Dyspareunia is a medical term for painful intercourse, defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. There are more than 200,000 cases per year that are diagnosed, and many more cases that are unreported. It may be caused by infection, trauma, vaginal dryness, or malignancy. There are other conditions such as endometriosis, pelvic congestion, vaginismus, vulvodynia, and interstitical cystitis that can all cause pelvic pain. These diagnoses may require medical care, yet sometimes women receive treatment and continue to experience symptoms. Sometimes after being seen and assessed by a doctor, doctors may treat dyspareunia by the use of antibiotics for infection, topical estrogen for hormonal imbalances, and other creams like Lidocaine for pain relief.
A few other factors may also contribute to pain in women who have any of the above listed conditions, as well as women with none of them. One of those biggest factors is your pelvic floor. The pelvic floor is a large, bowl-shaped muscle group stretching from your pubic bone to your tailbone. Your pelvic floor controls your bladder and bowel. It’s also what relaxes to allow for penetration, and contracts rhythmically and involuntarily during an orgasm.
From what we’ve seen, there is a lack of awareness and knowledge of the anatomy of the pelvic floor.
Physical therapy for pelvic health focuses on improving function of the pelvic floor muscles by educating our patients on how the floor functions. Manually assessing the muscle’s tone and seeing what areas of the muscles are not able to relax as well as assessing the core muscles are part of the initial assessment. These other core muscles that are assessed include: the abdominals, the hips, the low back, and the lower extremity muscles that are attached to the pelvis. Treatments that pelvic floor therapy include to help dyspareunia are: manual myofascial release, biofeedback, internal E-stem, vaginal dilators to help stretch the muscles, and education on bladder and bowel function. Physical therapy for the pelvic floor allows patients to gain control over their pain and teaches them how to use their body and mind to relax certain muscles that they’ve never been able to relax. In many cases pelvic floor therapy can help manage the pain and help patients enjoy pain-free intimacy with their mate.
In our personal experience we have seen remarkable outcomes in the use of pelvic floor therapy as a treatment of dyspareunia. Within three to five visits our patients have less pain.
Look for our podcast next week on the personal story of a couple married for 29 years who experienced painful intimacy, and after literally five visits of pelvic floor therapy, had NO pain!