Ever had a doctor tell you that it’s normal to have pain the first few times you have sex? Or that it’s normal to have painful sex after having a baby? How about it’s perfectly normal and happens to everyone during menopause?
PSA: At any point in your lives, it is NOT normal to experience painful intercourse (unless this is something you have specifically requested of your partner)
And Kegels are perfect for every issue in your pelvic floor. Am I right?
Nope. In fact, doing Kegels can be counterproductive and harmful to your symptoms if you have certain diagnoses.
First, a little background. In basic physical therapy training, we learn that there are proper and improper times to strengthen a muscle. When speaking about the pelvic floor, you should only strengthen it if it is of normal to over lengthened state and weak. If a muscle overactive (guarded, hypertonic, short, or with limited flexibility), the LAST thing you should do is continually contract it by performing more and more Kegels. Doing so will only further shorten/tighten an already short/tight muscle and likely make your problem worse, or at the very least, prevent if from getting better.
There are many diagnoses and symptoms presentations where doing a Kegel might due more harm than good. This is not an exhaustive list, but covers many. Here are the primary diagnoses that I generally recommend holding off on doing Kegel exercises (and even core strengthening) with, at least in the early stages of treatment until you can be formally assessed by a skilled and licensed pelvic floor physical therapist:
- Vaginismus or other painful sex diagnoses
- Vulvodynia / Vulvar Vestibulitis / Vestibulodynia / Provoked Vestibulodynia
- Clitoral pain
- Overactive Pelvic Floor
- Genito-Pelvic Pain/Penetration Disorder (GPPPD)
- Introidal Dyspareunia (pain with penetrative intercourse)
- Deep Dyspareunia
- Interstitial Cystitis / Painful Bladder Syndrome
- Urinary Urgency & Frequency
The above diagnoses are frequently in need of muscle relaxation and stretching to get the muscle to a normal state of rest and length. As physical therapists, our job is to break the cycle of pain. The best way to approach these diagnoses is through a full orthopedic and pelvic floor evaluation and advanced muscle rehabilitation techniques, which should always include a complimentary home program.
Using medical dilators and lubrication are an essential part of a home recovery program for sexual pain and an overactive pelvic floor. I recommend GoLove lube in my offices as it is water-based and contains CBD – which studies have shown help with tissue inflammation and neuropathic pain, a big component of many of the diagnoses listed above.
Later stages of recovery will be more focused on strengthening and balancing out any asymmetries that were identified on your initial visit and will be necessary in order to make a full long-term recovery. If painful intercourse is a part of your diagnosis, the program outlined in Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve offers a comprehensive program to overcoming this type of pain. When you purchase from the link above, you’ll also save 15% by using code GOLOVE15 (expires never)!
Don’t dismiss your pain as normal because your doctor, mother, sister or best friend tells you that’s just the way it is. There are treatment options for every diagnosis listed above and pelvic floor physical therapy is one of them! I am in Los Angeles, but you can message my office at Femina Physical Therapy if you want to set up an in-office or Telemed appointment.
Author: Heather Jeffcoat, DPT