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Painful intercourse

Painful intercourse, or dyspareunia, refers to pain during or after intercourse. The pain may be at the entrance to the vagina or felt deeper inside. For some women, there has never been a time when they have not had pain with intercourse. For other women, they have experienced pain-free intercourse before developing symptoms.

Understanding why the pain has started is key. There are many potential causes of painful intercourse. Collaboration with other health specialists and correct diagnosis should help identify the cause in each individual and resolve the problem as quickly as possible.

Possible causes include

  • Vulval skin conditions

  • Endometriosis, and heavy/painful periods

  • Adenomyosis

  • Vaginal or Caesarian delivery

  • Abdominal surgery

  • Interstitial cystitis or painful bladder syndrome

  • Bowel dysfunction

  • Pelvic Organ Prolapse

  • Abuse or trauma

What to expect from physiotherapy

Taking the time to listen and understand your story will help to direct treatment, so we will ask you lots of questions about your symptoms.

Our assessment and management is likely to include

  • Pelvic floor muscle assessment: We will teach you how to use these muscles well. This often includes some down-training or relaxing exercises, as well as some gentle internal manual release work. We will assess for any prolapse and provide appropriate support using pessaries if indicated.

  • A full body assessment: We need to understand how other regions in the body may impact on pelvis and abdominal wall function. We may include some manual releasing of specific muscles, retraining, strengthening and stretching to help optimise loading across the body.

  • Understanding bladder and bowel habits to ensure their optimal function. We might suggest you complete a bladder or bowel diary. We may suggest changing some lifestyle or dietary factors which may improve function. We will address any issues with voiding or emptying the bladder and bowel, and or any continence concerns.

  • We will refer you to relevant specialists if we think it is appropriate to resolve your symptoms.

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