When Sex Hurts

One of the more common issues we hear about on a daily basis in the clinic is difficulty with sexual health and function. Sexuality is a broad concept, and sexual health relies upon many factors. When considering pain with sexual activities, it’s crucial to know that most issues can be healed and sexual function restored. Below are some common pain issues related to sexual health we treat in pelvic rehabilitation:



Pain with arousal

 The mere physiologic function of having increased blood flow into erectile tissues (we’re talking about any gender here) can cause increased discomfort. Perhaps the muscles, nerves or tissues (including the vessels) are sensitive to any change in filling and pressure. Thinking about sex or feeling attraction can trigger such blood flow. This means that even a kind word whispered into a loved one’s ear or a gentle touch, even the thought of intimate acts can be painful. To emphasize this point, the pelvic area can become painful even before a person is ever touched. 


Pain with orgasm or ejaculation

With pelvic dysfunction, achieving orgasm can be difficult due to muscle tension, changes in blood flow or physiology, or even due to fear and worry about performance or pain. Orgasm is often associated with ejaculation, and either often involve some really intense muscle contractions. If the muscles involved are painful, or if the nervous system is too sensitive, what should be pleasurable is excruciating. The rhythmic contractions that often characterize orgasm or ejaculation (remember that ejaculation is not for men only) can cause severe cramping, making it challenging for the person to want to engage in sexual activities, or to even avoid achieving climax. 


Pain with positions limiting comfort

 A couple’s usual positions for engaging in sexual activities (or even new positions) may cause activation of tender areas in the thigh, cause a cramp in the hip, or lead to aching in the back or pelvis. A severe case of sacral pain can make any prolonged position challenging to tolerate, and can feel worse with any added motion or weight. General orthopedic issues like arthritis, a joint replacement, a torn hip labrum, or tailbone pain can get in the way of lovemaking or sexual health.


Pain limiting penetration

This is a really common problem. When the goal of the sexual activity is penetration of a canal, the opening or canal may be so tight, so tense, or so painful that the muscles and soft tissues do not allow for penetration. This can lead to frustration within relationships, more pain, avoidance of activity (or even avoidance of all sexual relationships) and may lead to harm if the person who has pain ignores the body’s tension. In the clinic it is not so unusual to meet a couple who has been trying to consummate a marriage for a very long time. 


Pain following sexual activity

Even when sexual activity is tolerated, some people describe increased pain or cramping, aching, even burning for several days and sometimes 1-2 weeks after engaging in sexual activities. It’s no wonder that a person might give up on engaging in sexual health activities when these types of pain are present.  


Pain limiting sexual health is very isolating, and not only within the relationship. Many of the people who come to the clinic describing limitations in sexual health think they are the only one to experience such challenges. When hearing that we in pelvic health work with people every day who have similar issues, this information can feel reassuring and hopeful. Some typical conditions that pelvic rehab specialists work with include sexual health following surgeries, in relation to cancer care, as part of healing pelvic pain, and for postpartum recovery. In all ages of life, from adolescent to adult, to older ages, all deserve to experience healthy and pleasurable sexual activities. This may include masturbation, or sex with a partner or partners, and the rehabilitation process may require a multidisciplinary approach. Knowledge from sex therapists or relationship counselors may be needed to bring about a return to healthy sexual activities.


Although pain with sexual activities is common in cases of pelvic dysfunction, other issues can be going on. Sometimes lack of healthy blood flow, difficulty keeping blood flow into the erectile tissues, or difficulty getting the increased flow out of the pelvis afterwards is difficult. Some folks have low arousal, have issues related to hormones, and some have neurologic conditions that affect sexual health. As part of a team approach, pelvic rehabilitation is essential in helping people recover. If you have questions about the care that could be included in your recovery, find a local pelvic health therapist, and find out more about how to optimize your sexual health.

14 Ways to Love Your Pelvis!


Your pelvis does so much for you, and much of the time, asks for very little in return. How can you give your pelvis and pelvic floor muscles a little more appreciation and attention? Read along to see a few of the many ways that you can love your pelvic floor.

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1. Give your pelvic muscles a squeeze!

When you contract your pelvic floor muscles (the ones that help you hold back gas or stop the flow of urine) you can protect against the forces created by a blasto sneeze or a strong cough. Think of this as good body mechanics for the pelvis! Similarly, if you are lifting something heavy, giving the pelvic floor muscles a gentle squeeze can help counteract the pressures from the strain of lifting.

2. Stop holding in your gut!

Did you know that when many people tighten their abdominal wall, other muscles like the pelvic floor can tighten too? Sucking in your gut unnaturally and for long periods can create too much tension and create soreness in your muscles from all of that clenching. This situation can make it difficult for the pelvic floor muscles to contract when you really need them, or rest and recover.

3. Go for a walk!

You don’t have to do high-intensity workouts to have many of the benefits of exercise. Moving your body by going for a walk gets your limbs, trunk and pelvis moving, your heart pumping, and keeps your pelvic floor active. Just about any exercise that you participate in will get your pelvic floor going, especially total body exercises like swimming, hiking, playing soccer or tennis.

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4. Don’t push when you pee!

Emptying your bladder should not require much effort from you. When you pee, your pelvic floor muscles are supposed to relax, and the muscles surrounding your bladder are the ones doing the squeezing. If you are pushing to pee, there might be too much tension in your pelvic floor or you might be in too much of a hurry! Slow down a little, breathe, and let it flow. 

