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Dyspareunia, painful sexual intercourse has been shown to affect between 8-21% of women. There are numerous physical, psychological, and social causes of pain with intercourse. A gynecological exam is the first place to start if a person is experiencing pain with intercourse. If the gynecological examination and work up are normal the pain with intercourse may be attributed to spasm in the muscles of the pelvic floor.
Pelvic pain, in particular, can result from:
Pain during intercourse may also point to other pelvic conditions, including:
Vulvodynia: chronic vulvar pain with no discernable cause that may be the result of sex-related nerve injury or irritation
Vaginismus: painful vaginal contractions that may be a result of performance anxiety, often treated with Kegel exercises
Levator Ani Syndrome: a type of chronic proctalgia (or recurrent rectal pain) in which a muscle in the pelvis is often sensitive and sore\
Pelvic floor physical therapy and a physiatrist who specializes in the treatment of the pelvic floor may be able to help relax the spasms. The involuntary spasm during penetration, whether it is intercourse, a gynecological exam or the use of a tampon can restrict penetration and be painful. Relaxation of the pelvic floor muscles is obtained by teaching proper breath
ing techniques, improving posture and biomechanics of the pelvis, myofascial release of muscle trigger points, muscle relaxers in both the oral and suppository form, as well as trigger point injections to specific tight muscles that are no responding to manual release.
A team approach is important in treating patients with dyspareunia, addressing stress management, nutrition, exercise, relationship, and psychological health are important in obtaining a global picture of a patients overall wellbeing in order to get them on the path to recovery.
Shrikhande A, Ahmed T, Shrikhande G, Hill C. A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections. The International Continence Society. 2018 Aug. Link to Article.
Walter Frontera, Julie Silver, Thomas Rizzo,Tayyaba Ahmed, Isabel Chan. Musculoskeletal Disorders, Pain, and Rehabilitation. Essentials of Physical Medicine and Rehabilitation. 2018 Nov; 4(107): 587-595. Link to Article.
Ahmed T. Interviewee on Pelvic Health Summit – Pelvic Pain and Sexual Health. Pelvic Health Summit. 2018 May. Link to Interview.