I don’t think there could be a more insensitive comment to say to someone struggling with intercourse.

I’ve been a pelvic therapist for over 4 years and I cannot count how many times a woman has come in to my office and told me this is what their physician or mom or friend or even partner told them. Another comment was “You’re lucky to have your partner”. That is a shameful remark to say to a woman suffering with painful intercourse, as if she should just feel lucky that her partner hasn’t left her yet.

But for thousands of woman this is the reality. They go from doctor to doctor trying to understand why sex hurts (if they’re even able to tolerate penetration at all). They’ve taken every pill, cream, and vaginal suppository they were prescribed, and yes, even had a glass of wine and nothing has worked. Numbing the pain or mind doesn’t help. They start feeling like it is their fault or feel some sort of shame or guilt for not being able to have intercourse anymore or in some cases even consummate their marriage. This is a debilitating condition and effects the women’s self-esteem, confidence, and ultimately can destroy their marriage or relationship. I’ve even had women tell me they gave permission to their partner to have sex with someone else since they could not satisfy them. They are so lost and tired of fighting their body and it consumes them.

Then comes the lack of desire. It usually doesn’t start out that way—they want to and try to have sex but after several failed attempts they’re mind turns against them. They start thinking maybe it is in their head (it’s not!) but who wants to have sex when it hurts?! The body is trying to protect itself. The mind and body are eventually going to stop desiring it no matter how much they love or are attracted to their partner! And of course the partner can’t help but internalize it and start to feel they’re not attractive anymore. Do you see the cycle?

I’ve seen it for years and all I can say is that there truly is hope. I was once there and I had all those thoughts too. I enjoyed my sexuality and I felt a piece of me had died. The shaming begins: What did I do? Why did this start happening? Last week I was fine and this week I cannot even think about having sex. Will this destroy my relationship?

But that’s not my story anymore. I was able to get the help I needed through physical therapy and you can too. It’s a safe place you can go, divulge all your secrets, even the ones you don’t tell your best girl friend (she doesn’t get it—her and her partner have sex 3 times a day!) The thoughts you have and the questions can be shared and answered by a professional and the healing can begin. The hope of having a normal sex life again is there!

Read more about Pelvic Floor Dysfunction, Vaginismus, and Dyspareunia and how physical therapy can help you or a loved one.

I originally wrote this on my Facebook page in April 2015 but the topic came up again at the ISSWSH conference that I spoke at this past Saturday. I was invited to speak to Physicians on the importance of physical therapy for Pelvic Floor Dysfunction and when, where, and how to refer to a credentialed Pelvic Floor Therapist. So I decided I would repost to get this blog started:

I recently was watching an episode of Botched–following the episode was a talk show with Terry Dubrow (one of Surgeons on Botched). They did a spot on Vaginal Weightlifting! I believe they called it Vaginal Kung Fu.

I have to say something about it because I’ve been disturbed since watching these ladies in class carry gatorade bottles and pickle jars from their vaginas (!!!). Your pelvic floor muscles are skeletal muscles like the other muscles in your body (biceps, hamstrings), as Dr. Dubrow stated, however, the big difference (that he did not clarify) is that they are SMALL muscles and are not designed to be WEIGHT LIFTERS. Less is more with these muscles! There is no Pelvic Floor Olympics—no need to train your pelvic muscles to carry 31lbs (world record apparently)! There is NO functional gain in that and can lead to over training, which can lead to other problems including pelvic pain.

Exercising your pelvic floor has many benefits especially in regards to bowel, bladder, and sexual health. However, not everyone is a candidate for KEGELS (pelvic floor exercises) especially if you’re adding weights.

A reported 30% of the female population have pelvic pain. It is a serious and debilitating disorder and is in desperate need of public awareness. As a general rule of thumb if you have any pelvic pain (abdominal, groin, bladder, etc.) you should not perform Kegels unless you’ve been examined/instructed to by a pelvic floor specialist.
And for the record being “tight” does not equal “strength” and there is much more to the function of your pelvic floor muscles!

Read more about this: #vaginalweightsnotrecommended

Vestibulodynia is defined as pain at the vestibule, which is the area around the opening of the vagina. Being diagnosed with vestibulodynia can leave patients feeling frustrated because it doesn’t explain WHY they have pain at the vestibule. There are several types of vestibulodynia including infection, inflammation, neoplastic, neurologic, trauma and hormonal deficiencies.

The most common type of vestibulodynia iis caused by hormonal deficiencies known as Hormonally-Mediated Vestibulodynia. This type is caused by hormonal changes including taking birth control, breast feeding, postpartum, estrogen blockers, peri and post menopause.

The most common cause of Hormonally-Medicated vestibulodynia in younger women (under the age of 25) is systemic birth control (i.e. oral contraceptive pills (OCPs), depo-shot, nuvaring).  Side effects of birth control (BC) such as break through bleeding, nausea, headaches, increased risk of stroke, and abdominal cramping are more commonly discussed among doctors and patients.

However, what is NOT often discussed with patients prior to starting birth control, especially OCPs, is that systemic BC use cause vestibulodynia, decrease vaginal lubrication, decrease thickness of labia minora, and decreased vaginal introitus (opening to the vagina) size, all leading to dyspareunia (painful sex). These changes can occur as early as 90 days after starting OCPs or with long term use.

Unfortunately, if the onset of birth control was before the age of 17, there’s even a higher risk of developing hormonally associated vestibulodynia.

• Goldstein, A, Burrows L, and Goldstein I. Can oral contraceptives cause vestibulodynia? J Sex Med 2010; 7: 1585-1587

So, WHY and HOW, does this happen?

Systemic birth control gets processed through the liver which INCREASES a protein called the Sex Hormone Binding Globulin (SHBG). SHBG binds to the free testosterone in the blood, so even if your body is making testosterone, high levels of SHBG (from the BC) DECREASE the testosterone in your body. This inhibits testosterone from getting to the tissue that needs it to be healthy—–the vestibule. The vestibule is rich with androgen receptors! If those receptors aren’t getting the testosterone (and estrogen) they need because of the increased SHBG then the vestibular tissue can become painful (vestibulodynia)!

Most commonly patients will complain about pain at the opening upon entry, dryness, friction, feeling of tearing, and actual tissue tearing resulting in bleeding, or inability to tolerate penetration at all.

Vestibulodynia can also lead to pelvic floor muscle overactivity which contributes to even more pain!

But don’t worry, we can treat it!! Click on the Client Portal to schedule a pelvic floor assessment in person or sexual counseling telehealth appointment!