Curezone Physiotherapy, Mississauga collaborates with a team of providers providing treatments in various Pelvic health conditions including Dyspareunia or penetrative Pain (PP).
What is Dyspareunia or PP?
Dyspareunia or PP is considered any pelvic or vaginal pain that occurs with penetration (intercourse, tampon, fingers), which can be superficial (entry of vagina) or deep. It is estimated that almost 10% of women experience significant PP1. During pregnancy and post partum the incidence has been reported to be as high as 30-50%2. Dyspareunia is genital pain experienced just before, during or after sexual intercourse. some women have always experienced pain with intercourse from their very first attempt. Other women begin to feel pain with intercourse after an injury or infection or cyclically with menstruation. Sometimes the pain increases over time. When pain occurs, the woman may be distracted from feeling pleasure and excitement.
What causes Dyspareunia?
As is common with women’s reproductive health research, we still are discovering what the causes of PP are. In my clinical experience, every single client may have different factors that may contribute to PP. What I would recommend is to consider the following factors and how they may be helpful for you to understand and treat your PP.
- Endometriosis3
- Hormonal issues (post partum, perimenopausal, menopausal, estrogen based birth control use etc.)2
- Emotions and perceptions regarding sexual enjoyment1 and communication/closeness regarding sexual health with partner1
- Vaginal dryness1
- Pelvic floor muscle tension
- Allodynic/hypersensitive vaginal and pelvic tissues
- Respiratory diaphragm issues (i.e., how you breathe)
- General perceptions of health and wellness1
- Depression, anxiety1
- Central sensitization (I will screen you for this!)
- Potential nutritional, dietary sensitivities (still emerging research)
- Vaginal dryness from menopause, childbirth, breastfeeding, medications
- Skin disorders that cause ulcers, cracks, itching, or burning
- Infections, such as yeast or urinary tract infections
- Uterine fibroids
- Irritable bowel syndrome
- Radiation and chemotherapy
Some factors also affect a person’s ability to become aroused can also cause dyspareunia. These factors include:
- stress, which can result in tightened muscles of the pelvic floor
- fear, guilt, or shame related to sex
- self-image or body issues
- medications such as birth control pills
- relationship problems
- cancer, arthritis, diabetes, and thyroid disease
- history of sexual abuse
What are the symptoms of PP?
- Pain while inserting a tampon or during penis penetration
- Pain with particular partners.
- Deep pain during thrusting
- Burning pain or aching pain.
- Throbbing pain, lasting hours after intercourse.
What are my treatment options?
- It is becoming increasingly clear that a multidisciplinary approach is beneficial for helping people experiencing PP3. However, this can be challenging for a variety of factors including time and funding.
Physiotherapy Treatment
- Education: by helping to describe the role of the pelvic floor musculature in the pain cycle and provide techniques that can be used in the home environment
- Manual Therapy to mobilize muscle and soft tissue, normalize overactive muscles, improve circulation and desensitize areas
- Desensitization therapy: learning vaginal relaxation techniques, such as Kegel exercises, that can decrease pain
- Sex therapy: learning how to re-establish intimacy and improve communication with your partner.
- Water-based lubricants rather than petroleum jelly or other oil-based lubricants are preferable. Oil-based lubricants tend to dry the vagina.
- Psychologic therapies, such as cognitive-behavioral therapy and mindfulness-based cognitive therapy
- Pelvic muscle relaxation exercises, sometimes with biofeedback can help women with tight pelvic muscles learn to consciously relax them.
- Meditation/relaxation techniques
- Somatosensory remapping and desensitization techniques (either self led, partner and self led, or in clinic led with me)
- Yin yoga with a focus on pelvic floor relaxation
- Discussions regarding the influence of hydration, caffeine consumption, and other potential irritants and pelvic floor function
- Discussions on how pain works in the body and what we now know regarding pain science
- Internal and external muscle release/manual therapy
- Retraining your respiratory and pelvic diaphragm through breath techniques
References
- Mitchell, K. R., et al. “Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey.” BJOG: An International Journal of Obstetrics & Gynaecology11 (2017): 1689-1697.
- Lagaert, Liesbet, et al. “Postpartum dyspareunia and sexual functioning: a prospective cohort study.” The European Journal of Contraception & Reproductive Health Care3 (2017): 200-206.
- Yong, Paul J., et al. “Prospective cohort of deep dyspareunia in an interdisciplinary setting.” The journal of sexual medicine12 (2018): 1765-1775.
Make sure you book your appointment today and get assessed by our physiotherapist now.
