If you are a woman who recently had pain with penetrative sex, you should consult your OB/GYNO to determine the medical factors that may be causing painful sex. Medical conditions that can cause pelvic pain include endometriosis, vulvodynia, interstitial cystitis, various skin conditions, hormonal changes related to menopause, pregnancy, or while breastfeeding, physical trauma from childbirth, hip and back problems and pelvic floor muscle dysfunction. Even when there is a medical cause for your pain, there are always psychological factors that could be causing or exacerbating the medical problems. Review the following psychological factors to determine if any of the following factors could be contributing to your pelvic pain:
- Issues with Arousal: If you are having pain with penetrative sex, make sure that you are not engaging in penetrative sex prematurely. If you begin having sex before you are adequately aroused, sex will likely feel painful. Make sure that you and your partner are spending enough time on “outercourse” or “foreplay.” Most women need at least twenty minutes of foreplay to become physically ready to have penetrative sex. One good indicator of whether you are ready to have penetrative sex is if you are lubricated enough.
- Relationship Distress: If you and your partner are going through a difficult time, your body may not be responding the same to his/her sexual advances. Unconsciously the muscles in your pelvic floor could be tightening, causing sexual pain. If you are feeling resentful, angry, or untrusting of your partner you may want to question whether these emotions are sitting in your pelvis! One client began to experience pelvic pain after learning her husband had been having an affair. While he wanted to save the marriage, she felt conflicted about whether she wanted to stay in the marriage and was extremely angry and resentful towards her husband. She began to notice a connection between a worsening in her symptoms when she was most upset about the relationship. Just as some people get headaches or migraines when they are stressed, others hold their stress in their pelvis. This muscle tension causes pain! Without dealing with the relationship distress, pelvic pain is unlikely to resolve.
- Anxiety/Depression: If you are going through a period of anxiety and/or depression, your body may not be responding to the sexual arousal process in the same way. As mentioned above, if you are not adequately aroused for sex, your body will likely experience pain with sex. You may also be holding tension or stress in your pelvic floor, creating muscle dysfunction that can cause or exacerbate pelvic pain.
- Negative Body Image: If you do not feel confident in your body or feel negatively about your body, you may hold your body in ways that could contribute to pain. For instance, some people who do not feel comfortable in their bodies, slouch their shoulders. This can result in neck, shoulder or back pain. Some women position their bodies in ways that hide features they do not like about their bodies. Whether you’re doing this all day, or just during sex, the resulting muscle changes from these positions could be causing or contributing to your pelvic pain.
- Sexual Trauma: Many women have experienced sexual harassment, sexual assault, rape and other gender related violations and crimes. Research has shown that trauma is very neurological. In short these means trauma stays in your body. Some women may experience “body memories” which refers to experiences in which your body reacts as if the trauma is still happening, and will create physical sensations like the ones felt during the trauma. Also, your body may be “holding” the trauma in the pelvis, again creating muscle dysfunction that can cause or contribute to sexual pain.
- The Pain Itself: Pain with sex can create anticipatory anxiety. What this means is that because you have pain in the past with sex, you anticipate having pain with sex in the future. This anticipation can create muscle tension, making sex more painful.
If any of these psychological factors are contributing to your pelvic pain, therapy can be useful in helping you to resolve these issues.