Menopause often results in symptoms like vaginal dryness, vaginal atrophy, and pelvic floor muscle dysfunction, leading to painful sex (dyspareunia). Decreased estrogen levels during menopause can cause changes in vaginal health and pelvic floor muscle function, which contribute to discomfort during intercourse. Pelvic floor physiotherapy can alleviate pain by targeting and treating the underlying causes, including muscle weakness, tension, and poor coordination and flexibility. Treatments such as pelvic floor exercises, education on lifestyle changes, manual therapy, biofeedback, and the proper use of lubricants can help restore comfort and improve sexual health. Early intervention is crucial for maintaining pelvic health, preventing more serious conditions like urinary incontinence or pelvic organ prolapse, and supporting a fulfilling sex life.
What Does Menopause Mean?
Menopause is a natural biological process marking the end of a woman’s reproductive years. Officially, menopause is defined as occurring 12 months after a woman’s final menstrual period. The transition to menopause, known as perimenopause, can begin several years before the final period and is characterized by fluctuations in hormone levels—particularly a decline in estrogen and progesterone. The years following menopause are referred to as postmenopause.
During this time, women may experience a range of symptoms as their bodies adjust to lower hormone levels. Common symptoms include:
Hot Flashes and Night Sweats: These are sudden feelings of warmth, often accompanied by sweating and flushing, that can occur during the day or disrupt sleep at night.
Mood Changes: Many women experience shifts in mood, including irritability, anxiety, or depression, often related to hormonal fluctuations and lifestyle changes.
Sleep Disturbances: Night sweats and other physical discomforts can contribute to insomnia or restless sleep patterns.
Vaginal Dryness: A key symptom related to sexual discomfort, vaginal dryness occurs as estrogen levels decline, leading to less natural lubrication.
Vaginal Atrophy: Also known as genitourinary syndrome of menopause (GSM), vaginal atrophy refers to the thinning and drying of the vaginal tissues, which can make intercourse painful.
Reduced Libido: Many women report a decrease in sexual desire during menopause, often linked to physical discomfort, changes in body image, or hormonal shifts.
While these symptoms are widely recognized, one of the most significant—and sometimes under-discussed—issues that women face during menopause is painful sex. Known medically as dyspareunia, this condition can seriously affect a woman's quality of life, emotional well-being, and intimate relationships. Fortunately, pelvic floor physiotherapy offers a powerful solution.
Painful Sex During Menopause: Causes and Effects
Painful sex during menopause is a multifaceted issue, caused by both physical and hormonal changes in the body. It can manifest in several ways, from discomfort during penetration to sharp or burning pain. Here’s why:
Vaginal Dryness and Atrophy: The decrease in estrogen levels leads to reduced blood flow and less natural lubrication in the vaginal tissues. As a result, the vaginal walls become thinner and less elastic, causing irritation and discomfort during intercourse.
Pelvic Floor Dysfunction: The pelvic floor muscles, which support the bladder, bowel, and uterus, also play a key role in sexual function. These muscles need to be strong and flexible to allow for pain-free intercourse. During menopause, some women experience pelvic floor weakness due to reduced tone in the muscles, while others develop hypertonicity (muscle tightness). Both conditions can lead to pelvic floor muscle dysfunction and pain during sex.
Reduced Sensitivity and Blood Flow: With lower estrogen levels, blood flow to the pelvic area decreases, resulting in reduced sensitivity. This can make intercourse less pleasurable and more painful.
Psychological Factors: Menopause often brings emotional and psychological challenges including, anxiety, and stress, which can contribute to painful sex. Women who experience pain may unconsciously tighten their pelvic floor muscles in anticipation of discomfort, further perpetuating the cycle of pain.
These physical and emotional changes can make sex a source of stress rather than pleasure for many women. Left untreated, painful sex during menopause can impact intimate relationships and overall quality of life. However, with the right intervention, relief is possible.
