Painful Sex: Best Therapy Practices for Women and Couples

Women who experience painful penetrative sex due to Provoked Vestibulodynia (PVD), Vulvodynia  and other forms of Pelvic Pain may have suffered in silence for years. They may have thought that the pain was due to being new to intercourse and that it would subside. Or perhaps they may have mentioned it to a gynecologist, only to be told that there was no evidence of any diagnosis, or that they had a bacterial infection and prescribed a medication that didn’t help. For some women who had painful sex that was intolerable, they may have avoided going to a gynecologist for their entire adult life.

Women we see at Center for Love and Sex who are in heterosexual relationships where penetrative sex is an expected part of the sexual repertoire over time develop tremendous shame, anxiety and fear of any sexual encounter if they feel it will lead to intercourse. Their partners may gradually avoid initiating sex due to the obvious reason of not wanting to cause their partner/spouse pain but in addition, of wanting to avoid being turned down which they experience as outright rejection, lack of desirability and at times shame.

As a consequence to the painful sex, some male partners/husbands may develop their own sexual disorder like erectile dysfunction or premature/uncontrolled ejaculation due to the anxiety that develops around their penetration hurting their partner. Couples like this tend to self refer to a CLS therapists when sexual avoidance has gone on for some time and couple is in crisis or fear of losing their sex life altogether. The physical ailment causes intra-personal and interpersonal challenges that have to be addressed in therapy. Many times these women can treat and heal their pain when working with a pelvic pain physical therapist.

When I mention pelvic floor physical therapists to friends and even other therapists, they have never heard that this specialty even exists.  As a systemic sex therapist, I frequently see women and couples who present with painful sex and collaborate with pelvic floor PTs to coordinate treatment in a holistic manner. I have had general therapists refer some of these cases to me after seeing clients for many months or years assuming the pain was a somatic outcome of early trauma.

It is critical for all therapists to understand the structure of the pelvis and causes of pain so that they know how to support, advocate and refer their client to the right doctors and pelvic floor PTs so that they can move ahead quickly with a treatment protocol that addresses their particular issue. It is also important for pelvic floor PTs to understand the consequences the pain has had on the client’s primary relationships, her Sex Esteem®, and shame level around discussing the specifics of her condition so that they can collaborate with the therapist. I will often assign homework assignments that will echo or support the exercises being assigned by the pelvic floor physical therapist.

Amy Stein Co Presenter

In my upcoming webinar for therapists, sex therapists and physical therapists titled The Collaborative Clinical Care Model Between Therapists and Pelvic Floor Physical Therapists Involving Sexual Pain, I’ll be collaborating with Amy Stein, DPT Founder and Director of Beyond Basics, a specialty PT practice in NYC and the author of Heal Pelvic Pain, a self-help book for people dealing with painful sex, urination and other physical activities involving the pelvis. I invite you to spread the word about the webinar which will be live and take place on Monday February 6th from 12:30-2:30 PM EST and is geared for professionals.

For those of you reading this who suffer from any sort of pain during sexual activity, I invite you to contact my practice, Center for Love and Sex via email sari@saricooper.com or coordinator@saricooper.com to discuss your situation and set up an appointment for an in person session or a coaching session if you’re outside of the NYC region.

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