Pain with Sex, Tampons, Wiping, Oh My!

In a society where sex is one third of the “forbidden” trifecta of conversation topics (sex, money, and politics), I’m on a mission to tell people that pain (unless you want it!) is not normal with sex, orgasm, tampons, gynecological or prostate exams, wiping, sitting, wearing pants or otherwise.

As with most things, it is a multifactorial experience requiring a multifaceted approach to improving function and rehabilitation!

What causes there to be pain in the genitals?

There are a number of things that can contribute to pain in the genitals at rest or with stimulation (tampon, wiping, sitting, inserting anything. etc.). Many times there can be a hormonal imbalance either systemically or at the local tissue, a blood flow restriction issue, physical/emotional/psychological trauma, nerve dysfunction from surgery nearby or local trauma, orthopedic dysfunction (spine, hip), constipation, bacterial/viral infection or a clogged gland, stiff fascia or organs, autoimmune dysfunction, and many other things. There can also be any combination of these items with pelvic floor muscle tension! A seasoned pelvic health physical therapist will help you treat and identify if the pelvic floor and surrounding joints/muscles/bones are part of your issue and connect you with another healthcare professional to address dermatologic, nerve, hormonal, physiological and psychological pieces of your experience. In some rare cases, spinal cord issues can also appear as genital pain and dysfunction.

What are the treatment options?

Treatment options will always be determined by the identified factors in an exam from a pelvic health rehabilitation physical therapist and a physician (usually obstetrics/gynecology, urology, or urogynecology, sometimes a psychiatrist). Most basically put, it can look like this:

• Pelvic floor muscle dysfunction: treat with pelvic health physical therapy that includes an external and internal pelvic floor assessment, hip, low back, jaw, neck, core exams and neurological exams
• Local or systemic hormonal dysfunction: topical or systemic hormone therapy as dictated by your physician, over the counter moisturizers, appropriate intimate or daily lubrication, naturopathy and functional medicine for gut and hormone health
• Autoimmune dysfunction such as lichens sclerosus/planus/chronicus: topical prescription and over the counter moisturizers, naturopathy and functional medicine for gut health and inflammation control
• Hip, low back, scar tissue or fascial restrictions: advanced pelvic health physical therapy, chiropractic, acupuncture
• Nerve pain: advanced pelvic health physical therapy, prescriptions for nerve pain including antidepressants and other medications from your physician; acupuncture
• Trauma (physical, emotional Trauma or trauma): pelvic health physical therapy, EMDR, CBT, somatic therapy, support groups

How do I prevent or even cope with this pain?

An ounce of prevention is worth more than a pound of cure and prevention starts with the most basic things that we all overlook: sleep (yes at least eight hours, no exceptions), nutrition (Fiber! Water! Eat the rainbow! Protein! Eat enough!), exercise (resistance training! cardio!), stress management, and healthy social/community connection. There is an overwhelming amount of scientific evidence to support that addressing these factors alone will help treat or even prevent acute and chronic pain. You can have the most skilled practitioner in front of you with the most magic hands, medicines, and certifications but if you do not have these foundational items working for you, none of their interventions will last. I’ve always loved the KISS principle: keep it simple, stupid! This principle is especially profound for those of us that live with pain.

Conclusion

Frankly, it is impossible to prevent pain and dysfunction in life. What we can control is taking responsibility to notice when something is up and talk about it right away with your doctor.

If you are ever told that you should, “relax and have a glass of wine” to solve your problem, or “It’s just part of being [fill in the blank],” you should find a new care provider.

Sex, orgasm, health exams, wiping, sitting, peeing, pooping and many other things should be effortless and pain free- even relieving or pleasurable!

Join the revolution with me and talk about pee poop and sex with your doctor and friends and join the growing community of people who are tired of having their intimate and sexual wellness shoved aside or deemed as taboo.

Sexual health is health and you deserve to live uninhibited.