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Making Sex Enjoyable Again: Understanding and Overcoming Dyspareunia


Sex should be exciting, fun, and pleasurable. That seems obvious, right? But did you know that research shows 3 out of 4 women will feel pain during sex at some point in their lives? For some, this pain goes away on its own. But for many, it can be a long-lasting problem. Just because pain with sex, known as Dyspareunia, is common, it doesn’t mean it’s normal.



What is Dyspareunia?


Dyspareunia is the medical term for painful sex. This can include any kind of pain in the genital area before, during, or after sex. The pain can be felt around the vulva (outside part) or inside the vagina, anus, abdomen, or pelvis. The pain can be mild to severe, and it can feel like aching, sharp pain, or burning. People who have dyspareunia might feel anxious, have low self-esteem, and may even feel depressed.


Common causes of Dyspareunia:


  • Gynecological problems: Medical causes like endometriosis, ovarian cysts, or hormonal imbalances

  • Medical infections: Active infections such as UTIs, yeast infections STIs or pelvic inflammatory disease 

  • Dryness: Lack of lubrication can create irritation within the vaginal canal and contribute to pain. It is completely normal for natural lubrication to fluctuate depending on where you are in your cycle. Low estrogen levels can also contribute to vaginal dryness which can occur while breastfeeding, when in perimenopause or menopause or even while on birth control pills. 

  • Pregnancy or childbirth: Both pregnancy and childbirth have a significant impact on your pelvis and pelvic floor musculature. During pregnancy, pelvic floor muscles may become fatigued and overactive from increased weight bearing. In childbirth, it is common to have pelvic floor injuries like perineal tearing, which can cause scar tissue to form creating pain. 

  • Fear-tension-pain Loop: When we experience pain during sex or any sexual activity, our body learns to expect that pain and a fear may develop of the pain recurring. Fear and anxiety causes the body to respond with increased muscle tension, usually in our pelvic floor muscles. When the muscle in and around the pelvis are tensed during sexual activity, this can lead to increased pain and can further perpetuate the pain/tension loop.  


How to make sex more comfortable:


  • Take a breath: Slow down, whether you’re having sex with yourself or with a partner, give your body time to enjoy the experience. Take time to create a relaxing environment but in your physical space and in your body. This may look like taking a bath, lighting candles, performing diaphragmatic breathing or meditation, or turning on a playlist. 

  • Communicate: Make sure to communicate with your partner that sex can be painful for you. Ask your partner for support during sexual activity, this can look like taking a pause when necessary or changes positions.  

  • Use lubrication: When in doubt, use lube. Water-based lubricants tend to be the best for reducing irritation and sensitivity. Try brands like Slippery Stuff, Good Clean Love and Uberlube. 

  • Consider different positions: Try sidelying, lying on your back with pillows under your knees for support, or on top to allow for more control. 

  • Take penetration off the table: Focusing on external or clitoral stimulation can be key to learning how to re-enjoy sex if penetrative sex is painful. Consider opting for a vibrator with different settings and intensity to learn what feels best for you. 


When to see a pelvic PT?


At Freya, all of our physical therapists are expertly trained in helping patients manage sexual pain and pelvic pain. Your pelvic floor PT will use a variety of diagnostic tools and treatment techniques to get to the root cause of your pain and help get you back to pleasurable sex. If you’re ready to start the journey to enjoyable sex, schedule your appointment today! 

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