Pelvic Pain

Women who are unable to experience pleasurable sexual penetration with a partner is often due to pelvic discomfort or fear of pain.

What is Pelvic Pain?

Pelvic pain encompasses several different definitions and is medically referred to as Genito-Pelvic Pain/Penetration Disorder. It can refer to:

• Dyspareunia – Pain associated with genital stimulation causing a difficulty to have intercourse.
• Vaginismus – Tension of the pelvic floor muscles or involuntary spasms of the vaginal walls.
• Vulvodynia – Chronic pain in the area around the vaginal opening (vulva) for which there is no identifiable cause.
• Generalized pain – Located in the genitals or pelvic region.
• Fear of pain and/or vaginal penetration.

Pelvic pain can occur in various situations and can be intermittent or persistent. The pain may be limited to one area or occur in different pelvic regions. Experiences of pelvic pain range from somewhat mild to very severe and debilitating pain. Some women experience pelvic pain from the first time becoming sexually active, but others experience pain after a period of relatively normal sexual functioning.

If you are experiencing distressing pelvic pain, it is imperative to first be properly assessed by a qualified medical professional to rule out any underlying medical conditions.

What Causes Pelvic Pain?

• Inadequate sexual stimulation and foreplay prior to intercourse
• Menopause
• Vaginal atrophy
• Personal or relationship issues that cause stress, anxiety, and depression
• Past or recent physical or psychological trauma
• Vaginal dryness
• Pelvic medical conditions:
  • Vaginitis (vaginal infections)
  • Urinary tract infections (UTI)
  • Bladder infections
  • Interstitial cystitis
  • Endometriosis
  • Pelvic Inflammatory Disease (PID)
  • Ovarian cysts
  • Pelvic organ prolapse
  • Pelvic cancers and side effects from cancer treatments

Treatments for Pelvic Pain

• • Communicate openly and honestly with your partner about your pain, sexual needs, and desires. Read more on Tips for Talking With Your Partner.
  • Use sexual lubricants and vibration therapy toys to increase pleasure and reduce pain.
  • Use vaginal dilators to gradually relax vaginal muscles. This can be especially useful for women with vaginismus.
  • Botox: these injections may help reduce symptoms of vaginismus by reducing spasms of the vaginal canal muscles.
  • Strengthen pelvic tone by doing kegel exercises. (It is important to note that kegel exercises could diminish or exacerbate pain depending upon the condition and severity.)

• Seek treatment for an existing pelvic medical condition.
• Find a physical therapist that specializes in pelvic physical therapy.
• Talk to a doctor about medications to manage medical conditions, pain, and discomfort.
• Talk with you doctor about pelvic floor and vaginal reconstructive surgery.

Vulvodynia

Vulvodynia is the experience of chronic pain in the vulvar region. The vulva consists of all the external genital parts on the female body. This includes the mons pubis, labia majora, labia minora, clitoral hood, clitoris, urethral opening, and vaginal opening.

See an illustration of external female genitals below:

The pain associated with vulvodynia can come on suddenly and disappear suddenly or be persistent. It can be localized to a specific spot or region or generalized across the entire vulva. Symptoms can include:

• Burning or stinging
• Rawness or severe sensitivity
• Pain when pressure is applied
• Itching
• Throbbing
• Soreness

The vulva can be visibly red, swollen, or inflamed. However, there are often no visible signs of any issues and the pain still persists. Vulvodynia is a fairly common issue for women that can cause a decrease in sexual desire and dissatisfaction with quality of life. It is important to speak to your medical provider about any concerns you may have and pain you are experiencing.

Vaginismus

Vaginismus is the experience of involuntary contractions of the vaginal canal when something is entering the vagina, like a penis or a tampon. This experience can cause mild to severe pain with intercourse and lead to a loss of sexual desire and relationship satisfaction. It may also lead to discomfort from the use of tampons or during a medical pelvic exam. It is uncertain what causes vaginismus, but it is often linked to anxiety or fear of having sex.

The most common treatments for vaginismus are learning to relax the muscles through kegel exercises, the use of vaginal dilators, and pelvic physical therapy. Using a combination of medical and mental health care may help lead to a faster and more productive recovery. Very severe cases of vaginismus can be treated with botox injections to help relax the vaginal muscles. It is important to speak to your medical provider about any concerns you may have and/or pain you are experiencing.