I am Robyn Murray RPT, and welcome to my first blog post for All Things Pelvic on penetrative pain (PP) or what the medical community has delightfully named Dyspareunia (I am not a fan of labels but that is my own bias).

When it comes to guiding others through their pelvic health journey, PP is something near and dear to my heart. I have experienced PP myself and so have many of my clients. I joke that life is too short for painful sex. If you feel so too, please read on to learn a little bit more about what we know thus far about PP and how to help it!

Note: There is still emerging literature regarding PP including its causes and treatments. Some of the below is based on clinical and personal experience.
First, it is normal to feel embarrassed, unsure, or fearful about pain with penetration. Historically, our bodies and stories as women are something we are not used to talking about candidly (although that is slowly changing thank goodness). If you are experiencing PP, I want to reassure you that you are not alone and PP can be managed well with what we now know with pelvic health physiotherapy

What is Dyspareunia or PP?

Dyspareunia or PP is considered any pelvic or vaginal pain that occurs with penetration (intercourse, tampon, fingers), which can be superficial (entry of vagina) or deep. It is estimated that almost 10% of women experience significant PP1. During pregnancy and post partum the incidence has been reported to be as high as 30-50%2. 

What causes PP?

1. Endometriosis 3

2. Hormonal issues (post partum, perimenopausal, menopausal, estrogen based birth control use etc.) 2

3. Emotions and perceptions regarding sexual enjoyment1 and communication/closeness regarding sexual health with partner 1

4. Vaginal dryness 1

5. Pelvic floor muscle tension

6. Allodynic/hypersensitive vaginal and pelvic tissues

7. Respiratory diaphragm issues (i.e., how you breathe)

8. General perceptions of health and wellness 1

9. Depression, anxiety 1

10. Central sensitization (I will screen you for this!)

11. Potential nutritional, dietary sensitivities (still emerging research)

Note: this is not a comprehensive list by any means!

What are my treatment options?

• It is becoming increasingly clear that a multidisciplinary approach is beneficial for helping people experiencing PP 3. However, this can be challenging for a variety of factors including time and funding.

• What I would recommend is to be curious about what aspects of your life may be contributing to your PP. Based on this, we can discuss what avenues or professionals may be a good fit to help you on your journey!
  
  

What I (and many other pelvic health physios) can offer

I utilize a combination of tools to help my clients. 

• Meditation/relaxation techniques

• Somatosensory remapping and desensitization techniques (either self led, partner and self led, or in clinic led with me)

• Yin yoga with a focus on pelvic floor relaxation

• Discussions regarding the influence of hydration, caffeine consumption, and other potential irritants and pelvic floor function

• Discussions on how pain works in the body and what we now know regarding pain science

• Internal and external muscle release/manual therapy

• Retraining your respiratory and pelvic diaphragm through breath techniques
  

In conclusion, PP can be something that can be quite alarming and disruptive to our wellbeing as people. Fortunately, we are doing more research on causes and treatments. This is fuelled by an increasing number of women/people taking ownership of their sexual health and learning more about what they can do help alleviate PP and enjoy intercourse again. 

Kindness for you today,

Robyn Murray RPT
Email: rmurray@allthingpelvic.com
Phone: 519-222-2402
Instagram @allthingspelvic and @pelvicphysio_mom (that’s me!)

References

1. Mitchell, K. R., et al. "Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey." BJOG: An International Journal of Obstetrics & Gynaecology 124.11 (2017): 1689-1697.

2. Lagaert, Liesbet, et al. "Postpartum dyspareunia and sexual functioning: a prospective cohort study." The European Journal of Contraception & Reproductive Health Care 22.3 (2017): 200-206.

3. Yong, Paul J., et al. "Prospective cohort of deep dyspareunia in an interdisciplinary setting." The journal of sexual medicine 15.12 (2018): 1765-1775.