Painful Sex Due to Menopausal Tissue Changes
Condition Overview
Painful sex also known as dyspareunia, occurs when a patient has pain with penetrative sex, oral sex, or external touch to the vulvar or penile tissues.
Specifically during menopause there are changes to the vulva, vaginal tissues that can exacerbate this condition. In peri-menopausal and post-menopausal stages of life, women have a significant reduction in estrogen. Lack of estrogen causes atrophic changes of the vaginal and vulvar tissues including thinning and dryness.
What are the symptoms of dyspareunia?
Symptoms can include feeling sharp, burning, tearing, rawness, dull, achy, or deep pressure sensations. These symptoms can occur with insertion, deeper penetration, thrusting, or can be based on the position you are in. You may feel the pain in your abdomen, rectum, vulva, vaginal or penile region. This pain can occur during or after intercourse and often causes fear/avoidance of intercourse. In addition, due to the thinning of the tissues during menopause you have a higher likelihood of minor tearing of these vulva/vaginal tissues which can lead to bleeding and increased scar tissue formation which can exacerbate the problem.
What can physical therapy do?
It will be important to have a multi-disciplinary approach to treating your symptoms especially if you are contemplating hormonal replacement therapy.
In pelvic health therapy we will discuss your symptoms and go over each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to understand your pelvic health history as well as current goals. With your consent we will perform an external and internal pelvic floor muscle assessment. We will assess your abdominal wall, low back/hips, adductors, and superficial and deeper pelvic floor muscles. We will determine your muscle function, strength, endurance, and coordination. If you cannot tolerate an internal vaginal assessment we always stop at your tolerance and never push you to handle more than you can. We move at a slow pace to ensure we are not generating a larger pain response which can slow progress down.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics! Manual treatment can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization.We also may include dilator or pelvic wand training in order to teach these muscles how to relax and lengthen. In addition, we may recommend a form a vaginal moisturizer especially if hormonal replacement therapy is not in your treatment. Typically, but not always, dyspareunia is associated with more overactive pelvic floor muscles because these muscles respond to stress, pain, and fear by tightening. Since this is the case, we will avoid kegels for the time being to ensure we are not worsening muscle spasms and therefore symptoms. We will most likely focus on downtraining/pelvic floor stretches and then progress as able with each session.
If you are experiencing pain with pelvic exams or sexual activity you should seek treatment!