On the first Friday of each month, PhysioFit Physical Therapy & Wellness hosts an online “Ask a PT – Q&A Friday” session to give patients and local residents the opportunity to learn about a range of health topics from a licensed physical therapist. The free sessions have opened the door to some important discussions about pelvic health and more.

Today’s column topic is inspired by a question asked by an attendee at a recent session: Is pain during sex normal?

Pain before, during, or after sex is clinically known as dyspareunia. But if you’re one of the three out of four women who experience painful sex at some point, you might think about it in other terms – words such as “frustrating,” “embarrassing” and “uncomfortable” come to mind.

Sex shouldn’t hurt, and even though pain during sex is relatively common, it’s not “normal.” Men can struggle with painful sex, too, but I will focus on the impact on women.

Symptoms

Pain during sex can vary, but many women report signs and symptoms including:

• Pain with penetration (including sexual penetration only or all types of penetration, for example, insertion of a tampon)

• Burning or aching pain near the genitals

• Throbbing pain that persists for hours after intercourse

• Deep pain during thrusting

These symptoms might occur only once or twice or could persist for a long time. Unaddressed, painful intercourse can have a dramatic impact on a woman’s sex life, her intimate relationship and her physical and psychological well-being. These symptoms shouldn’t be ignored, especially if they repeatedly occur.

Causes

According to the American College of Obstetricians and Gynecologists, there are two main types of pain with sex that women may experience: pain related to a woman’s gynecologic health and pain related to her sexual response and function.

Gynecological reasons or causes for pain:

• Pelvic floor dysfunction

• Ovarian cysts (fluid-filled sacs that form on or in an ovary)

• Endometriosis (a relatively common condition that causes a tissue similar to the inner lining of the uterus to grow outside the uterus)

• Scar tissue (adhesions) in the abdominal and pelvic region due to prior injury or surgery (for example, cesarean section, hysterectomy, hernia repairs)

• Vaginismus (when muscles in the pelvic and genital region involuntarily contract or spasm when something penetrates the vagina)

• Vulvodynia (a chronic condition that causes abnormal sensations in the vulva, including itching, burning and soreness

• Vaginal infections (vaginitis), including bacterial vaginosis, yeast infections and sexually transmitted infections

• Certain congenital defects that affect the shape, depth and overall structure of a woman’s reproductive organs

These aren’t the only factors or causes that could lead to painful sex. The only way to know for sure what’s causing your discomfort is to speak with a health-care provider.

Managing the pain

If you repeatedly experience painful sex or are concerned about the sensations you notice while being sexually intimate, consult with a health-care provider who can offer personalized guidance. Discuss your symptoms, review your sexual and medical history, and implement specific tests or examination techniques that can help pinpoint an underlying cause or diagnosis.

A physical therapist specializing in women’s health and pelvic health can be a valuable resource when dealing with underlying conditions such as pelvic floor dysfunction or adhesions. Pelvic health PT is personalized to meet the needs of each patient and typically includes techniques that have been shown to help reduce pain during sex and other symptoms.

Physical therapy includes:

• Posture/alignment evaluation and re-education

• Pelvic muscle relaxation exercises

• External and internal trigger-point release

• Myofascial release

• Scar massage

• Pelvic floor and fascia stretches

• Dilators and therawand techniques

• Breathing

I encourage women to speak honestly about their sexual health problems with their partner, trusted health-care provider or women’s health physical therapist. Know that your concerns are legitimate and deserve to be addressed.

Kim Gladfelter is owner of PhysioFit Physical Therapy & Wellness in Los Altos. For more information, call (650) 887-6046 or visit physiofitpt.com.