Sex Doesn’t Have to Hurt

By Rachel Levy PT, DPT, CIMT

Sexual health is an important part of our physical and mental wellbeing, and while there’s no judgement here if you enjoy some pain with your pleasure, you do not have to accept painful sex as an unchangeable fact of life.

Pain with vaginal penetration is called dyspareunia, and in addition to pain with sexual activity women with this condition often have difficulty with tampon insertion and gynecological speculum exam as well. Overall 10-20% of women in the U.S. experience dyspareunia (1). If you have always experienced pain with penetration the condition is referred to as primary dyspareunia however if you previously had pain free penetration and then experienced a change this is called secondary dyspareunia.

One common life change associated with dyspareunia is pregnancy. In a study of over 600 first time moms 41% had dyspareunia at 3 months postpartum, and 22% were still experiencing pain with penetration at 6 months postpartum. This same study found women with second degree tearing of the perineum are 80% more likely to have pain with penetration, and that women with third or fourth degree tearing are 270% more likely to have pain with penetration 3 months after delivery when compared to women without tears. (2) Another study of more than 1500 women found that 24% of their participants continued to experience pain with penetration 18 months postpartum, and also found increased likelihood of dyspareunia associated with vaginal delivery with perineal trauma, vacuum extraction, or emergency cesarean section. (3) 

Breastfeeding is also associated with dyspareunia following both vaginal and cesarean deliveries (4,5) and is thought to be due to decreased estrogen levels in breastfeeding mothers. Decreased estrogen is also associated with dyspareunia in postmenopausal women, and although hormonal supplementation can be helpful a significant number of women will require additional treatment to resume pain free sex. (6) And dyspareunia is common in women with endometriosis, and somewhere between 30-70% of women with endometriosis have pain with penetration. (7) 

Treatment options for dyspareunia include medication prescribed by your doctor, pelvic floor physical therapy, and counseling. Pelvic floor physical therapy for dyspareunia will likely include interventions to help your muscles stretch and relax and decrease overactivity and muscle spasms, graded exposure may be performed with dilators to help your body learn to allow penetration from larger objects without pain, and breathing exercises can help with both mobility and relaxation. 

So if pain is getting in the way of your optimal sexual health consult your treatment team and get an individualized plan to help you reach your goals.

Any questions? You can reach me at rachel@bridgebody.com 

1. Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014 Oct 1;90(7):465-70. PMID: 25369624.
2. Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001 Apr;184(5):881-8; discussion 888-90. doi: 10.1067/mob.2001.113855. PMID: 11303195. 
3. McDonald, EA, Gartland, D, Small, R, Brown, SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015; 122: 672– 679.
4. Alligood-Percoco NR, Kjerulff KH, Repke JT. Risk Factors for Dyspareunia After First Childbirth. Obstet Gynecol. 2016;128(3):512-518. doi:10.1097/AOG.0000000000001590
5. Figen Alp Yılmaz, Ayşe Şener Taplak, and Sevinç Polat.Breastfeeding Medicine.Oct 2019.587-591.http://doi.org/10.1089/bfm.2018.0249
6. Kao A, Binik YM, Kapuscinski A, Khalife S. Dyspareunia in postmenopausal women: a critical review. Pain Res Manag. 2008;13(3):243-254. doi:10.1155/2008/269571
7. Witzeman K, Antunez Flores O, Renzelli-Cain RI, et al. Patient-Physician Interactions Regarding Dyspareunia with Endometriosis: Online Survey Results. J Pain Res. 2020;13:1579-1589. Published 2020 Jun 29. doi:10.2147/JPR.S248887