Yay sex!! Sounds like a fun topic, right? Well, not so much if you are experiencing pain, low libido, performance inability and anxiety, trauma, and/or stress. For many, the idea of talking about intercourse, sexuality, and sensuality can be triggering and generate anxiety, fear, frustration, and thoughts of decreased self worth. I would like to open up a thoughtful and safe space to talk about these not so fun topics relating to sexual health and get to the bottom of some common symptoms.
Defining sexuality:
First it’s important to establish what sex means for you. This is an all inclusive, no right or wrong way discussion of sexual health. All genders, all ages, all couple dynamics, all cultures, and all religions welcome. Some considerations when talking about sex:
- Solo or partnered
- Coupling dynamics
- Penetrative (fingers, penis, toy, vaginal trainer/dilator,)
- Non penetrative activities (massage, light touch, fast vigorous stimulation, deep pressure, intimate gestures)
- Multi sensory stimulation (all 5 senses)
- Arousal (physical and psychological components)
- Desire (psychosocial factors, hormone levels, anxiety, depression, fear, fatigue, medication, chronic illness).
Motivating factors:
It can be useful to identify what is motivating you to want a sexual experience as there can be many different reasons. Are you doing it for yourself, for your partner, or both? Are you the motivator or are you along for the ride because you love your partner and want to make them happy? Are you doing it just get it over with so you can get back to your to-do list for the day? Maybe you really want sex to be pleasurable and desirable but the truth is you could care less. Are you looking to have a baby? What are your goals and expectations, then ask yourself why do you have these expectations. Taking a deep look to see if they are truly yours, someone else’s, or what you perceive societies to be. Establishing a grounded sense of what your goals and expectations are can help guide the therapeutic process.
Painful intercourse (dyspareunia):
Now let’s take a look at pain with intercourse and drill down to specifics. What kind of pain, when, and where
specifically. Getting in touch with your own anatomy and how to describe the pain can be empowering and a great
road map to healing.
Some questions to ask:
- Does the pain occur before, during, and/or after intercourse?
- Is it painful upon arousal, with orgasm, upon entry, with deep thrusting, with certain positions?
- Does the pain feel like burning, tearing, shooting, radiating, sharp, dull, a “tooth ache”?
- Is the pain Internal, external, left/right, superficial/deep?
Identify potential causes:
- Musculoskeletal imbalances or injury
- Vaginal dryness (nutrition, hydration, breast feeding, hormone changes)
- Postnatal considerations
- Menopause (peri and post)
- Restricted connective tissues (pelvic, abdominal)
- Overactive pelvic floor muscles
- Pelvic organ shifts
- Orthopedic considerations
- GI distress
Tools to reduce pain:
- Education and body awareness
- Down regulation of the nervous system
- Breathing strategies, mindfulness, meditation
- Positional considerations, propping
- Pelvic floor muscle assessment for hypertonicity, coordination, ROM
- Endopelvic and abdominal assessment and treatment for restrictions
- Biomechanics assessment and treatment
- Nutrition and hydration
- Heat/ice
- Dilator and vibrator use
- Self massage techniques
- Proper vaginal hydration: lubrication and moisturizers
- Compound ointments
- SITZ baths, vaginal steaming
- Counseling
- OhNut: a buffer to prevent penetration beyond the point of comfort
Sex should be much more than pain free though don’t you think? Let’s talk about pleasure, sex drive, and how to give ourselves permission to be a sexual being.
Orgasm, Arousal, Libido:
When discussing these components of sexual health, it becomes clear that we need to look beyond the musculoskeletal contributors and dive into the psychological components as well. Sexuality is an umbrella that intercourse falls under along with identity, psychology, education, culture, and religion to name a few.
Libido:
Are you confused and frustrated with a lack of desire to have sex? Do you think to yourself “wow that was great, I should do that more often”, but you just fall back into the same lack of initiation and desire? Maybe you just don’t understand what all the fuss is. Perhaps you once had the desire but have lost it. There may be hormonal changes and physical components attributing to this, but for some it is just a lack of sex drive. For these folks, you may have a hard time shifting gears from go go go, doing and multitasking, and taking care of things and others that you find it hard to slow down and take the time for yourself. Maybe the thought of intimacy feels like another thing you have to do rather than a time for receiving pleasure. Arousal and orgasm requires a balance between the sympathetic and parasympathetic nervous systems. You can’t be too wound up or too wound down to find your flow for arousal and orgasm. Identifying where you are at the moment and drawing attention inward to the current moment and space can be helpful to tune out the extra noise interfering with your pleasure goals.
Fear, anxiety, trauma:
Fear of pain, having another baby, or not being able to perform can create a self protecting contractile response in the muscular and connective tissues. Shame, disappointment, low self image can be hurdles as well. Folks may try to ignore these things and just push past them, but our brain has a strong protective response that is autonomic (out of our conscious control) that will interfere with our ability to engage in certain activities. You can’t just grin and bear it to get over these sensitive circumstances because the body will beat you around every corner! Trauma in all forms will arise when sorting out your body’s response to stimulus. Finding the right progression and forms of sensuality specifically for you is paramount to reconnect with your body and develop a healthy relationship with sex and intimacy. Trauma in any form can be triggering during a sexual experience and present in one or more of these areas. Perhaps you have had counseling and feel secure in your relationship with the traumatic experience, but sex or orgasm are still really painful or unachievable. Our bodies keep the score and need the opportunity to process and release the holding patterns they have been stuck in. The mind body connection is paramount to consider when talking about sexuality.
Arousal and orgasm:
Everyone’s desires, curiosities, and stimulation are different. Identifying what you like on your own can be a safe and empowering place to start identifying what type of touch you like, where you like it, and what types of stimulus you find arousing. This can be a great way to build confidence to introduce a partner into this space. Having sensual touch without sex can be a great way to build intimacy without expectations as well. Establishing ways to communicate are great ways to avoid feelings of guilt, disappointment, and/or lack of self worth.
Orgasm mechanics:
- Arousal, increased blood flow, dilation of blood vessels, increased sensation
- Release or hormones and chemicals (Oxytocin and other endorphins)
- Rhythmic contractions of the pelvic floor muscles, and uterus.
- Climax: strong contraction and muscle spasm of the pelvic floor muscles leading to a full release and blood flow to drain
Factors to consider for orgasm:
- Stimulation of nerve endings
- Connective tissue in surrounding area and neighborhoods
- Pelvic floor muscle integrity: too loose or weak can lead to decreased sensation, too tight can lead to pain or inability to have rhythmic contractions.
- Hormone imbalances
- Positions, pace, angles
- Vaginal moisture
- Orthopedic conditions
- Chronic illness
- Breathing strategies (for letting go of tension, and arousal)
The work I do is gentle and observant to how the body processes introduction to touch to the muscles and tissues. I
work to restore balance to these system’s, establish a homeostasis for the brain to feel secure, and guide the nervous
system to self regulate through your experiences. I am available to accompany you through this process as you feel
safe and comfortable. I am not a sex therapist and I do not engage in any sort of stimulating activities. My focus is to
address the musculoskeletal as well as psychosocial components, and to accompany you in identifying successful
tools to achieve your personal goals. I can guide you through self programs for you alone and/or with your partner. I
look forward to your questions during this weeks free virtual pelvic health support series “Pain Free Sex to Orgasm”!
Permission to be an empowered sexual being,
Laura Rowan, OT/L
Pelvic Rehab Specialist
Essential Pelvic Health
www.essentialpelvichealth.com