Pain During SexJun 1st, 2011 | By Voron | Category: Contributors, Guest Authors
Some women experience non-consensual pain during sex, pain created by a rebellious body. Pain which is neither asked for nor welcome. According to one review article “The reported prevalence rates of pain within the pelvis range from 3.8% to 24% in women aged 15 to 73 years” . If the pain is severe enough and the individual seeks medical advice the condition is often diagnosed as vulvodynia. Unfortunately, medical diagnosis sometimes doesn’t lead to much relief. In general it is an understudied disorder. If you are interested in more information on the medical treatments available for vulvodynia, I suggest you check out the National Vulvodynia Association website. They have a variety of patient hand outs and other information people may find useful.
There is a little-known therapy which can be very beneficial for those who experience vulvar pain during coitus. Several medical researchers have noted the correspondence between muscle dysfunction and vulvodynia, , , , , . In particular, myofascial trigger points in the adductor magnus can be the cause or a contributing factor in female pelvic pain conditions. Luckily, self treatment is easy and can provide some degree of relief. For those with severe pain conditions, a skilled operator (e.g. physical therapist or orthopedic pain specialist) is much more capable of providing effective treatment.
Therapy often consists of massage, proprioceptive neuromuscular facilitation stretching, and/or dry needling, as well as other interventions. Self massage techniques for the adductor magnus can be found in The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition by Clair Davies. There are also many online resources which can help you locate and self treat the adductor magnus. Triggerpoints. net is an excellent muscle-by-muscle picture guide, and shows both the common location for the trigger point and pain referral patterns. Trigger points can be worked with general massage, a vibrating massage tool, or more specific techniques like trigger point pressure release. If the area is particularly tender to the touch, a topical counter irritant like ben gay can make massage more comfortable. After massage, applying warm, moist heat (e.g., sitting in a bathtub) for 20 minutes can improve the effectiveness of the manual therapy.
PNF stretching is a category of stretches which use active contraction to enhance the effectiveness of the stretch. The preferred method for trigger point deactivation is post isometric relaxation developed by Karrel Lewit , , .
To perform PIR stretching follow these steps
- Bring the muscle to its maximum pain free length
- Engage the muscle with only minimal force (isometrically) and count slowly to 10
- Cease contracting (relax), exhale slowly, and slowly attempt to move the into a greater stretch
- Three to five times repetitions is standard
- Some authors have described having the subject look up (eyes only). This helps facilitate the inspiration, which facilitates the muscle. Have the patient look down during expiration to aid in relaxation.
A qualified physical therapist, personal fitness trainer or other healthcare/fitness professional can help instruct on proper PIR techniques for releasing contractions in the adductor magnus. A YouTube and general Google search with the key words adductor magnus PIR or PNF can produce many useful videos, pictures, and hand outs from a number of qualified health care professionals.
To sum up, if you have or know some one who has pain during intercourse, it is helpful to seek the aid of medical professionals and organizations like the NVA. The more an individual educates themselves on this topic the more likely they are to achieve positive results from their health care team. The Clair Davies book and other texts and articles I have cited can provide a wealth of information for those interested in this topic.
 Recognizing and Treating Pelvic Pain and Pelvic Floor Dysfunction Prather, T. Spitznagle, S. Dugan Physical Medicine and Rehabilitation Clinics of North America, Volume 18, Issue 3, Pages 477-496
 Current Therapy in Pain By Howard S. Smith page 207
” Chronic Pelvic Pain, Musculoskeletal Syndromes”, Robert Gerwin Encylopedia of pain 2007, Part 3, 380-383, DOI: 10.1007/978-3-540-29805-2_712
 “Consensus Guidelines for the Management of Chronic Pelvic Pain”, SOGC Clinical practice guidelines No 164, part two of two september 2005, John f. Jarrell, George A. Vilos
 Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Tanual, Volume 2, By David G. Simons, Janet G. Travell, Lois S. Simons
 Therapeutic Exercise for Musculoskeletal Injuries By Peggy A. Houglum page 861
 Manipulative Therapy: Musculoskeletal Medicine By Karel Lewit page 246
 Facilitated stretching By Robert E. McAtee, Jeff Charland page 6
 Myofascial Pain: Relief by Post-Isometric Relaxation, Lewit K, Simmons DG Arch Phys Med Rehabil 1984 Aug;65(8):452-6.