Dyspareunia (Painful Sex)
Dyspareunia, or painful sex, is a topic that has received quite a lot of media coverage recently. This is so important as many women do not talk about this issue and, as such, need to see that they are not alone and that there are many things that can be done to help. A woman may experience pain, burning or stinging at the entrance to the vagina, often called vulvodynia, whilst trying to achieve penetrative sexual intercourse. Others may find that the discomfort or pain is deeper inside. For some, the symptoms that they experience are so bad that they can not tolerate sex at all. While this might be a short-term problem with a recognised cause, perhaps due to an episiotomy sustained during labour, it can also be a long-term and very debilitating condition where, seemingly, there is no obvious cause for it or where the original cause, such as a bout of thrush, has long since passed.
Whatever the cause, the result is emotionally draining and frustrating. If you experience pain during or after sexual intercourse, it is always worth a check up by your GP/Gynaecologist to rule out any causes that require medication or onward referral. Such causes may include infection, skin conditions, endometriosis, tumours or fibroids, amongst others. Where there is no obvious cause, you may be suffering with Vulvodynia (pain around the vulva) and/or Vaginismus (involuntary tightening of the pelvic floor muscles).
When the pelvic floor muscles become ‘overactive’ they fail to relax or stretch out appropriately. Over time this can result in tightness and tenderness of the muscles, just as any other muscle in the body would react if it was held in a shortened position all the time. This shortened position then becomes its ‘normal’ state and so the woman does not realise she has not relaxed her pelvic floor. Stress and fear of pain may further exacerbate the presentation and subsequently the woman may end up unable to experience pain-free sexual intercourse.
This is where Women’s Health Physiotherapy comes in. There is a lot that can be done to reduce the overactivity, and associated symptoms, of the pelvic floor muscles. After a detailed assessment, treatment may include advice, postural, breathing and abdominal re-education, manual release of overly tight pelvic floor muscles, stretches, downtraining or release work of the pelvic floor, mindfulness, acupuncture, TENS and lifestyle changes, amongst other things.
With appropriate advice and treatment, women can experience huge improvements, sometimes this occurs quickly, sometimes it may take longer, depending on numerous factors. If you are experiencing similar symptoms to those mentioned above, do not be embarrassed and do not suffer in silence, seek help. There is much that can be done.
For more information about vulval pain, check out www.vulvalpainsociety.org
Ladies! If you ever pop to the toilet ‘just in case’ or to ‘squeeze out a teaspoonful’ then please read on.
Bladder health is so important and something that often gets overlooked. Problems such as going to the toilet too frequently and incontinence are too often perceived as a normal part of ageing or a natural consequence of having children. This simply isn’t true. Although, unfortunately, urinary incontinence is a very common condition in women (in fact one in three women have bladder incontinence at some point in their lives) it doesn’t make it normal and there are many things that can be done to resolve it. The first of which is to make sure your bladder is as happy as possible.
Top tips for good bladder health include;
1) Sit down, do not hover – your pelvic floor muscles are unable to fully relax in a hovering position and so you are unlikely to empty your bladder fully, this may result in needing to go again sooner that you should.
2) Do not go to the toilet ‘just in case’ – your bladder will never be 100% empty so it is always possible to squeeze out a teaspoonful but that doesn’t mean it’s the right thing to do. Allowing your bladder to empty before its full enough encourages the feelings of urgency and perpetuates the cycle of going too often. Going to the toilet 5-7 times a day in total is considered ‘normal’ (although this can alter in pregnancy).
3) Drink the right fluids – caffeine, acidic/citrus fruit juices, alcohol and fizzy drinks can irritate the bladder lining and make you feel like you need to go before you should. Therefore, try to cut down on such drinks, although do this gradually if you drink a lot of caffeine to avoid withdrawal headaches. Replacements can include decaffeineated tea/coffee, herbal teas, water, non-acidic fruit juices, milk or flavoured water.
4) Drink enough fluid – if you are not drinking enough the urine being stored in your bladder can be very concentrated and subsequently irritate the bladder lining. Aim to drink enough fluid (usually about 1.5-2litres per day). Judge this by the colour of your urine, it should be a light straw colour. Conversely, do not drink too much as this will naturally send you heading for the toilet more frequently than desired.
5) Do your pelvic floor muscle exercises – you should aim to relax fully, then tighten the muscles around your anus and vagina, imagining that you are holding in wind. Try and keep that squeeze going for between 5 and 10 seconds (remember to keep breathing) depending on your ability. Relax fully and repeat this up to ten times. Then try and do 10 faster squeezes where you squeeze in the same manner then let it go immediately. Both of these exercises should be done three times each day in lying, sitting or standing.
Hopefully these tips will help, however, if you find you are struggling to make improvements or finding the exercises difficult it may be worthwhile having an individual assessment and further advice.