Pain is to Sex as Oil is to Water. Our everything-is-sexualized culture doesn't allow us to believe that pain and sex can be said in the same sentence.
For the majority of the adult female population, it's difficult to say the word, "sex." It's even more difficult to talk about sex. And if that's the case, who is going to readily admit that they have painful sex?
There are many other reasons as to why sex is a difficult topic, but that isn't the point of this article. I'd like to bring to light the fact that painful intercourse does exist and can be an emotionally and physically excruciating reality for many women of which, in most cases, can be addressed with physical therapy intervention, and collaborative medical care if needed.
Prior to PT school, I worked as a PT tech in an outpatient clinic where I was privileged to be introduced to pelvic rehabilitation by a wonderful pelvic health physical therapist, who is now my friend and forever mentor. Of the many successful outcomes I heard from her, the following story was the most powerful at that time to my baby PT ears:
After ten years of marriage, this particular patient and husband had been unable to have intercourse due to the associated pelvic pain she experienced with attempts. As time went on, this couple desired to have children, but it was an impossibility to naturally conceive due to their inability to have intercourse. This journey led them to seek assistance from a pelvic health physical therapist. A thorough evaluation was completed to determine origin of pelvic floor dysfunction followed by implementation of individualized interventions to perform during PT sessions and at home. Within a matter of weeks, she and her spouse were able to have long awaited pain-free intercourse with the hope of conceiving a child. - Life. Changing.
The moment I heard this story, I aspired to join the physical therapy world for the purpose of contributing to the success of helping this underserved population of women.
The prevalence of painful intercourse among women is likely higher than we think. A study conducted in primary care practices found that 46% of women who were sexually active had dyspareunia (genital pain with intercourse), and another study discovered that out of 62 women, 45% experienced postpartum dyspareunia. In addition, it was found that about 60% of women experience dyspareunia when more generally defined as pain with intercourse. The bigger issue may be that symptom reporting tends to be very low, especially in those who have more persistent symptoms.1
Statistics like this make my heart hurt. Statistics like this mean that we as clinicians need to be screening our patients for these symptoms. Sex will most likely never be easy to discuss, especially by those who experience pain with sex. As highly educated and skilled professionals, we should be comfortable in discussing and addressing all physical impairments, including painful intercourse, associated with a related primary diagnosis. From there, it's up to you to decide if it is necessary to refer to a pelvic health physical therapist for further intervention.
1. Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician. 2001;63:1535–1544.
2. Teaser photo source: http://www.mychemset.com/new/articles/theoilandwater.php
Lacey graduated from the University of Central Arkansas in 2010 with a Doctor of Physical Therapy degree. She then moved back to her roots in Texas to practice in outpatient physical therapy. In 2011, she accepted a position to facilitate the development of a women's health program, which is where her passion lies. She seeks opportunities to educate the community and other healthcare providers on the availability and importance of pelvic rehabilitation and women's health physical therapy. Check her out at: LinkedIn and Twitter.