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Painful Sex

Updated: Nov 2, 2023

Experiencing pain during or after sexual activity is a common occurrence in both women and men. This discomfort can stem from various sources and may lead to significant emotional distress and relationship challenges. Seeking professional assistance is crucial if you're dealing with this issue.

What Are the Underlying Causes of Painful Sexual Intercourse?

Frequently encountered issues include:

  • Vaginal and vulval skin problems, such as dryness, thinning, splitting, or dermatological conditions like eczema, psoriasis, dermatitis, and lichen sclerosus (thickened white skin in the vulva).

  • Endometriosis, characterized by deep pain during intercourse, intense pain during menstruation, discomfort during bowel movements at menstrual times, pain between periods, heavy bleeding, and clotting.

  • Pelvic floor muscle tension, sometimes described as "ball" in the rectum.

  • Nerve pain resulting from injury, surgery, or childbirth, manifesting as burning, tingling, or shooting pain that worsens when sitting.

  • Mechanical pain arising from musculoskeletal issues affecting the pelvic or hip joints and muscles.

  • Infections, such as bacterial, fungal, or sexually transmitted infections like genital warts or herpes, and recurring yeast infections leading to itchiness and pain.

How Can the Underlying Causes of Painful Sex Be Identified?

During your consultation, we will discuss the following questions to tailor the most effective treatment plan for your specific concerns:

For Women:

1. Is the pain more surface-level, near the vaginal opening or vulva, during touch or penetration?

This inquiry could lead to identifying:

  • Skin issues affecting the vaginal and vulval area, like dryness, splitting, and dermatological conditions such as eczema, psoriasis, dermatitis, and lichen sclerosus.

  • Vaginal thinning (atrophy), characterized by dryness, burning, and itchiness.

  • Recurrent fungal, bacterial, or viral infections.

  • Nerve pain following injury, surgery, or childbirth.

  • Pudendal nerve pain (pudendal neuralgia) if discomfort is worse while sitting and towards the end of the day, often manifesting as pain in the anus, rectum, perineum, vagina, labia, and clitoris.

Additionally, tight pelvic floor muscles or bladder issues like Bladder Pain Syndrome could contribute to discomfort.

Anticipating pain and constantly worrying about intercourse can exacerbate the problem, leading to further muscle tension and amplification of pain.

2. Is the pain located deeper in the pelvis, lower back, or abdomen?

This could lead to identifying:

  • Endometriosis, if accompanied by deep pain during intercourse, severe menstrual pain, discomfort during bowel movements, pain between periods, heavy bleeding, and clotting.

  • Trauma post-surgery, childbirth, injuries, or psychological distress.

  • Pelvic scarring or adhesions resulting from infections, surgery, or radiation.

  • Bowel issues like Irritable Bowel Syndrome (IBS), constipation, loose stools.

  • Bladder issues such as recurrent infections or Painful Bladder Syndrome.

  • Sacroiliac or hip joint pain, indicated by discomfort in the low back, hips, pelvis, or lower abdomen, possibly accompanied by limping.

  • Pelvic floor muscle pain due to muscle over-contraction.

  • Pudendal nerve pain (pudendal neuralgia), particularly if aggravated by sitting and day's end.

  • Pelvic infection, often accompanied by indicators like fever, diarrhea, cramping, unusual discharge, painful urination, or a history of unprotected sex.

For Both Women and Men:

3. Is the pain related to specific sexual positions?

Pain occurring due to sexual position or movement can signal musculoskeletal problems, possibly affecting the muscles, joints, and soft tissues of the pelvis, hips, and back. This can be prevalent in both genders and might coincide with other forms of pain.

For Men:

4. Does pain manifest during or after intercourse?

This could point toward pudendal nerve pain (pudendal neuralgia). The pain may be linked to sexual activity and can be felt in the scrotum, anus, rectum, or testes. It might also occur post-intercourse, presenting as pain or numbness in the penis.

Other potential causes for men include:

  • Recurrent fungal, bacterial, or viral infections.

  • Bladder issues like Bladder Pain Syndrome or recurring infections.

  • Prostate-related concerns.

  • Pelvic floor muscles characterized by tension, bulkiness, over-contraction, or spasms, leading to an inability to relax the muscles. These overactive muscles can generate additional pain that amplifies the initial discomfort.

How Is Painful Sex Managed at The Osteopathic Pelvic Hub?

We adopt a comprehensive approach to address your pain. We begin by gathering a detailed medical history, conducting a thorough assessment and alongside evaluating mental well-being through specific questionnaires.

Holistic Approach:

Pain is a deeply personal experience intricately tied to emotions. Emotions have a significant influence on pain perception, mediated by both nerves and hormones. Hence, considering the full spectrum of pain, including its psychological dimensions, is crucial.

Neuroimaging studies indicate that anticipating pain or having fear and anxiety about pain can trigger or intensify the experience. Addressing your mental well-being and your response to pain are integral components of care.

Conservative Management:

We approach painful sex by tackling the underlying physical causes through treatment, education, and self-care. Your personalised conservative management plan may encompass:

  • Internal and external myofascial release techniques to the pelvic floor muscles

  • Spinal and whole body joint mobilisations

  • Visceral and cranial osteopathy

  • Reduce fascial tension through the abdominal cavity and lower limbs

  • Pelvic floor stretches and strengthening

  • Meditation, mindfulness and visualisation strategies

  • Pain management

  • Touch desensitisation

  • Vulvar hygiene and lubricants

  • The use of dilators, wands and/or vibrators


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