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Sexual Pains & Physiotherapy

Sexual Pain (dyspareunia) can affect up to 75% of women at some stage in their life according to the American College of Obstetricians and Gynaecologists. At any given time, 7.5% of the female population are having painful intercourse. This may occur from an individual's first sexual experience or may develop at different stages throughout their life. It can occur in heterosexual and homosexual relationships. Understandably, it can have a significant effect on an individual's ability to engage in intercourse. Women report avoiding sexual activity, losing their desire to engage, struggling with arousal, enjoyment and climax. This can cause strain on relationships and further psychology stress, worry and negative body image.

Symptoms associated with painful intercourse include:

 - Pain with vaginal examinations/smear test
 - Pain with tampon usage
 - Bladder urgency/frequency or night time toileting
 - Urinary incontinence
 - Difficulty urinating
 - Constipation or urgency to pass a bowel motion
 - Pain with masturbation or foreplay
 - Lower back/pelvic pain
 - Pain sitting on a bike/horse riding

The pelvic floor is the muscular hammock to the body.

Its role is:
 - To hold your urine/faeces/wind
 - To let go of your urine/faeces/wind
 - To support your pelvic organs
 - To support your back and abdomen
 - Allow for penetration
 - Allow for orgasm

Generally, women who present to physiotherapy with the above complaints may have an overactive/uncoordinated pelvic floor. This is when the pelvic floor muscles have tightened or do not have enough length. This is how the body involuntarily tries to protect itself from pain.

Common causes of sexual pain include:

 - Lactation
 - Menopause
 - Child birth
 - History of infection eg. UTIs, thrush, STIs
 - Vulvodynia/vestibulodynia
 - Vaginismus
 - Skin conditions eg. Lichen schlerosis
 - Excessive high intensity exercise
 - Pelvic organ prolapse
 - Psychological conditions eg. Anxiety/depression
 - Chronic Pelvic Pain eg. Endometriosis/IBS/PCOS/adenomyosis/fibromyalgia
 - Previous surgeries including C-Section and laproscopic
 - Lower back/coccyx or hip pain/injuries
 - A history of trauma or pain
 - Neuralgia

There are two main types of sexual pain: deep and superficial. However, some individuals can have both and fluctuations between symptoms. Pain can occur prior to or during penetration, throughout intercourse or afterwards. It can even persist for up to 3 days. It can be sharp, burning, achy, tight or cutting in nature.

Sexual activity is an emotional, psychological and physical experience. Pelvic Health Physiotherapy can help you identify some of the primary causes and secondary complications of sexual pain.

Treatments include:

 - Pelvis/pelvic floor awareness education
 - Lubrication advice
 - Desensitisation/electrical stimulation therapies
 - Toileting advice
 - Bladder retraining
 - Biofeedback
 - Dilator therapy
 - Myofascial release
 - Scar massage
 - Pelvic floor relaxation
 - Mindfulness

As Pelvic Health Physiotherapists we work alongside Psychologists, Gynaecologists, GPs, Sexual Health Doctors and Sex Therapists.

Here at Auckland Physiotherapy, we have a Real-Time Ultrasound machine which can be used as an assessment tool as well as an adjunct in your therapy.

Prior to seeing your physiotherapist, we recommend you see your GP to rule out any potential pathology that may be causing your pain.

Patients are entitled to see their physiotherapist individually or you may bring a support person/partner with you if you wish.

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