Both men and women can experience pain and/or discomfort with intercourse. 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, prolonged use of the oral contraceptive pill, and fear due to pain experienced with previous attempts to have intercourse.
Physical therapy treatment can treat sexual dysfunction through muscle re-education, nerve flossing, joint mobilizations, improving 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 treated by us:
- Pelvic Congestion
The pelvic veins are susceptible to chronic dilatation, which results in venostasis (the blood accumulates in the veins and doesn't flow), resulting in venous congestion of the pelvic veins. Signs and symptoms of pelvic congestion include chronic pelvic pain, dysparuenia, urinary frequency and urgency, infertility, erectile dysfunction, and possible back and leg pain. Patients may complain of a dull ache which is aggravated by physical activity (especially with standing).
Physical Therapy Treatment may consist of:
- rehabilitation of the pelvic floor, abdominal and adductor muscles
- lymphedema therapy
- range of motion and strengthening of certain muscles to improve circulation and therefore venostasis
- 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, male 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, i.e. pudendal neuralgia, may result in sensory symptoms in any or all areas it supplies and spasms of the muscles supplied by it. A common site for pudendal nerve irritation may be at the 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 men or women. 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
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.
- range of motion and strengthening of certain muscles to improve core and lower extremity balance and stability.
- Pelvic Pain
- Persistence of unexplained pain in the lower abdominal and pelvic region without evidence of active disease.
- Erectile Dysfunction/Sexual Dysfunction
- Persistent failure to achieve and sustain erections of sufficient rigidity for penetration during sexual intercourse
- 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 testis than the right testis and are usually asymptomatic. If symptoms are present, they may include pain in the scrotum, feeling of heaviness in the testicle, infertility, atrophy of the testicle, and/or visible or palpable enlarged vein. Physical Therapy can help with any pain due to the person tightening or contracting the pelvic floor and/or abdominal muscles as a result of the discomfort.
- 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 wherein tissue similar to uterine tissue is found outside the uterus (ovaries, fallopian tubes). Menstrual endometrium regurgitates from the uterus, through the fallopian tubes, and into the pelvis and peritoneal cavity. The tissue can also be found in scars (c-sec, laparoscopy) and on the bladder, bowel, intestines, colon, appendix, and rectum. Rarely, it is found inside the vagina, bladder, or on the skin.
There isn't any known cause of endometriosis, however, it is believed that estrogen exacerbates the condition and regulation of estrogen production is the medical option for endometriosis treatment.
The chief complaint is commonly 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. Diagnosis of endometriosis is through laparoscopy.
- Lichens Planus
- Inflammatory pruritic skin lesions; scarring and adhesions may lead to narrowing of the vagina.
- Lichens Sclerosus
- 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 with resultant scar tissue formation or pelvic adhesions. PID is usually seen 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 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 on vestibular touch or vaginal entry; erythema in vestibule and bartholin gland openings.
- Chronic vulvar discomfort; characterized by burning, irritation, rawness, and inability to have penetration without pain.