Many women have experienced pain during penetrative sex. What are the causes and how to fix them? We tell you more with the insight of Marion Pollono , physiotherapist specializing in the perineum and sexologist.

Painful sex is never normal. However, many women have already experienced pain during penetration. What is this due to? What to do to stop suffering?

The different types of pain during intercourse

“ Pain can be of two types: superficial or deep ,” begins Marion Pollono. “ Deep pains are felt when the partner touches the vaginal floor, in contact with the cervix .”

In superficial pain, the physiotherapist specifies that it is necessary to differentiate between vaginismus, which makes penetration impossible, and vulvodynia (pain in the vulva) and vestibulodynia (entrance pain which is often located in the vestibule).

“ Vaginismus can be primary, that is to say that there could never have been penetration, or secondary, there was penetration but it is no longer possible .”

Victoire's testimony , funny and touching, which sounds like a pillow secret, made us want to explore the question with a health professional and particularly a woman who deals with this subject daily with her patients.

Dyspareunia: what are the causes?

“ Deep pain is often linked to endometriosis or colopathy ,” explains Marion Pollono. “For superficial or entry pain, the causes are multiple,” explains the specialist. She distinguishes in fact:

• Hypersensitivity of the mucous membrane: “ sometimes we do not know the cause but it can be due to repeated mycoses, or a dermatological pathology, such as lichen or even vaginal dryness. The latter can happen at several stages of life: menopause, postpartum while breastfeeding, due to lack of excitement, or taking certain contraceptive pills which do not improve lubrication .”
• Muscular hypertonia: “ it can be innate, can lead to vaginismus, either the muscle is too contracted or the muscle bundles are too short, not relaxed. »
• A psychological cause: “ the pelvic floor is a place of somatization. Stress can impact the perineum muscle, causing it to contract. There may be a cause external to the couple, such as burnout at work for example. There may be a connection to the area, such as sexual trauma, but this is not always the case. Sometimes again, a bad experience can generate apprehension, in the form of anticipation of pain.”

“The 3 parameters interact. The more we try to continue a painful relationship, the more we strengthen the protective and pain mechanisms. And once the pain pattern is established, it is complicated to deprogram,” explains the physio-sexologist.

What are the treatments ?

Above all for Marion Pollono, the patient must “understand what she has and do therapeutic education. It is important to explain to the woman how it is done, what is happening and how to treat.

Several treatment options should be considered. “ It is possible to improve the quality of the mucous membrane thanks to topical cream-based treatments ,” explains the physio-sexologist.

At the muscular level, with a physiotherapist, it will be about working on understanding the muscle. “ The perineum must be toned but also know how to relax it, particularly during penetration .”

Finally, for the psychological part, it is interesting to consult a sexologist. “ This will make it possible to break down preconceived ideas, to explain how sexual activity works, pleasure, to adapt relationships to put pleasure back at the center, provided you have a partner who listens », Specifies Marion Pollono. Here again communication within the couple is very important.

In the case of endometriosis, today medical treatments remain limited beyond the prescription of a progestin pill. “ We must also explain to the patient to review the paradigm of her sexuality, to consider sexuality outside of penetration, and that posture and movement are important if she wishes penetration. You have to help her understand that the excitement factor helps lengthen the vagina as well as lubrication, so it is important to give time to foreplay, this will significantly improve penetration. Under excitement, the vagina increases from 8 to 12 cm .

Relearning pleasure

“ Before penetrative intercourse is a source of pleasure we learn that it is not painful, thanks to perineal relaxation. We will use dilators to work on penetration. This allows you to realize that if you relax the muscle well, penetration is possible and not painful even if in the office there is no excitement so it is not in the natural conditions of intercourse. This is a first step towards the ability to control penetration to include it in the resumption of sexuality .” We also need to work on the concept of pleasure, “ putting pleasure back at the center of the relationship by placing external sexuality at the center ”.

“ If access to individual pleasure is impossible, this should be encouraged, it allows good vascularization and trains the pleasure mechanism .” Using a toy, your fingers, trying steps outside of penetration with your partner, everything is possible as long as you want it.

Nina Ristori

Source

Interview with Marion Pollono, physiotherapist specializing in the perineum and sexologist