Vee has Pain with Sex
Today we are going to tell a story about our patient, Vee. Vee is a conglomerate character of the hundreds of patients I have seen since starting as a pelvic physical therapy aid over 20 years ago, and throughout the course of my career. Even though sex education is distributed, very few patients understand the pelvic floor, the role of the pelvic floor in sex, how the brain is connected to every are of our body via the somatosensory cortex, and the pudendal nerve. In addition, environment, interactions, and experiences as we go through life with doctors, partners, sexual and non sexual (think of the first time you tried to insert a tampon), play a role in our sexual lives as adults.
Vee is a patient who met the love of her life, in her mid twenties, and was excited to start building a relationship with him, sexual and personal. This was the first time that she had sexual intercourse. It was painful during penetration, but she was able to push through it. They continued the relationship this way, and the pain worsened. Vee scheduled an appointment with a gynecologist, and was told there is nothing wrong with her, and even suggested that she didn’t really want to have sex, and this was the issue. The next time she tried sex with her partner, the pain was beyond pain with penetration and now cramping, and deeper. Vee scheduled an appointment with another physician, who told her that it was possible this was all in her head and suggested an antidepressant.
Vee was distressed. Having sex with her husband was painful to her, scary to her, and becoming scary to him because he did not want to hurt her even more than she was already hurting. She met some friends for coffee and finally broke down in tears, and explained what she was going through. This was when she heard about pelvic physical therapy, and that her friends were having similar.
Vee asked around and set up an appointment with a pelvic physical therapist recommended by her friends. Her partner came to her first visit with her. She broke down in tears, and shared how stressful the past several years have been. That she feels crazy, and that nobody is seeming to understand that she wants to have sex with her partner, is attracted to him, and is really unable to make it “work” anymore. She explained that as she sought more and more medical opinions, it worsened.
At this appointment Vee learned about the pelvic floor, and the innervation of the pelvic floor from the pudendal nerve. A unique nerve with autonomic fibers, meaning, it can respond to fight or flight. What that means is it is absolutely not in your head that you are having pain, it’s not an STD, or your fault, but that your private parts are incredibly smart in activating your fight response, and even leading to spasms that we don’t want, in anticipation of penetration. Vee learned about dilators, proper lubrication (nothing fancy, water based, productive), as well as controlling the pelvic floor muscle to both lengthen and contract. Vee also learned that these repetitive painful experiences mentally and physically are traumatic, and can heighten our brain’s awareness of the region experiencing pain, and put it on high alert to further sense when something isn’t exactly right, and warn your body via pain signaling. This is an attempt of our central nervous system to protect, but it ends up causing grief, relationship problems, and perpetuating more pain.
Vee talked to her physical therapist more about the rest of her body. As an athlete in her youth, teens, and still avid with running and weight training, she has experienced chronic hip pain. She also sits most of her day for her career, and this can flare it up to. Vee learned about the connections of the hip to the pelvic floor, the way the hip and the levator ani support a canal for the pudendal nerve to travel through, how this can and might likely be the driver for having pain with sex.
Vee was excited. She started doing weekly physical therapy that focused on spine, hips, pelvic floor, motor control exercises for the pelvic floor, full body movements that promoted the core and the pelvic floor working together again, and was able to have pain free sex. Her new goals were to be able to try more exciting positions without fear, and worry. Vee is also having less hip pain, and feeling more control of her pelvic floor and her core. She is happy that she is on the right track, and tells her physical therapist she always knew it wasn’t in her head.
Several women, and men too, experience stories like this. It does not have to be this difficult to find help, or this traumatic: emotionally or physically. When sex hurts there is help. There are answers. Pelvic physical therapists are highly trained in building comprehensive programs, learning about your full history and how the story started, and helping work directly with you to improve your pain, and take back control of your sex life.
