common instances of low estrogen occur with breastfeeding and menopause.

How to Resolve Pain with Sex

Now let’s get to the answer you’ve been waiting for – how do I resolve pain with sex? Addressing pelvic floor tightness, breathing, and using the right lubricant for you can make a big impact!

Fix Your Pelvic Floor Tightness

Relaxing the pelvic floor muscles is one of the biggest keys in resolving pain with sex. There are a few different ways we can get these muscles to relax:

  1. Pelvic Floor Stretching – Try the exercise below to help relax your pelvic floor muscles.
  2. Mindfulness or Meditation – Calming your entire body and nervous system can help relax your pelvic floor muscles. This often makes such an impact, because many of us hold tension in our pelvic floor muscles. If you clench your jaw, always have tightness in your neck muscles, or get headaches often, it’s very likely that you are holding tension in your pelvic floor muscles as well.
  3. Deep Breathing – This is actually a super important piece! Let’s talk about breathing more in depth next.

Deep Breathing

Our diaphragm and breathing can make a HUGE impact on your pelvic floor, especially when it comes to treating tightness. Really?! Something so simple? Yes!

Think of your core as a soda can. The top of our can is our diaphragm, the bottom is our pelvic floor, and the sides are the deep stabilizing abdominal and back muscles. These muscles all work together to regulate the pressure in our abdomen and create stability for our core. One of the biggest ways our core regulates pressure is with movement of both the diaphragm and the pelvic floor during breathing. When we breathe in, our diaphragm and pelvic floor both move downward. When we breathe out, they both move upward.

Two big things here – 1. If we are not using our diaphragm to breathe (chest and shoulders rising with the inhale), we’re not getting that great movement of our pelvic floor with each breath. This can contribute to pelvic floor tightness, as well as cause too much downward pressure on our pelvic floor (which can lead to other issues like peeing your pants). 2. We can manipulate our breathing to directly impact the pelvic floor! By using proper breathing patterns and focusing on big, deep inhales, we can help our pelvic floor muscles relax!

360 Breathing

So how should I be breathing? Check out the video below of my favorite breathing exercise. I literally give this exercise to everyone I see for pelvic floor issues – that’s how important it is! This is a great exercise to do daily to help relax the pelvic floor muscles. It is also super helpful to teach your body how to breathe deeply again so you can get that great pelvic floor movement with each breath throughout the day.

Let’s Talk Lube!

Using a lubricant can help to reduce friction, especially if you often experience vaginal dryness (like when breastfeeding or around menopause). Did you know there are different kinds of lubricants? Let’s talk about the 2 most common types I recommend.

Water Based Lube: This kind has a natural texture and is easy to wash off. It’s safe to use with condoms, toys, and dilators. However, they often do not last as long as other types of lube and may need to be reapplied. Examples of good water based lubricants include Slippery Stuff and Good Clean Love.

Silicone Based Lube: This is a long lasting lubricant – you won’t need much and no need to reapply. It’s a great choice for women after menopause or anytime you are experiencing vaginal dryness with low estrogen levels (like when breastfeeding). It is safe to use with latex condoms, BUT should not be used with silicone toys. Another issue with silicone based lubricants is that it can get a little messy (cleaning yourself up and the sheets). Uberlube is my favorite silicone based lubricant, and it is the lube I recommend the most to women who experience pain with sex.

*With all lubricants, you want AVOID ingredients that mess with your vagina’s environment, such as parabens, bulking agents, microbicides and preservatives, added flavors and warming gels, glycerin, glycols, grapefruit extract, petrochemicals and mineral oils, and chlorhexidine.*

See a Pelvic Floor Physical Therapist

Resolving pain with sex is a big goal that many of my clients have! (And it’s an important one!) There are a lot of other exercises and manual techniques that we can do to relax your pelvic floor muscles and the surrounding core and hip muscles. It’s often very helpful to be evaluated by a pelvic floor physical therapist to see exactly what all may be contributing to your pain with sex. If sex is painful for you, there is so much that can be done so you can finally enjoy time with your partner again!

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