Does Sex Hurt?

Performance Plus Women’s Health Practice is situated in Waverley. Their Physiotherapist Samara Nanayakkana discusses why 20% of women are having pain with sex. Here’s what you can do about it

Data on the subject of pain in the vulvar region, or with intercourse is hard to gather. Many women are not reporting accurately to their doctors.  According to the 2018 Jean Hailes Women’s Health Week Survey:

• 20% of younger women (aged 18-35) have discussed or need to discuss with their doctor feeling unexplained pains when having sex. 
• 25% have discussed or need to discuss a lack of interest in sex.
• 20% of women younger than 66 reported that they need to discuss with their doctor a lack of interest in sex; but haven’t. This is higher than any other topic that women identified as an issue.

Somehow this doesn’t fit with onscreen steamy sex scenes where most women seem to be at peak arousal within minutes.  

Diagnosing the issue.

The difficulty in addressing the cause of pain arises from confusion over the definition of the conditions.  Some conditions may be temporary or activity specific (i.e. postnatal or position related). Others are chronic and may require more than physiotherapy alone (endometriosis, fistulas, etc) to treat.

Dyspareunia & vaginismus were commonly thought of as separate condition. However they have now been merged with 4 symptoms under the term Genito pelvic pain / penetration disorder (GPPD).  Diagnosis of GPPD can be made if only 1 of the following symptoms is present:

• Difficulty with intercourse / penetration (comparable to old definition of vaginismus).
• Vulvovaginal or pelvic pain before, during or after vaginal intercourse or penetration attempts that is not caused by vaginismus or inadequate lubrication (comparable to old definition of dyspareunia).
• Fear or anxiety about vulvovaginal or pelvic pain or vaginal penetration.
• Tensing or tightening of the PFM during attempted vaginal penetration. This is considered to be due to emotional & behavioural consequences of sexual pain.

To make a diagnosis, symptoms will persist for a minimum of 6 months, and cause “clinically significant distress” in the individual. 

Other causes of pain with intercourse:

• Vulvar disorders (candidiasis, herpes, dermatitis, lichens sclerosis, trauma).
• Atrophy & hypo-oestrogenization.
• Inadequate lubrication.
• Interstitial cystitis (IC).
• Prolapse.
• Endometriosis.
• Regional pain syndromes.
• Fistulas.
• Dermatitis.
• Systemic diseases such as Crohn’s.
• Leaky gut.
• Congenital abnormalities.
• Psychosexual issues.
• Vulval varicosities / pelvic congestion.

Vulvodynia is vulval pain of at least 3 months duration “without clear identifiable cause,” which may have potential associated factors.  This is considered by some as a diagnosis of exclusion.  It can be localised (cliterodynia, vestibulodynia or mixed) or generalised and can be provoked (insertional, contact), spontaneous or mixed.  It can also be primary (PVD1) or secondary onset (PVD2). Generalised vulvodynia is on the rise in young women. Studies have linked the increase in more sex, partners, hair removal, and going on the OCP earlier as potential causes.

The “parts” or anatomy of pain drivers for most women is the same. Muscles, skin, fascia, nerves, and ligaments do not vary greatly.  Internal and external drivers on these tissues, can vary for each woman depending on her age, time in her life, etc.

Potential drivers for pain can include:

• Physical inflammation caused by eating sugar, processed grains, processed fats, or other inflammatory foods.
• Over-exercising.
• Not exercising at all.
• Lack of sleep.
• Chronic stress.
• Low vitamin D or other nutrient deficiencies.
• Digestive issues – bloating, chronic constipation, diarrhoea, abdominal discomfort .
• History of surgery, injury or severe illness.
• Chronic infections.
• Environmental toxic chemical, heavy metal or mould exposures.
• Fear.
• An absence of feeling safe in an intimate relationship.
• Lack of understanding about the condition.
• Not knowing strategies to address the pain & promote healing.

Treatment for pain with sex.

Do you know if your pelvic floor is over – active? 

Is it hard to relax your pelvic floor?

Do you have pain present before, during, or after intercourse?

Managing pain with intercourse requires a team which may include your doctor, gastroenterologist, pelvic floor physiotherapist, nutritionist and sexual psychotherapist.

Book in for an assessment today. Pelvic floor physiotherapists are trained to assess and treat over activity of the pelvic floor, scar tissue management, faecal urgency, straining and dyssyneric defecation, pelvic organ prolapse (POP), fascial release work for endometriosis and more. 

Performance Plus Women’s Physiotherapy provides the Women’s Health Service at Waverley Private Hospital. Consulting nearby at 40 Lemana Crescent Mount Waverley for outpatients means that all your Women’s Health Services are covered. It’s convenient location means that it services the suburbs of Glen Waverley, Burwood, Chadstone, Oakleigh and Clayton as well as suburbs along the south eastern corridor such as Wheelers Hill, Mulgrave, Dandenong and Springvale. Phone 03 9815 2555