Pain With Sex, Perimenopause, and Pelvic Floor PT: What You Should Know

Pain with sex is common, but it is never something you should be told to simply tolerate. Whether pain started after childbirth, during perimenopause, after surgery, during a stressful season, or seemingly out of nowhere, there is help.

Many people are surprised to learn that pelvic floor physical therapy can help with pain with sex, pelvic tension, urinary urgency, bladder symptoms, and discomfort related to changes in hormones and tissue sensitivity.

What does pain with sex feel like?

Pain with sex can show up in different ways. Some people feel burning at the opening. Others feel deep pelvic pain, pressure, aching, sharp pain, or soreness that lasts after intimacy. Some people feel like they cannot relax or that their body is guarding.

Pain may happen every time or only in certain positions. It may be worse with stress, around the menstrual cycle, during perimenopause, postpartum, or after a period of avoiding intimacy because of pain.

How the pelvic floor contributes

The pelvic floor muscles sit at the base of the pelvis and are involved in bladder control, bowel function, sexual function, core support, and pelvic stability. When these muscles are tense, guarded, painful, weak, or poorly coordinated, they can contribute to pain with penetration, pelvic pressure, urinary urgency, constipation, and low back or hip discomfort.

For some people, the pelvic floor is not too weak. It is actually overactive and has difficulty relaxing.

That is one reason why Kegels are not always appropriate. If the muscles are already tense, more squeezing may not be the answer.

Perimenopause and pelvic symptoms

During perimenopause, changes in hormones can affect tissues, lubrication, bladder symptoms, pelvic comfort, and recovery.

People may notice more urinary urgency, leaking, vaginal dryness, discomfort with sex, or increased pelvic tension.

Pelvic floor PT can work alongside your medical provider to address the muscular, movement, and coordination components of these symptoms.

What pelvic floor PT may include

At Top Notch Physical Therapy, pelvic floor care is individualized and always based on your comfort and consent.

Treatment may include education, breathing, pelvic floor relaxation, gentle mobility, hip and core work, manual therapy, scar tissue work if relevant, nervous system down-training, and gradual return to intimacy strategies.

We may also discuss bladder habits, constipation, lubrication, positioning, stress, exercise, and when to coordinate with your physician or gynecologist.

When to seek help

You may benefit from pelvic floor physical therapy if you have:

Pain with sex.

Burning, tightness, or pelvic tension.

Urinary urgency or leaking.

Pelvic pressure or heaviness.

Tailbone, hip, low back, or pubic bone pain.

Symptoms after childbirth, surgery, injury, or perimenopause.

Fear or anxiety around intimacy because of pain.

You are not alone

Pain with sex can feel isolating, but it is treatable. You deserve to be listened to, supported, and given a plan that makes sense for your body.

At Top Notch Physical Therapy in San Luis Obispo, we provide one-on-one pelvic floor physical therapy in a calm, supportive environment.

If pain with sex, pelvic tension, or urinary symptoms are affecting your quality of life, schedule a pelvic floor physical therapy evaluation at Top Notch Physical Therapy in San Luis Obispo.