Dyspareunia is defined as pain with intercourse and can be a result of Pelvic Floor Dysfunction due to the pelvic floor muscles being hypertonic or spastic not allowing for mobility or movement during intercourse. Symptoms may include pain upon penetration, and/or deep inside, dependent on position, or pain only after intercourse or with orgasm. It can be diffused pain in the pelvis or a specific area vaginally. Every women suffering from this may present differently, regardless of presentation this can have a severely negative effect on quality of life, disrupting relationships and self esteem.
Fortunately, physical therapy can help with pain associated with intercourse. However, as is the case with most pelvic pain syndromes, an evaluation by a pelvic floor physical therapist is required for the appropriate individualized treatment. Treatment may include manual therapy, dilators, diaphragm breathing, and even bowel and bladder retraining depending on presentation and other associated dysfunctions.
In some cases, there may be a “use it or lose it” effect that has occurred for women who have not been sexually active for a long time and then attempt intercourse; finding intercourse difficult or painful. In this case, if there is no other pelvic pain present (meaning the only complaint is pain with intercourse and no other time) then Kegel exercises may be beneficial. Pelvic floor muscle weakness or atrophy may be the problem versus hypertonic muscles. Consult with your Physician if the complaints are ‘dryness or friction’ based rather than a deep or sharp pain. The use of estrogen cream may also be beneficial for this.
Unfortunately, that is typically not the case and most women that suffer from pain with intercourse do so because of hypertonic or shortened, spastic pelvic floor muscles. In this situation, Kegels would be contraindicated. Instead, the focus would be on a dilator protocol, diaphragm breathing, and physical therapy intervention including manual therapy to reduce the tone and down train the pelvic floor muscles. See Physical Therapy for more information on treatment.