You might find yourself asking why you would see a physical therapist for dyspareunia (pronounced dis-puh-roo-ne-uh) or in layman’s terms, painful sex. The short answer is because musculoskeletal pain is a significant component of pelvic pain and dyspareunia. Pelvic Physical Therapy is a specialization in the field of Physical Therapy that treats pelvic pain.
Were you aware that you have muscles in the base of your pelvis that are under your control? These muscles are aptly called the pelvic floor muscles. The muscles are attached to the front of the pelvis, connect to the tail bone and sacrum at the back of the pelvis and extend outward to reach the side walls of the bony pelvis. They are the only load bearing horizontal oriented muscles in your body. Think of a muscular bowl or hammock in the bottom of your pelvis. Diane Lee PT, prefers to call these muscles a condominium rather than a floor as this gives a more accurate picture of their complex interactive placement with all the connective tissue, organs and nerves of the pelvis. These muscles serve three main functions:
- Supporting the organs within the pelvis, hence their load bearing function. They support your bladder, rectum, the female vagina, uterus and ovaries, and the male prostate. So they are” always working “at a postural level
- The muscles are sphincteric, in other words they control the opening and closing of the urethra, vagina, and rectum.
- The muscles assist in the sexual response, by providing tone to the vaginal walls, maintaining erection in the female and male and production of reflexive contractions of the deep muscle during orgasm. Poor sexual response has been associated with weak muscles and poor awareness of muscle. These same muscles provide stability to the pelvic joints, assisting the increased demands on the low back during strenuous tasks.
So what role does the muscle play in pain? Superficial dyspareunia involves the first layer musculature, those that assist with vaginal tone and erection. Deep dyspareunia involves the deeper muscles of the pelvis which support the organs and help the low back w stability. The organs of the pelvis, the muscles and even the skin communicate messages through spinal cord and to each other through nerve tissue.
Muscular tension can be generated through organic cause and by direct injury. Connective tissue can become restricted secondary to muscular tension and nerve irritation. Tense/ tight muscles can compress and or stretch nerve tissue. A pain cycle ensues moving from pain to muscular tension to nerve compression and connective tissue restriction and back to pain.
Muscular pain can be the source of dyspareunia, sometimes seen in postpartum women after injury to the muscle system during birth, or it can be in response to infection or dermatological changes within the tissue to name a few. Hip pain, because of the proximity of the hip muscles to the pelvic wall can be a contributing factor in dyspareunia. Low back pain can affect the pelvic floor musculature.
Dyspareunia can be related to hormonal changes in the postpartum breast feeding female or menopausal female, secondarily affecting muscle tissue. The pain of endometriosis and interstitial cystitis can include musculoskeletal pain. In dyspareunia muscles are generally over working and need to learn to regain their normal length, their ability to relax and return to normal postural levels. Assessment of dyspareunia includes an evaluation of the low back and pelvic joints, ability of the muscles to contract and especially relax and lengthen and evaluation of the nerve and connective tissue about the pelvis.
Physical therapists treat muscular pain with pressure, gentle stretching techniques and specific relaxation exercises. Mobilization of the spine, pelvic joints and connective tissue are generally a component of the treatment process. The goal of treatment is to gain awareness and specifically motor control of the muscle to reduce or eliminate the cycle of pain. Pelvic physical therapy restores the length-tension relationship of the muscles.
Painful sex can be embarrassing to discuss. A pelvic floor physical therapist will put you at ease. A pelvic health PT understands the complexities of the pelvic floor, and will help your muscles to regain their normal function.