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August, 2010: Focus of the Month | Technique of the Week

“Inside myself is a place where I live all alone and that’s where you renew your springs that never dry up.”

- Pearl Buck

Focus of the Month: Dyspareunia

Nobody talks about painful intercourse.

Dyspareunia is pain in the genitals caused by sexual intercourse: it can occur during any point in the sexual response cycle when genital stimulation occurs. Dyspareunia may be episodic and related to an obvious cause, or may be frequent without any obvious cause. Dyspareunia is never simply psychological, and should be treated medically and physically before psychological components are considered.

The pleasure of sex is diminished when accompanied by any form of fear and/or pain. Negative sexual experiences lead to frustration. An ongoing fear or pain reaction has established the difficulty, and then perpetuates it. It therefore makes sense that sexual pain disorders should be approached in the context of pain, rather than sex. The body’s basic response to pain is reflexive withdrawal: the withdrawal response is muscular in nature (e.g. pulling your hand away from a hot stove). Repeated sexual pain can set up a cycle of apprehension, avoidance and further sexual dysfunction, which may be out of proportion to the initial cause. Compare this to someone who on a long hike develops a severe blister which causes them to limp. The limp gradually leads to knee; hip or back pain which persists long after the blister has healed and is forgotten.

When painful sensations occur regularly during sexual activity, one may begin to view sex as dangerous, resulting in apprehension, anxiety, and a fight-or-flight response. For example, a painful twinge at penetration results in tension, pushing one’s partner away, resulting in a sense of relief when the pain is removed. This can be very reinforcing, and disrupts the sexual response cycle. The reinforced behavior becomes conditioned when it occurs predictably and repetitively. There is reason to feel hopeful: dyspareunia is often readily treatable. Treatment for dyspareunia is designed to help individuals (and partners) better understand their own body & sexuality, and to feel more relaxed and comfortable with sexual relations. The objective of treatment is to recognize and reverse fear and pain reaction, thereby achieving happier physical (and emotional) relationships.

While the most commonly recognized health professionals associated with treating dyspareunia are physicians, psychologists and sex therapists, physical therapists are trained to restore function, facilitate movement, and relieve pain. Physical therapists are in the unique position to provide comprehensive pelvic floor rehabilitation when pelvic floor muscle dysfunction is present. The pelvic floor is made up of muscles and connective tissue which surround the genitalia. These muscles may be too tense, which causes pain and friction during intercourse. Physical therapy techniques to treat this problem include manual therapy (massage and stretching to tight muscles), as well as helping these muscles to relax. Physical therapists may use tools to help stretch (for example, vaginal dilators), and to teach you how to relax and contract these muscles correctly (for example, biofeedback, electrical stimulation). Electrical stimulation may also decrease pain and increase blood flow in the vagina. Increased blood flow and tissue mobility can help healing and prevent injury (e.g. tearing of tissue) during penetration. Physical therapists are neuro muscular skeletal and movement specialists, which makes them an integral part of the collaborative team of providers when treating the multifaceted problem of dysparunia.

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