Intimacy and Sex

Pelvic floor physiotherapists can play a key role in managing vaginismus, vulvodynia, ejaculation pain, and pain with erection, using evidence-based approaches including pain education, pelvic floor exercises, and desensitisation training.

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Common Symptoms with Intimacy or Sex

Vulva

Stinging, burning or itching of the vulva in the absence of a skin pathology unprovoked (unprovoked vulvodynia)
Stinging, burning of the vulva when touched (prokved vulvodynia)
A history of recurrent thrush leading to increased sensitivity of the vulva
Stinging burning of the vulva and perineal body (vestibulodynia)

Vagina

Stinging, burning, sharp pain at the entrance of the vagina with touch from finger/tampon/penis/vibrator (superficial dyspareunia)
Deep burning/sharp pain in the vagina with penetration from finger/tampon/penis/ultrasound probe (deep dyspareunia)
A fear of sex due to pain, actively avoiding it (vaginismus)
Residual aching pain in the vagina following touch or penetration

Erection Pain

Difficulty in achieving or maintaining an erection due to fatigue or pain.
Pain during an erection in the perineum.
Pain with ejaculation in the penis/perineum (area between scrotom and anus) or low back.

Pelvic Floor Muscle Dysfunction

Involuntary contraction of pelvic floor muscle, deep pain
Intermittent spasm of pelvic floor muscle when inserting a tampon
Hard to relax pelvic floor muscle
Unable to maintain a pelvic floor muscle contraction

Pelvic floor muscle dysfunction

Pelvic floor muscle (PFM) disorders significantly contribute to persistent pelvic pain and vaginismus, yet are frequently underdiagnosed or undertreated. Because pelvic floor muscle dysfunctions can lead to symptoms such as dyspareunia, vaginism, vulvodynia, and vestibulodynia, physiotherapy has strong rationale in treatment (Berghmans, 2018)