Sexual Dysfunction

Many individuals can experience pain and/or discomfort with sexual activity. There are several contributing factors including pelvic floor muscle weakness or shortening, pudendal neuralgia, skin lesions, decreased blood flow, joint (pelvic bones, coccyx, sacrum, lumbar spine) dysfunction, hormonal changes, and fear due to pain experienced during previous sexual activity.

Physical therapy treatment can treat sexual dysfunction through muscle re-education, neural mobilizations, joint mobilizations, soft tissue mobilization for improved blood flow, and therapeutic exercises. At Beyond Basics Physical Therapy, we believe in multi-disciplinary treatment and refer our patients to doctors specializing in pelvic floor pain associated with intercourse, if needed.

Some common conditions we treat:

Pelvic Congestion

The pelvic veins are susceptible to chronic dilatation, which results in venostasis (the blood accumulates in the veins and pools), resulting in venous congestion of the pelvic veins. Signs and symptoms of pelvic congestion include chronic pelvic pain, dyspareunia, urinary frequency and urgency, infertility, erectile dysfunction, and possibly back and leg pain. Patients may complain of a dull ache which is aggravated by physical activity (especially with standing).


Abnormal enlargement of the testicular veins. Due to an obstruction or defective valve, blood does not drain out and stagnates inside the testicular veins with resultant dilatation. Varicoceles are more common in the left testicle than the right are usually asymptomatic. If present, symptoms may include pain in the scrotum, feeling of heaviness in the testicle, infertility, atrophy of the testicle, and/or visible or palpable enlarged vein.

Pudendal Neuralgia

The pudendal nerve originates from the sacral plexus (S2-S4). It has both sensory and motor fibers. The sensory pudendal nerve branches into 3 smaller nerves: the inferior rectal nerve, the perineal nerve (which supplies the perineum, vagina, scrotum, labia, and urethra), and the dorsal nerve of the clitoris or penis. The motor branch of the nerve supplies the external anal sphincter, sphincter muscles of the bladder, and the muscles of the pelvic floor.

Irritation of the pudendal nerve often referred to as pudendal neuralgia, may result in sensory changes in any or all areas it supplies and spasms and pain in the muscles it innervates. A common site for pudendal nerve irritation is at Alcock's Canal and/or at the obturator internus muscle. The sensory symptoms could manifest as itching, burning, tingling, cold sensations, and pain. The sensory symptoms may extend into the groin, abdomen, legs, and buttocks.

Pudendal neuralgia can occur in both sexes. Signs and symptoms may include the following, but they may vary between individuals:

  • Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat.
  • Discomfort with tight clothing.
  • Bladder and/or bowel symptoms (hesitancy, frequency, retention, constipation)
  • Dyspareunia and/or pain/spasm after orgasm
  • Possible abnormal pudendal nerve motor latency test (This may NOT be present in pudendal neuralgia)
  • Pudendal nerve block may assist in decreasing symptoms

Learn More About Pudendal Neuralgia

Pelvic Pain with Sex

Physical Therapy can help with any pain during sexual activity due to tightened, contracting, or non-relaxing pelvic floor and/or abdominal muscles.


Pain with initial penetration, deep penetration, thrusting, and lack of lubrication; may be due to superficial scarring, adhesions, skin irritation, or muscle tenderness.


A medical condition where tissue similar to the endometrium (lining of the uterus), is found outside the uterus, typically within the abdominal cavity. Typical places this tissue can be found is in scars (c-sec, laparoscopy), on the bladder, ovaries, Fallopian tubes, bowel, intestines, colon, appendix, and rectum. Rarely, it is found inside the vagina, inside the bladder, or on the skin. There is not any known cause of endometriosis, however, it is believed that estrogen exacerbates the condition and regulation of estrogen production is one of the medical options for endometriosis treatment.

The chief complaint with a diagnosis of endometriosis is a dysmenorrheal/pelvic pain, which is often debilitating. Other symptoms include dyspareunia, fatigue, painful urination, painful bowel movements, and other gastrointestinal problems such as bloating and abdominal cramps. The gold standard for diagnosis of endometriosis is biopsy with laparoscopic surgery.

Lichens Planus

Inflammatory, auto-immune, pruritic skin lesions; scarring and adhesions may lead to narrowing of the vagina.

Lichens Sclerosis

Chronic skin eruption diagnosed with biopsy; lesions associated with itching and burning and painful intercourse.

Pelvic Inflammatory Disease (PID)

An infection of the reproductive organs which can result in scar tissue formation or pelvic adhesions. PID can occur following a sexually transmitted disease, especially chlamydia and gonorrhea. PID may result in chronic pelvic pain, infertility, ectopic pregnancy, and abscess formation.

Symptoms of PID include lower abdominal pain, fever, painful intercourse, painful urination, foul smelling vaginal discharge, irregular menstrual bleeding, and pain in the right upper abdomen.

Physical therapy can help to break down scar tissue, once the infection has resolved, and aid in increased mobility of reproductive connective tissue. This, in turn, may decrease pelvic pain and help with infertility issues.


Inability to penetrate the vagina due to muscle spasm.

Vulvar Vestibulitis

Severe pain at the vestibule of the vagina that can be constant or occur with touch; erythema in vestibule and Bartholin gland openings.


Chronic vulvar discomfort; characterized by burning, irritation, rawness, and inability to have penetration without pain

Physical Therapy Treatment may consist of:

  • Rehabilitation of the pelvic floor, abdominal, gluteal, lumbosacral and hip rotator muscles
  • Pudendal nerve mobilization, connective tissue mobilization and myofascial trigger point release of the surrounding muscles and tissues.
  • The range of motion and strengthening of certain muscles to improve core and lower extremity balance and stability.