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Pelvic Floor Physical Therapy for Painful Sex

Painful sex is often confusing, overwhelming, stressful, and, for some women, quite crushing. It’s also quite common, affecting up to 20% of American women at some point in their lives. 1 Thankfully, there’s no reason to suffer in silence, because there are many ways to treat this condition—including physical therapy. 

There are various treatments for painful sex. While it’s always best to start with a doctor (often a gynecologist), many women can benefit from pelvic floor therapy for painful sex. This is physical therapy that directly targets the pelvic muscles which may be responsible for or contributing to pain. 

If you are experiencing painful sex, you deserve to move past this condition. Keep reading to see if pelvic floor therapy might be your route to getting there. 

Understanding Painful Sex

Painful sex, also called dyspareunia, is usually treatable. But since it’s a multifaceted condition—physical, emotional, and behavioral—it often requires a team to treat, including a gynecologist, pain management expert, physical therapist, sexual therapist, and mental health professional. 2

In other words, painful sex may be related to other medical conditions, such as pelvic inflammatory disease (PID), endometriosis, fibroids, or uterine prolapse. These are all treatable conditions to varying degrees, which is one of the major reasons you should seek medical treatment first (noting that painful sex could also be related to a more serious condition, again, demanding medical treatment first). 

If you are regularly experiencing painful sex, this may also be due to your pelvic floor, and/or pelvic floor dysfunction. If your doctor believes this is the case, they may refer you to a pelvic floor physical therapist. 

Understanding Pelvic Floor Physical Therapy

Pelvic floor physical therapy is, as you’d suspect, physical therapy that focuses on your pelvic floor. 

Remember, your pelvic floor refers to the incredibly important layers of muscles that run between your pubic bone and tailbone. These muscles support your pelvic organs, meaning they are also responsible for bladder and bowel control and supporting a baby during pregnancy, and they also contribute to sexual sensations. 

Just like other muscles in your body, your pelvic floor muscles can be too tight or too weak, which can lead to other issues like constipation, incontinence, or prolapse. When they’re too tight, this can lead to painful sex, including a condition called vaginismus, in which vaginal muscles involuntarily spasm in response to penetration.

And just like other muscles, you can learn how to strengthen or relax your pelvic floor muscles as needed—and a physical therapist can dramatically help in this process. 

Understanding Pelvic Floor Therapy For Painful Sex

OK, so we’ve had a refresher on painful sex, and on pelvic floor physical therapy. How do the two intersect? Thankfully, quite well! 

According to research, most women experiencing painful sex have both overactive yet weak pelvic floor muscles. Working with a pelvic floor physical therapist can therefore “help to strengthen the pelvic floor and at the same time reduce pelvic floor resting tone,” which makes it an important part of treatment. 3

In other words, pelvic floor therapy can help you strengthen and relax your muscles as necessary, which can help relieve pain during sex. 

A therapist may also use dilators or their fingers in a systematic way, to help women with vaginismus learn how to get more comfortable with insertion, or to determine trigger points and painful areas.  

Note, however, that physical insertion is not required for successful pelvic floor physical therapy.  Your therapist may use deep tissue massage, skin rolling, and other types of manual therapy, as well as modalities like heat, ice and electrical stimulation. They will understand your medical history, and, assuming you find a high quality doctor you trust, they will be gentle and not force you into anything you’re uncomfortable with. 

Note that pelvic floor physical therapy may help to relieve pelvic pain that is not associated with sex as well. 

Most women are so relieved to learn that they can live without painful sex. You deserve this relief, too! Treatment begins with seeing a doctor—to find one who specializes in pelvic health in your area, use our Physician Finder

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