Something that a lot of people don’t feel comfortable talking about, but do experience, is pain with sex. We are going to highlight a patient story, Anne’s story, about how therapy can help with this. 

Anne is in her late 50’s, postmenopausal, married and has the same parter for 30 + years. She has no history of pain with sex and then out of no where, in the last few years the pain has started to become unbearable during intercourse. This started affecting her confidence, her relationship, and it made her feel broken. Luckily, her OBGYN  referred her to us for treatment.  

We started the evaluation, buy getting to know some of her history, and learned that the pain had begun a couple years ago. She described the pain as coming from the vagina, and only felt with initial penetration. She felt it as a “burning” sensation like an open wound in her vagina. When she would continue to engage in intercourse, the pain would slightly lessen, but it would never go away. It was just not enjoyable to have intercourse because of the pain.

Some other thing we learned about her medical history includes, having 2 vaginal deliveries with 2 episiotomies. An episiotomy is a cut in the perineal area, or the tissue between the vagina and anus. She healed well, there were no complications, and she didn’t have any pain that she could remember following childbirth.

So while this pain was new, it’s important to note, there was a history of some pelvic trauma just from childbirth. 

We then started the assessment part of the examination process, looking at her pelvic floor muscles. These muscles were assessed internally through a vaginal exam. We found the very superficial, opening muscles, were really tight and not moving well, when we tried to stretch them, they would not stretch. When we asked her to contract her pelvic floor muscles or kegel and then bare down and try to lengthen her pelvic floor muscles to stretch them, the muscles wouldn’t move very much either. 

Seeing this, we concluded that it was likely the old scar tissue from her episiotomies that had adhered down and tightened up overtime.

Then because of menopause, when she started losing estrogen, the vaginal tissue lost its thickness and moisture in the area causing the old scar tissue to cause pain during intercourse. The act of intercourse is a stretch of the vaginal tissue and the pelvic floor muscles. So, if your muscles in this area cannot tolerate the stretch to have intercourse, or a gynecological exam, or inserting a tampon, this can result in that burning, open wound type of pain.

So, for Anne, the tissue just wasn’t moving well and the muscles were stiff and limiting stretch resulting in her pain.Once we got down to the bottom of why she was having her pain, then we could treat it. 

And so we did!  We did treatment to improve the mobility of her pelvic floor, helping with the flexibility of the muscle tissue and even the 30 year old scar tissue.  And once we got her tissue tolerating stretch, then her pain resolved and Anne returned to pain free intercourse.

A few months later I checked in on her and she emailed me to tell me that she was so thrilled that Physical Therapy could helped her have pain-free sex again. 

There are several different treatment approaches we take when it comes to pain with intercourse. You may be like Anne, and we will work on stretching and relaxing those muscles through various forms of exercises or breathing techniques. We can also use tools such as our hands or items called vaginal dilators to create that stretch in the muscles.

Vaginal dilators are a set of cylinder type devices that gradually increase in size. They are made of either medical grade plastic or silicone and are used as a tool to help stretch the vaginal tissue in a very gradual progression. We instruct the patient in utilizing these dilators to stretch the pelvic floor muscles in both the clinic and at home. 

Another treatment I did with Anne was soft tissue work on her pelvic floor muscle. I did a lot of hands-on treatment to her pelvic floor muscles directly to help increase the flexibility, decrease the pain, and increase the mobility of her pelvic floor muscles. She was sent home with some exercises and tips to do on her own. 

There is not a one-size fits all treatment for pain with sex. There are a lot of different directions we can take to fit your individual needs. Everyone’s pain is different but for Anne, we were able to find relief working with her pelvic floor muscles. The treatment was individualized for her and helped her achieve her goals of pain free intercourse. 

So, you’re not alone if you’re dealing with postmenopausal pain with sex. If it feels like something that just came out of nowhere, there is treatment available. Discuss this with your primary care doctor, your gynecologist. Don’t be afraid to talk to them about your painful sex because you should not be suffering in pain and just trying to deal with it.

Your only option isn’t to just drink another glass of wine, or try some more lubricant. There’s more we can do for pain with sex. If this sounds like something you’re currently experiencing or know someone who is currently experiencing pain with sex, give us a call and we would love to help.