Pelvic Health in Relation to Painful Intercourse

Pelvic pain during intercourse (or in medical terms, dyspareunia) can have varying causes and Physical Therapists can help with many of those!

Much of the time, this pain has to do with the position and/or tension of the pelvic muscles, fascia, scar tissue, nerves and/or bones and the relative input of the nerves in to those muscles and skin within the pelvis, vagina, introitus and perineum. Disruption of your efficient alignment, tight muscles or weakness in these muscles can all contribute to pelvic pain, but definitely don’t sound as daunting or vague as the term “dyspareunia”! As Doctor’s of Physical Therapy, we call these “mechanical” and “neuromuscular” issues. Like a car, your mechanics and alignment need to be sound for optimal function. And to have the best strength, your brain and nervous system (the “neuro” part of the term “neuromuscular”) need to talk to your muscles (the “muscular” part of the term “neuromuscular”) as clearly and quickly as possible.

Imagine you have a sore neck and shoulders. You probably can assume that you were overusing your upper traps, were doing some weird, compensatory motion to make up for weakness of a nearby muscle or were just sitting at your desk with poor posture…. or all of the aforementioned! Now, that could make sense to you as to why when you go to get a massage, your neck and shoulders are so painful. This same idea occurs within the pelvis, but without the option for you or your friend to notice and cue you to “Relax, you look so tense!” If it is your pelvic floor muscles that are over activating, doing some weird, compensatory motion to make up for a weak core, have inefficient alignment of the pelvic bones attached to them… or all of the aforementioned, then there’s a chance you will have pain when having intercourse. Our pelvic floor muscles are just like all the others, except you cant see them from the outside and people don’t often talk about them. So lets keep talking about them!

Another big contributor to keep in mind, are the nerves that run within these muscles, fascia and joints we just talked about, and remembering that they originate in the spine. As the nerves exit the spine and continue down to innervate the organs, muscles and skin of the pelvis, it is imperative that they have a clear path to run. If these paths are inhibited by issues such as: tight sections of the spine, crooked tailbone or just tight muscles and fascia round the nerves, this can contribute to pain or weakness within the area the nerves were intended to innervate.

As Doctors of Physical Therapy, we are specialists in soft tissue and joint mobility, function and biomechanics and with that, we can help to ensure optimal function specifically of and within the pelvis, helping you to address the frustrating pain of dyspareunia. If infection, vaginal dryness, skin irritation or inflammation is the biggest contributor to your pain, then we can also work with other medical professionals, to help you to find the best team to address your pain.

For more information, feel free to contact any of our pelvic health specialists or schedule a free health screen!

By: Dr. Lauren Mallari, PT, DPT, Women’s Health Specialist