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Diagnosed With Dyspareunia

A study found that 75% of sexless marriages end in divorce. I don’t say this to pass judgment but sex is a big factor for many marriages and relationships.

That connection is such a beautiful part of the human experience. When I hear that my clients have been struggling with painful intimacy, whether it started when they lost their virginity and continued throughout their adult life or maybe it’s changed over time, I know it can bring up so many different emotions; embarrassment, low self-esteem, sadness, anger, and stress.

Dyspareunia is a diagnosis for women experiencing pain or discomfort during sex. It’s a blanket term that includes pain with penetration or deeper thrusting. Common “solutions” include; topical estrogen and lube. Those are the only options my clients receive when struggling with these issues before they come to my specialized pelvic floor therapy clinic. The care provided by the pelvic experts in my clinic should be standard care and accessible to all women, but that’s a conversation for another day.

But there isn’t something innately wrong with people who experience dyspareunia. The root cause is often a shortening of the muscles leading to a tight pelvic floor. If you’ve been around and seen my content before you may know where I am going with this but if not it’s essential information.

Women walk around with pelvic floor tension, it is instinctual for our bodies to hold both physical and mental stress in these muscles. Pair that with the idea that to have a strong and healthy pelvic floor we have to be doing Kegel exercises consistently actually reduces our pelvic floor strength and the blood flow to these muscles. This causes pain with intimacy because these muscles become dehydrated and fibrotic.  Even environmental and social influences can affect the pelvic floor; shame, sexual trauma, past injuries even a high level of athleticism can cause a hypertonic pelvic floor.

Sorry for the following example but a hypertonic pelvic floor is made up of fibrotic muscles that resemble beef jerky and a hydrated healthy pelvic floor is supple like a chicken breast. As you can imagine adding lube or estrogen cream to encourage natural lubrication is a surface-level short-term solution.

What has to happen to eliminate dyspareunia, pain during intimacy,  is internal manual therapy. This is when a Pelvic Expert Physical Therapist inserts a gloved finger into the vaginal canal and releases the tension, scar tissue, and adhesions present in the three layers of the pelvic floor to restore optimal blood flow and strength to these muscles.

An extremely hypertonic pelvic floor is diagnosed as Vaginismus and that is when any type of penetration is extremely painful and oftentimes “impossible”. Gradual dilation with dilators that increase in size is a common treatment plan for individuals struggling with that. A pelvic expert can help you if you are struggling with vaginismus and can provide insight into how to connect to the internal pelvic floor muscles to restore coordination so you can relearn how to relax these muscles.

I mentioned earlier that dyspareunia and vaginismus can stem from environmental and societal influences and because of that it is often super therapeutic for our clients to be able to share their sexual history and internal beliefs regarding sex with a professional who can provide actionable steps to begin healing their relationship with sexual relations.


Allison Feldt

Body Motion Physical Therapy

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