pelvic health Archives - Revitalize Physical Therapy

Introduction

Being in a relationship is something to celebrate! But having sex after you’ve been abstinent (for example, because it’s your first time, because you’ve just had a baby, or because you had a medical procedure) can feel scary. This anxiety is perfectly valid because it’s based in reality. Yes, real psychological and physical challenges can arise when you have sex again. But you don’t have to be scared. You just have to be prepared!

Why Sex Might Feel Painful After a Break

Similar to the nerves many first timers feel, you might worry that sex will hurt when you resume it after a break. A lack of lubrication and increased anxiety—which is completely expected—can make sex feel physically painful, according to Romper. Fixing lubrication is pretty self-explanatory, but anxiety can feel more complicated.

We all reduce stress in different ways, but some general recommendations include mindfulness, yoga, and exercise. You may also want to tell your partner that it has been awhile. They should know how to make the experience less stressful. And if they don’t, don’t be afraid to tell them.

Returning to Sex After Pain or Diagnosis

Returning to sex after a pain diagnosis can feel even more complicated. First, ask yourself: are you even ready to return? It’s ok if you’re not.

Chronic pain does not erase your libido on its own, but pushing through pain can create negative associations with something that should feel fun and enjoyable. Fear and anxiety can also cause your muscles to tighten instinctively. This is your body’s way of trying to protect you. That tightening can make sex even more painful, and the cycle continues.

And THAT can be a real libido buster, because who wants to participate in an activity that hurts? (My blog post on dyspareunia is particularly helpful here.) You should talk to your medical team and pelvic floor physical therapist about exercises that can help you prepare, such as dilator work and hip stretches.

In addition, if a hormonal component contributes to your pain (for example, as some women on prolonged birth control may experience), or if you are postmenopausal, you may benefit from estrogen or estrogen/testosterone creams.

Bleeding with Sex: What It Can Mean

Believe it or not, bleeding with sex is not limited to only the first time. Many things can cause postcoital vaginal bleeding in sexually active folks, including more serious conditions like cancer and pelvic inflammatory disease, according to the Mayo Clinic.

However, you may simply need more lube, more foreplay, or a different type of birth control that isn’t hormonal. There may also be no clear reason! Although it can feel embarrassing to talk about, you should always tell your doctor if it’s happening so you don’t miss an important diagnosis.

When Desire, Identity, or Emotions Shift

At any point in your sexual life, you may notice less desire than you used to. You may also experience challenges related to trauma, shame, orientation, identity, or addiction. The person you were when you were having sex at 25 may not be the person you are when you return to it in your late thirties.

This is where a psychologist or sex therapist can help. Sex therapists are real healthcare professionals trained to support people with a wide range of concerns, from lowered desire to difficulty maintaining an erection.

Final Thoughts

Sex is one of the most beautiful parts of being human, but it should never cause pain. It may feel silly to prepare for it, but remember: you can’t fully engage in loving someone else before you love and care for yourself first!

Here’s how to handle a real pain in the butt! When I say “pelvic floor,” what do you envision? Most people think of a vagina, but the pelvic floor isn’t the vagina. Rather, it’s “a group of muscles and tissues that support important organs like the bladder, urethra, anus—and in women—the uterus, cervix and vagina,” according to the FDA.

So yes, the pelvic floor involves your back door. And while you may not want to bring up back door pain, bleeding or discomfort to your pelvic floor therapist (because you think of her as the vagina expert), she might just be the key to solving it, or at least understanding it better!

And what exactly can cause this? Let’s explore.

Levator Ani Syndrome

Let’s start with levator ani syndrome. Levator ani syndrome is caused by muscle spasms and is a type of pelvic floor dysfunction. Getting its name from the levator ani itself, it’s a group of muscles located around your butt and vagina. They can range from mild pelvic or rectal pain to something way more intense than “pain in the butt”. It can even cause you to awaken from a dead sleep! It can also feel like pressure that mimics “sitting on a ball,” according to the Cleveland Clinic.

What causes it? There are theories: Everyday activities can be likely culprits, from prolonged sitting while working or traveling, to sex, to life stress, to painful bowel movements. But a definitive cause hasn’t been found.

Pelvic floor physical therapy can treat this condition, along with muscle relaxers, warm baths and rectal dilation (ideally taught to you by your awesome pelvic floor PT!).

Hemorrhoids

You’re probably pretty familiar with hemorroids already, maybe a little too familiar! What you may not know is that there are three types – internal, external and thrombosed, as the Mayo Clinic explains.

Hemorrhoids are just another way of saying your veins are swollen. Internal and external are exactly like they sound, either in the rectum (internal), which is the last stoop for stool on its way from the large intestine to the toilet, or external, typically viewable from the outside, where the anus is. Both can involve bleeding and pain. Thrombosed hemorrhoids may be located externally or internally, according to the Cleveland Clinic. The pain can be much worse and you develop a clot.

The same causes of pelvic floor dysfunction can also cause hemorrhoids – aging, pregnancy and/or constipation. Do your best to avoid constipation, whether that means more water, more fiber or exercising. Never strain to have a bowel movement.

There are many hemorrhoid prevention exercises, like Child’s Pose and pelvic floor contractions that your physical therapist may be able to help you master. The Mayo Clinic recommends over-the-counter cream, Tylenol and warm baths to treat.

Fissure

A fissure is a tear in tissue around the anus. And again, constipation is often the culprit. Bowel movements may not be the simple process they were before you had the fissure, as now you’ll experience pain and bleeding. You may also experience spasms near the anal sphincters. The good news? It doesn’t take much to treat this condition – a warm bath and avoiding constipation can do the trick.

Anal Fistula

An anal fistula is a connection that has sprung up between your anus and the external skin, according to the Cleveland Clinic. This leads to pain, swelling and possibly pus. Most often, the cause is a perianal abscess which typically happens when an anal gland is infected. Surgery is the main way to treat anal fistulas. An MRI that shows the pelvic floor may be needed in the diagnosis stage. There is also a rectovaginal fistula, which, according to the Mayo Clinic, is an unnatural connection bonding the rectum or anus and vagina. Stool or gas is then able to emerge from the vagina once this happens. Childbirth, Chron’s disease, surgery and radiation are a few causes.

Rectal Prolapse

In a rectal prolapse, a person’s rectum leaves their anus and is actually visible. It is part of a larger category known as POP or pelvic organ prolapse. In more severe cases, you may even see pink tissue emerging from the anus. Fecal incontinence, constipation, bleeding and incomplete emptying of the rectum are all symptoms, says the Mayo Clinic. As with hemorrhoids and pelvic floor dysfunction, advanced age (over 50) and constipation could be to blame. Treatment might be as simple as a laxative or as complex as surgery.

While many of us don’t want to think about anything related to the anus, as the symptoms tend to be uncomfortable and private, it is important to listen to our bodies when they speak to us. Colon and anal cancer are real risks. Screening is important if your doctor recommends it. Take care of that pain in the butt now before it becomes a bigger one later. And that’s … the bottom line.

Tag: pelvic health

Sex after Abstinence: Why It Doesn’t Have to Be So Scary