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Pelvic floor physiotherapy to relieve pain during intercourse (treatment of dyspareunia/vaginismus)

Written by Nathalie and Yuxin

Some women may experience pain or burning sensations during vaginal penetration during intercourse; when 1-2 fingers are inserted; or even when putting a tampon into the vagina. Most of the time, doctors recommend using a lubricant. But when a lubricant doesn’t help, it may be necessary to investigate a little further. It may be dyspareunia.

Why is there pain?

  • Difficulty relaxing: The pelvic floor muscles surrounding the vagina, which should relax to allow the penis or fingers to penetrate, fail to do so.
  • Hypertonia or reduced length (flexibility): The pelvic floor muscle or skin may be too tight. During intercourse, the tense muscle is stretched, like when you want to stretch a very tense thigh to be able to do a splits. Over-stretching a tight structure can cause pain.
  • Sensitivity in the vestibule (vestibulodynia): The vestibule is located at the vaginal entrance. It is very rich in nerve endings that could overreact to a tactile stimulus, amplifying the signal and interpreting it as painful or burning.
  • Soft tissue changes (trophicity): the vaginal mucosa can become dehydrated and lose its ability to stretch to allow friction of a penis or finger against it.

The difference between dyspareunia and vaginismus

Dyspareunia is a general term describing pain during intercourse. Vaginismus is a type of dyspareunia that also involves psychological factors in addition to pain. For example, the fear of someone else touching your body can cause significant fear and stress. Pelvic floor muscles can become uncontrollable, contracting instead of relaxing during intercourse.

The role of pelvic floor physiotherapy

  • A pelvic floor physiotherapist is specifically trained to assess pelvic floor conditions.
  • Here’s what happens during an initial assessment:
  • An interview about the history of your symptoms and general questions about urinary, sexual, fecal and organ support functions.
    Assessment of respiratory technique.
  • External observation and palpation of pelvic floor muscle contraction, relaxation, tone.
  • Intravaginal palpation with 1 or 2 fingers to assess contraction, relaxation and tone of pelvic floor muscles.
  • Some patients (mainly those with vaginismus) may not feel comfortable allowing a therapist to perform observation or palpation during the first session. In such cases, the therapist could guide the patient through a self-assessment.

Physiotherapy treatment – perineal rehabilitation :

During the first session, your perineal physiotherapist will recommend a treatment plan and give the first exercises or manual treatments based on the results of the assessment. Treatments may include:

  • Breathing techniques or general relaxation to help relax the pelvic floor muscle
  • Exercises and manual guidance to improve pelvic floor muscle control (in particular, complete relaxation)
  • Manual release, stretching, exercise or dilator therapy to reduce pelvic floor muscle tension and increase pelvic floor muscle flexibility
  • Vestibular desensitization exercises
  • Recommendations for improving perineal skin hydration and mobility.

If your sex life is affected by this condition and you’re interested in learning more about pelvic floor exercises and treatments, don’t hesitate to contact us! Our well-trained physiotherapists are here to help!

Call us for a physiotherapy appointment or book online!

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