Dyspareunia is the term for persistent and/or recurring pain or discomfort before, during or after sexual intercourse. This pain is typically localized to the vagina or lower pelvis and occurs in the absence of other medical conditions. Clinical trials by the Meirs Medical Centre found that Postpartum dyspareunia (PD) is a recognized phenomenon and stated that on average “ 50-60% of women have dyspareunia 6 to 7 weeks following delivery, and 33% and 17% will still report pain during intercourse three and six months after delivery, respectively”. These clinical trials also evaluated the prevalence and the causes for PD and interestingly discovered no clinical difference between the prevalence of PD between between vaginal deliveries and cesarean sections. According to their findings it can be assumed that the mechanical trauma to the vagina and pelvic floor during delivery is not the main cause for the development of PD. Multiple studies have shown a number of different causes that may lead to dyspareunia. Some of theses causes include:
Injury to the pelvic floor: child birth, post surgical conditions, pelvic inflammatory disease, endometriosis, scar adhesions and scar tissue build up
Musculoskeletal dysfunction: the pelvic floor muscles may be overactive and have difficulty fully relaxing
Breastfeeding: breastfeeding decreases the amount of estrogen in postnatal womans' systems. Estrogen is a key hormone for arousal and natural vaginal lubrication. With the low levels of the hormone, arousal and vaginal dryness may result causing the vagina to be too dry for comfortable penetration during intercourse
Psychosocial factors: stress, depression and anxiety
Fortunately, painful sex can be treated by a Pelvic Floor Physiotherapist. Pelvic floor physiotherapy can help to reduce vaginal pain with intercourse by mobilizing muscle and soft tissue to release tight pelvic floor musculature, improve circulation and desensitize areas through manual therapy and normalize overactive muscles through education and awareness. A pelvic floor physiotherapist will also give you specific exercises that focus on relaxing your pelvic floor and teach appropriate techniques for penetration.
In the meantime, try to avoid repetitive contractions of the pelvic floor muscles such as “kegels” and instead focus on taking deep expansive inhales into your back and side ribs around the level of your bra strap. When we actively contract our pelvic floor muscles by performing a kegel, we are causing increased tension in what may be already tight and overactive muscle. This could potentially increase pain.
Exercises initially should focus on relaxation of the pelvic floor muscles with diaphragmatic breathing and imagery. A good position to start is in a seated position with feet flat on the ground. Begin by bringing awareness to where your sit bones are. Take a deep breath in and imagine the sit bones moving away from each other. As you exhale feel the gentle gliding of the sit bones moving inward without performing a contraction. When we inhale our pelvic floor hammock descends, expands and widens. As we exhale our pelvic floor gently comes together and “hugs up and in”. Focusing on deep belly breathing or diaphragmatic breathing and visualizing the release of the pelvic floor musculature can release both physical and emotional tension decreasing the level of discomfort felt with intercourse.