You are experiencing pain. Maybe this is outside of the vagina, around the labia (called vulvodynia, -dynia meaning pain). This could be at the entrance of the vagina (vestibulodynia). Maybe you have painful sex with female anatomy – when you attempt vaginal intercourse or penetration (dyspareunia) and the muscles tighten so much you cannot achieve penetration or insert a tampon (vaginismus). This could be related to your menstruation cycle, with cramping and back pain (dysmenorrhea). Maybe you’ve had this pain forever, or maybe it’s new with a new partner, or it’s been since childbirth (vaginal or ceasarean). Maybe you have pain after a pelvic surgery and it’s limiting your daily or sexual activities. Regardless, it’s bothering you and you want to do something to make it feel better. Physio can help!

First, a little bit about pain in general. Pain is an unpleasant sensation or discomfort that we all experience at one point or another. We can feel it in a variety of different ways – sharp, dull, achy, electric, firey, zingy and in any part inside or outside of the body. Pain is a signal from your brain, telling you that something is or could be wrong. Pain is a threat detector or alarm system, like a smoke detector. It is designed to go off when there is tissue damage (FIRE!) so that we take action and change our behaviour (put the fire out)! But, it can also be a sensitive system that goes off when we make toast or fry onions – no fire, no tissue damage, but the alarm still goes off.

This does not mean the pain is “all in your head”. No one wakes up and thinks, “Well, I think I’m going to have painful sex today that will impact how I feel about myself and my relationship with my body and partner”. The brain is just where all the pieces come together. Those pieces are:

– signals coming up to the brain from the muscles, tissues and gut to tell us how it’s doing (ie tight, tired, injured, bloated, inflamed.. or maybe strong, flexible, chugging along nicely)

– signals coming into the brain from the environment around us (ie I am in a (un)safe environment, I’m really (not) into sex right now)

– signals pinging around in our brain about past injuries and beliefs (ie this happens every time we are intimate; this never used to happen to me; what if I’m not healed yet from my birth/trauma?)

So how do you know what your pain means – am I injured or not? What do I do about it?

During a Pelvic Heath Physiotherapy Assessment we go through a complete health and lifestyle history. This is to help determine what was going on when your pain started and to look at other factors apart from muscle tension, weakness or injury, that can contribute to how sensitive your alarm system is – sleep, nutrition, stress and your beliefs. Then we can progress to a gentle external and interal abdominal and pelvic exam. This involves feeling more muscle tension outside of the pelvis (ie on the abdomen, through the hips and thighs) as well as at the perineum and/or vulva (bottom outside of the groin/pelvic area). If you are comfortable, we can then proceed with an internal pelvic floor assessment at the entrance of the vagina or rectum, depending on your anatomy, concerns and comfort. This is me feeling with gloved finger(s) for any muscle tension or sensitivity so that we can develop a plan together.

Internal exams are always done with your congoing consent and within your comfort. You can always stop at any time. Check out my detailed overview of the internal portion of a Pelvic Health Physio assessment.

What can you do now?

– consider what was going on in your life when you started to have your pain

– if you find yourself in a high stress situation or lifestyle, consider looking at ways to decrease global stress than can contribute to muscle tension and tissue sensitivity.

– if you are cis-female and post partum, breastfeeding, having irregular periods or are peri/post menopausal, you may want to consider using a vaginal moisturizer such as Gynatroph or asking your doctor about an estrogen cream such as Premarin. These can help keep vaginal tissues elastic and moist, which may help decrease tissue sensitivity

– excellent sexual health resources include the books “Come As You Are” and “Becoming Clitorate”, which talk about factors around intimacy and arousal that can contribute to our thoughts and beliefs around sexual touch

Our Physio treatment plan will revolve around your goals and incorporate movement and training, lifestyle modifications and manual therapy if needed in a holistic, multimodal approach. This way we can work on decreasing the sensitivity of your alarm system from all angles. Let’s work together towards pain-free, pleasurable sex!