Up to 20% of American women experience painful intercourse throughout their lives. As a pelvic floor physical therapist who treats pelvic pain every day, I guess that number doesn’t surprise me.
Many of the women I treat end up in my office after they've seen many doctors and tried other treatment approaches, and some have been dealing with painful sex for decades. My patients are a diverse group of different ages, backgrounds, and fitness levels. But the one thing they almost all have in common is feeling alone in their experience.
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If you've also suffered through sex that hurts in some way, I’m here to tell you that you aren’t alone, and pelvic floor physical therapy can help. A number of emotional and physical stressors, as well as medical conditions, can cause or contribute to pelvic pain. However, in many cases, exercises done at home can manage discomfort and help you return to pain-free, enjoyable sex.
These exercises are not meant to replace proper medical care. Painful sex can have serious causes, and it’s important to see your gynecologist or primary care provider for testing and diagnostics. Conditions like endometriosis, pelvic congestion, infections, vaginismus, vulvodynia, and interstitial cystitis can all cause pelvic pain. These diagnoses may require medical care, yet sometimes women receive treatment and continue to experience symptoms. What then?
A few other factors may also contribute to pain in women who have any of the above listed conditions, as well as women with none of them. One of those biggest factors is your pelvic floor. The pelvic floor is a large, bowl-shaped muscle group stretching from your pubic bone to your tailbone. Your pelvic floor controls your bladder and bowel. It's also what relaxes to allow for penetration, and contracts rhythmically and involuntarily during an orgasm.
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Like all other skeletal muscles in the body, this muscle group can be weak, or it can be tight. While both pose potential concerns for pelvic floor functioning, tightness in these muscles can lead to painful sex, which is medically known as dyspareunia.
The following three exercises are in no way meant to encourage forgoing visits with doctors and physical therapists. But they are the ones I frequently advise patients to do at home to relax their pelvic floors and work toward pain-free sex. They can be done prior to sex to make penetration less painful, and they can be done after sex to help relax the body following an orgasm. It all depends when you experience pain.
Diaphragmatic breathing
The diaphragm is a dome-shaped muscle that sits beneath your rib cage and is connected to your pelvic floor via muscles and fascia (fibrous tissue). As you take a breath into your belly, your diaphragm draws downward. At the same time, your pelvic floor drops into a more relaxed position, stretching your pelvic floor. As you exhale, your diaphragm rises back to its resting position and your pelvic floor follows suit. Diaphragmatic breathing allows us the opportunity to stretch the pelvic floor throughout the day and can even be performed during sex to decrease pain.
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How does one diaphragmatically breathe, correctly? Lie on your back, placing one hand on your chest and the other on your belly. Take in a slow breath. You want your belly hand to rise, while your chest hand stays still. Pause, and let the air slowly escape your lungs. Your belly hand should fall, while your chest hand remains still. Go slow; breathe in for 5 seconds, then out for 5 seconds. Your rib cage and abdomen should slowly expand, and then slowly come back to resting. This exercise cannot be overdone and can be practiced in any position. The more, the better.
Child’s pose
Child’s pose is a common yoga pose and an excellent pelvic floor stretch. In a kneeling position, bring your knees out wide while keeping your toes together. If this hurts your knees, you can roll up a towel or blanket to kneel on. Sit up straight, and then bring your head toward the floor. If this is too much for your knees, hips, or back, bring your forearms to the ground in front of you and rest your head on your arms. When comfortable in this position, start taking big, slow breaths.
As you breathe in you may feel a gentle drop through your pelvic floor, and as you exhale you may feel it gently rise. Breathe in this position for at least 30 seconds, up to a few minutes.
Happy baby
For happy baby, another common yoga pose, lie on your back. Take in a deep breath and exhale to bring your knees toward your underarms, keeping your feet and knees wide. With your hands, grab the outside of your feet if you can, but your shins and knees are a great alternative if you have trouble reaching. If you are flexible enough, try to bring your feet over your knees, perpendicular to the ground. Start breathing, slowly.
To intensify this stretch, you can gently rock your hips back and forth, bending and unbending your lower back against the ground until you find a comfortable position. As you breathe in, you may feel that same gentle drop. As you exhale, you may feel that same gentle rise. Just like for child’s pose, breathe in this position for at least 30 seconds or longer if comfortable.
How often should you do these moves? I typically recommend 5 breaths at least 5 times per day. For child's pose and happy baby, 30 seconds to a few minutes at least 2-3 times per day. But they also can't be overdone, so the more the merrier. Everyone is different, but the great thing about stretching is it can't hurt you.
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