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Pain with Intercourse

There are many ways that a women’s health physio can help with painful sex (dyspareunia). It is a very common issue that we treat at The Physiotherapy Clinic in our three Sydney Clinics in the lower north shore (Cammeray) , eastern suburbs (Bondi Junction) and Sutherland Shire (Woolooware).  


Painful sex (dyspareunia) can be experience by any woman at any stage of her life.  


What is involved? The first thing is for our women's health physio (the Shire (Woolooware), Bondi Junction and Cammeray) to really understand your story. Taking a thorough history  to establish a timeline of what issues presented in each order, helps us establish the underlying cause of the patients pain. We will also ask about any other musculoskeletal injuries as it may also contribute to issues within and around the pelvis and pelvic floor. Of course, medical causes of painful sex need to ruled out including infection, skin disorders, oestrogen deficiency. 


Our women’s health physio (the Shire (Woolooware), Bondi Junction and Cammeray) will perform an assessment of your whole body, taking particular attention to the pelvis, hips, feet abdominal wall and thorax. If able, a vaginal examination will be performed. A vaginal examination involves inspecting the vulvar and perineum for any obvious issues. We assess the resting tone of the pelvic floor muscles, the coordination of a pelvic floor muscle contraction and importantly, coordination of the relaxation phase of the muscles. We grade your pelvic floor strength and endurance. We would assess for any pelvic organ prolapse.  


Treating someone with painful sex is multifactorial because pain is complex and everyone’s story and body is different! Often a physiotherapist will educate their patient about pain and pain processing. It is important for patients to understand why they may be experiencing their symptoms. Graded exposure to previously painful stimuli is a way a women's health physiotherapist can gradually build up a patient to their goal of pain free sex. Graded exposure can assist in desensitising the vulvar to a specific stimulus and can be performed using a variety of techniques. One such technique is dilator therapy which involves gradually inserting a dilator which is a similar shape to a penis of varying sizes from slim to larger sizes. This works well for women who have entry pain. 


Manual therapy includes pelvic floor release work. This is often performed by a women’s health physiotherapist to the deep and superficial layer of the pelvic floor muscles that can only be accessed vaginally. The goal of manual therapy is to release any trigger points and tight areas to help facilitate normal resting tone and function of the pelvic floor muscles. Pelvic floor release work can be taught to patients using their hands or a device called a Therawand. Pelvic floor exercises may be prescribed to optimise the function of the pelvic floor. 


Of course, down training exercises, stretching, and breathing exercises may be also beneficial in your treatment.  


Our women's health physios in the Shire (Woolooware), Bondi Junction and Cammeray will also address any external factors that may be contributing to issues they may find with your pelvic floor, for example any tightness in your hips, twists/turns in your pelvis, poor breathing patterns and abdominal wall gripping patterns will be addressed externally with breathing exercises, mobility exercises, stretching and strength work. 

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