Early Days
3. Pelvic floor muscle tightness
The varying causes for the muscles around the vagina becoming over active or tight warrant an article of their own, but I cannot ever remember treating a client experiencing painful sex who didn’t also have associated pelvic floor muscle tightness. In the same way that our trapezius (neck) muscles can develop painful trigger points, the three different muscle layers in the vagina can too. This general tightness, and the more specific painful trigger points, can cause pain with penetration during intercourse or difficulty with orgasming. I help ladies with this by educating them as to why this may be happening, releasing these trigger points with massage internally, and teaching them how to connect to their pelvic floor with their breath to relax it (as many of the ladies I treat are constantly tensing these muscles without even realising that they are doing so). I also encourage my clients to perform their own internal massage at home, using their fingers or a pelvic wand to help to reduce this muscle tension independently. I also recommend that women who have had a past history of sexual abuse or a very traumatic birth to seek counselling regarding this, as painful past psychological associations can also contribute to an inability to relax the pelvic floor and enjoy sex.
4. Constipation
The detrimental effects of constipation to a women’s pelvic floor, sexual enjoyment, and bladder and bowel function, during pregnancy and following childbirth has to be one of the most under-rated and undiscussed issues in the whole motherhood journey. Constipation and straining on the toilet weaken the vaginal walls and pelvic floor, and can contribute significantly to a vaginal prolapse and urinary continence in the future. Stool sitting in the rectum for a prolonged period of time can also increase pelvic floor muscle tightness and often when I am doing an internal assessment I can feel that a woman has stool sitting in her rectum that she is unaware of, and this can also make intercourse uncomfortable. Make sure that you are drinking enough water and having enough fiber to do a soft banana-shaped poo without holding your breath or straining every single day. If your dietary intake isn’t enough to ensure this, please ask your GP to prescribe some stool softeners or laxatives to help you with this.
5. A vaginal or perineal infection or disrupted vaginal flora
I encourage all the ladies that I am treating to have a swab taken by their GP to rule out an underlying infection, as this can also cause pain and discomfort. Sometimes the infection is obvious when looking at the colour of the vaginal tissues, or if the client reports discharge with an unusual smell or consistency. There is also research that indicates that women with a history of constipation and or having had to have antibiotics in the preceding 12 to 18 months may have abnormalities in their underlying gut microbiome or vaginal flora which can cause inflammation and pain in the vagina or back passage. While I am currently unable to test for this in my clinic, often my clients’ history is indicative of this. In particular, many of my ladies who needed antibiotics during or after child birth and now have strong sugar cravings, have underlying yeast overgrowths. For this reason I recommend that all my clients with pain during sex to try to eliminate sugar and increase their intake of probiotics and fermented foods such as sauerkraut, to try to rebalance their own gut bacteria. I also frequently refer these clients on to a functional medicine practitioner for further help diagnosing and treating their gut microbiomes.
Breastfeeding and decreased oestrogen (together with the inevitable exhaustion that accompanies caring for a small human) can also reduce a women’s libido and this coupled with pain or discomfort during intercourse can have a very detrimental effect upon a couple’s relationship. So please see your GP and a women’s health physio if you are struggling with this at all.