Sexual Dysfunction

Sexual dysfunction includes ongoing problems with sexual response, desire, orgasm, or experiencing pain during sex. This is often connected to the health of pelvic floor muscles. These muscles are really important for sex. In men, they help keep erections firm. In both men and women, these muscles should contract during an orgasm in a way that feels good, not painful, and usually makes sex more pleasurable. But if there's a problem with these muscles, it can turn sexual pleasure into pain and mess up how sex normally works. Luckily, pelvic floor physical therapy can really help with these problems.

Key facts

• One-third of premenopausal women experience painful sex at some stage in their lives

• 60% of menopausal women don't discuss painful sex with doctors due to embarrassment

• Oral contraceptives and acne medications can lead to vulvar pain and reduced natural lubrication

• 65% of women still encounter painful sex 18 months postpartum

General symptoms

• Difficulty or reduced lubrication

• Discomfort during vaginal penetration, especially with deep penetration, or persistent pain during penetration

• Clitoral discomfort and heightened sensitivity to touch

• Pain or burning sensations after sexual activity

• Difficulty achieving orgasm or reduced intensity of orgasms

• Urinary leakage during sexual activity

• Climacturia, which involves incontinence during orgasm

Postpartum symptoms

• Reduced lubrication while breastfeeding

• Perineal pain upon touch due to episiotomy or perineal trauma

• Reduced or absent orgasm

• Incontinence during orgasm or intercourse

• Painful sexual intercourse

Menopause symptoms

• Reduced lubrication

• Challenges in achieving or experiencing discomfort during vaginal penetration

• Painful intercourse, both during and after

• Decreased or complete absence of orgasm

Causes

• Pelvic pain syndromes related to pelvic floor dysfunction

• Childbirth

• Medications

• Obesity

• Cardiovascular disease

• Menopause

• Genital mutilation or cutting

• Surgically induced factors

  • Pelvic Floor Reconstruction

  • Gender-affirming surgery

  • Episiotomy

  • Vestibulectomy

  • Pudendal Nerve Decompression

  • Mesh excision

How we can help

Pelvic floor physical therapy is a valuable approach to addressing sexual dysfunction, especially pain during intercourse. It involves a thorough assessment by a specialized therapist who identifies muscle tightness, weakness, or other issues in the pelvic area. The therapy includes personalized treatment plans that may encompass relaxation techniques, strengthening exercises, manual therapy, education, and behavioral strategies. Patients are given home exercises to reinforce their progress. Collaboration with other healthcare providers is common. This holistic approach aims to improve pelvic muscle function, reduce pain, and enhance overall sexual health, offering significant benefits to individuals experiencing sexual dysfunction.

What to expect

At your initial appointment, we will start by taking your medical history, followed by a comprehensive musculoskeletal examination of your pelvic area. This will include assessing your posture, joint alignment, any muscle restrictions or trigger points, the health of your connective tissue, and muscular strength. An internal examination is often part of this process, but it's entirely optional and will only be conducted if you feel completely comfortable with it. This exam is much more relaxed and comfortable compared to a typical ob/gyn visit, and it provides essential information about your pelvic muscle tone, strength, and coordination. If impairments are found during the exam, the physical therapist can treat the problems with manual therapy techniques resulting in pain relief and improved function. Following the exam, we'll discuss our findings with you and outline a personalized treatment plan aimed at achieving the best results. Most patients start feeling better after their first session and see significant improvement by their third visit.