Our private times with our partners is not normally a topic we discuss freely with others, but what happens when things start to hurt? Who do we talk to? What can be done for it? Is it just a normal part of aging?

Pain with penetration is not “normal” no matter what your age.

A discussion with your PCM or even your gynecologist is a good place to start. They can test for any medical issues and also provide you with a referral to pelvic floor physical therapy.

Physical therapists are the musculoskeletal specialists and your vagina is made up of muscle making them the best practitioner to see.

Pelvic pain can show up at different times in your life

Pain can start with the very first interaction with the vagina. This is most commonly after menstruation has started and a tampon is attempted for the first time. This can be very painful for some making it so they are not able to use them.

Yearly pelvic exams are can also be painful. Sometimes the pain gradually comes on and slowly progresses until it is no longer tolerable.

Pain can also begin after the birth of a child. There could be tearing and after it heals the scaring is painful.

Menopause is another time in which it is common for pain to start. Estrogen levels decrease causing decreased blood flow to the vaginal tissues. The tissue becomes thin, dry, and very sensitive.

In all of these examples the muscles of the pelvic floor are affected. With pain, muscles tighten as a way to protect the body. By doing so they restrict the blood flow to the muscles. If the muscles remained in a tightened state for too long the blood loss with cause pain. This pain will cause the muscles to tighten more and thus the pain cycle has begun. It can be very challenging to break this cycle. It is very easy to tell if you are contracting a muscle but it is much more difficult for you to relax something you cannot see.

What can physical therapy do for you?

Pelvic floor physical therapy is designed to improve muscle coordination and control. Pelvic floor physical therapists can help you learn to relax your pelvic floor muscles through a variety of ways:

  • Internal manual muscle releasing. Pelvic floor specialists are trained to perform internal work on the muscles of the pelvic floor. They use different techniques to allow for muscle relaxation while creating as little discomfort as possible.
  • Stretching of the muscles in and around the pelvis. You will be given stretches for the muscles affecting the painful area. Stretching for pelvic floor pain is done with low reps, 1-2, but longer sustained holds of 1 min. Gentle stretching is most often more effective than more aggressive stretching. Thus, holding a stretch in the position in which the first stretch is felt is most effective.
  • Use of vaginal dilator at home. Dilators are graduated devices that are inserted into the vagina until a stretch or pain is felt. This is done at home daily along with breathing and stretching exercises. This helps to retrain your muscles to relax, even when feeling the stretch that they equate with pain.
  • Vaginal biofeedback. A sensor about the size of a tampon is inserted into the vagina which allows you and the therapist to see the activity of the pelvic floor muscles. During your treatments you will do contraction and relaxation techniques to improve coordination and start to learn the sensation of relaxation.
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