5. Don’t strain when you poo! 

Let your pelvic floor muscles relax when you have a bowel movement too. Just like when you empty your bladder, the lengthening and relaxing of the pelvic muscles helps the body empty during a bowel movement. A little effort with a bowel movement is ok, but straining for long periods of time or with outrageous efforts can harm your pelvic floor muscles. 

6. Sit down on the toilet!

If you are hovering over the toilet, your pelvic floor muscles will not relax. See #4 and #5 for why this is important. If you *hate* public bathrooms, pack some travel size toilet seat covers in your car or purse, and use them if it helps you sit down. If you are accustomed to squatting or find that your legs dangle when sitting on a toilet, try using a small foot stool. Your pelvic floor will thank you. 

7. If it hurts, get help. 

If your pelvic floor muscles hurt when you try to tighten them, sit, have sex, when you are toiling, or during any other activity, talk to a healthcare provider. Getting a referral to a pelvic rehabilitation provider may be the first step in easing your pain. Although these issues may seem tough to talk about, rest assured that others area dealing with these same issues, and that you deserve to have any concerns heard.

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8. Check things out “down there.” 

How are you going to know what your genital area is supposed to look like if you’ve never checked it out? Use a mirror and see what your tissues look like. See what your pelvic floor muscles do during a contraction and relaxation! If you have questions, ask a healthcare provider for more information about what you see and what is normal for you.

9. Stop calling it “down there.” 

One of the healthiest things we can do for ourselves and for our loved ones is to stop calling our body parts cutesy, strange names or avoiding using the anatomy terms out of embarrassed or because that’s what we were raised believing it should be called. Your pelvic floor muscles, vagina, or testicles are amazing parts of your body with really cool jobs, and deserve to be properly recognized. 

10. Wear clothes that feel good. 

If you aren’t comfortable or can’t move well because of the clothes you are wearing, or if you simply don’t like how you feel, try changing things up! Some folks like boxers, some like briefs, maybe it’s thong versus granny panties. Do jeans feel restrictive or skirts feel best? Wear what feels comfortable, and choose fabrics that allow your body to feel good. 

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11. Drink plenty of water. 

Your body feels best when you are properly hydrated and when you are eliminating with ease. If you are dehydrated, your bladder can get irritated, or bowel movements can be painful to your pelvic floor. Keep some fresh water nearby and keep reaching for it! 

12. Have more sex.

Healthy sex keeps the pelvic floor muscles active, in addition to other terrific benefits to the body and soul. Whether you are having sex with others or solo, sexual activity can be a great part of a pelvic health regimen. If you would like to learn more about your sexuality, finding a sex therapist or counselor can be of great benefit.

13. Buy some new underwear.

You read that right- some new underwear. While they may not directly impact your pelvic floor muscles, when you put on some well-fitting underwear that still retracts after being stretched, life feels a little bit better. Choose some in your favorite color, or that make you smile when you pull them on- remember Underoos and the power of the underclothes?

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14. Find a pelvic health expert who lives nearby.

This last one is really important. When you feel confident that you are doing the right stretches, performing your Kegels correctly, or have a qualified person to help ease your aches, you’ve got a lifeline to some really intimate and valuable care. Even if you don’t need pelvic rehab today, keep in mind that at any age you or a loved one may benefit from expert care. 

What Keeps You Moving During Pregnancy?

Across any group of people, beliefs about physical activity and exercise habits vary greatly. During a pregnancy, many hope to be as healthy as possible, and may even choose to start a new exercise program. For those who already have an exercise habit, it’s common to want to continue with usual activity as able. Because every pregnancy is different from the next, and because the goal of a pregnancy is both a healthy mother and fetus, a person’s desire to be physically active may not match what is possible or best. For example, conditions related to nausea and vomiting, blood pressure issues, a cervix that softens too early, or health challenges in the mother or fetus can mean that rather than exercise, bed rest or light activity only is recommended.

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So what keeps women motivated? When their body gets heavier, when swelling and joint aches increase, what is it that helps a person keep moving? A recent research article (reference below) identified attitudes and perceived barriers for being active during pregnancy. The authors found that being tired, a lack of time, and discomfort related to pregnancy were barriers to physical activity during pregnancy. Discomfort included a range of symptoms from nausea to pain, or even a sense of "awkwardness" from body changes. The factors that aided in more movement included a belief in the value of improving health for both mother and fetus, goals of decreasing stress, increasing fitness levels, have social support and having access to pregnancy-specific programs. 

Social support was the most frequently cited interpersonal enabler of physical activity, particularly partner support and family/friend’s support.
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When pregnancy is complicated, a medical provider may tend to provide vague recommendations to err on the side of caution, and provide general information about modes of exercise such as “swim but don’t jog.” If more detailed information is desired, working with a person trained in pregnancy-related fitness and wellness may be needed. It’s always critical to follow a medical provider’s advice, yet unless that medical provider is with you when exercising, it’s unlikely you will have detailed guidelines on how hard to exercise or how to modify the activity in real time.

If body aches and pain are limiting your participation in physical activity, during or after pregnancy, find a rehabilitation provider who is trained to optimize your comfort and movement so you can stay as active as possible. The more active you are during pregnancy, the easier the transition may be from early postpartum recovery to increased physical activity.

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