The Role of the Pelvic Floor in Sexual Function
The pelvic floor is a group of muscles that form a sling-like structure at the base of the pelvis. These muscles support the pelvic organs (bladder, bowel, and uterus) and play a critical role in sexual function. Pelvic floor muscles provide the tone around the opening of the vagina, and they play a crucial role in arousal and orgasm. When the pelvic floor muscles are healthy, they provide the flexibility and strength needed for comfortable intercourse. However, changes in hormone levels, muscle tone, and blood flow during menopause can negatively affect the pelvic floor. Some women experience pelvic floor hypotonicity and weakness due to a lack of coordination and reduced tone; in this case, the muscles are too lax to provide proper support. This can lead to problems such as urinary incontinence or pelvic organ prolapse, as well as a lack of sensation or discomfort during sex. On the other hand, some women develop pelvic floor hypertonicity and weakness due to an increased tone, where the muscles become too tight, leading to pain during penetration, especially at the vaginal opening. This condition can make intercourse not only uncomfortable but also emotionally distressing. Given the pelvic floor’s central role in sexual function, addressing pelvic floor dysfunction is crucial for alleviating painful sex during menopause.
How Can Pelvic Floor Physiotherapy Help?
Pelvic floor physiotherapy is a non-invasive, effective treatment that can help restore the strength, flexibility, and coordination of the pelvic floor muscles. By addressing the underlying causes of pelvic floor dysfunction, physiotherapy can significantly reduce pain during intercourse and improve overall sexual health. Here’s how:
1. Pelvic Floor Assessment
The first step in pelvic floor physiotherapy is a comprehensive assessment of the pelvic floor muscles as well as the whole body. During this evaluation, a pelvic health physiotherapist will examine the tone, strength, flexibility, and coordination of your pelvic floor muscles. The assessment helps determine the root cause of your symptoms.
2. Pelvic Floor Muscle Training
Based on the information collected during the assessment, the physiotherapist will guide you through exercises designed to improve the function of your pelvic floor muscles. These exercises aim to help improve muscle tone, increase blood flow, and enhance pelvic organ support. Stronger pelvic floor muscles can alleviate discomfort, enhance sexual sensation, and improve sexual function.
3. Manual Therapy
For women experiencing pelvic floor hypertonicity (tightness), manual therapy can help release tension and improve muscle flexibility. Manual therapy involves gentle internal or external techniques to relax the muscles and improve flexibility and muscle tone. This form of therapy can be especially effective for reducing pain and improving the ability to engage in intercourse comfortably.
4. Biofeedback
Biofeedback is a tool used to monitor the activity of the pelvic floor muscles. Through biofeedback, you receive real-time information about how your pelvic floor muscles are working, allowing you to learn how to control them more effectively.
5. Vaginal Dilators
For women who experience pain at the vaginal opening due to increased tone, vaginal dilators can help gradually and safely expose the nervous system and the vaginal tissues to insertion and help to relax and stretch the muscles at the opening of the vagina, reducing discomfort during penetration. Your pelvic floor physiotherapist can guide you in how to use dilators safely and effectively.
6. Education on Lubricants and Moisturizers
Addressing vaginal dryness is a crucial aspect of managing painful sex during menopause. In addition to pelvic floor therapy, your physiotherapist can provide education on the use of lubricants during intercourse and vaginal moisturizers to maintain hydration and reduce irritation in the vaginal tissues.
7. Whole-Body Approach
Pelvic floor physiotherapy takes a holistic approach to health, considering how factors like posture, breathing, and body alignment influence pelvic floor function. Improving your overall body mechanics can contribute to a healthier pelvic floor, reducing discomfort during sex and improving your quality of life.
Early Intervention Matters
Early intervention is essential for preventing further complications and maintaining pelvic health. Many women delay seeking help for painful sex during menopause, thinking that it’s a normal part of aging. However, ignoring the problem can lead to more serious issues, such as pelvic organ prolapse, persistent pelvic pain, or urinary incontinence. By addressing these problems early, you can prevent long-term damage and maintain a fulfilling sex life.
Adapted from: Ova
Comments