There are several different root causes for pain with sex. Often the three common reports of pain with sex are these 3:
- Initial penetration, right at the opening of the vagina
- Only with deep penetration with pain being at deeper vaginal tissues and with certain positions
- Pain in general with simple thrusting motions, the inner vaginal tissues feel very “raw”
So what do these different presentations mean!? Well, the only way to really know is by having an assessment done by a pelvic health PT and going through your history and symptoms. But let me share some of my experience and common patterns we see clinically.
1. Initial penetration pain: typically this pain is right at the “Posterior Fourchette”, which is the bottom part of the vaginal opening, and at the lower inner vaginal region, this is where the puborectalis muscle is at. Okay, so why rawness and burning irritation here?! Common trends that I see for women who have pain here:
-High anxiety and stress cause the pelvic floor muscles to be highly overactive and the muscle tone is too high. This can be from past trauma, chronic pain, or generalized anxiety.
-Recent or chronic UTIs and Yeast infections can irritate the nerves around the vaginal and vulvar tissues.
-Vagina tearing during delivery can leave restricted scar tissue around this region & hypersensative nerves which can cause pain.
-History of endometriosis or painful menstrual cycles which causes the muscles to be over active and the nerves to be hypersensitive.
2. Deep penetration pain: typically women will have this pain around the bladder and cervix region (which is the deeper vaginal wall area). Pain will occur more with certain positions during sex and with deeper insertion. Common trends for the root cause are:
-Bladder irritation from past and chronic UTIs, past surgical traumas, or food/drink irritants to the bladder such as caffeine.
-Sensitivity from an IUD implant whether it is still inserted or not
-Deep pelvic floor muscles around the coccyx (tailbone) can have irritation and high tone in them as well from past trauma or high anxiety.
-History of endometriosis is very common to see this pain pattern with deeper penetration due to tissue restrictions.
-Past surgical interventions such as a bladder sling or mesh implants.
3. Global raw vaginal pain with thrusting:
-I see this more with post menopause and women who are breast feeding due to hormonal imbalances often. When hormones change such as low estrogen levels it can cause vaginal tissue atrophy (shrinking of the tissue) largely due to poor blood flow to the tissues. This can be best managed by hormone treatment and vaginal creams (Revagination - is a cream I now recommend that was created by an acupuncturist/ herbalist and has several natural oils, CBD, and arnica in it to allow the vagina tissues to feel moisturized and decreases the rawness sensation).