Have you ever felt pain during sex?

If sex is painful for you at times, you are not alone. In fact, according to Cedars-Sinai Medical Center, 75% of women will report pain during intercourse at one point in their life.

Many women are reluctant to talk about any issues they’re having in the pelvic region, whether it’s urinary incontinence, painful sex or a prolapse. Many don’t open up to friends or loved ones about these issues and, as a result, people feel alone in their struggles. Oftentimes women are experiencing pain during intimacy because of dryness or not enough lubrication. Other possible causes of this may include hormonal imbalances, endometriosis (when tissue that normally lines the uterus grows in other areas of the pelvis, such as the ovaries, fallopian tubes or intestines), interstitial cystitis (painful bladder syndrome), infections, ovarian cysts (fluid-filled sacs on the ovaries) or fibroids (non-cancerous growths on the uterus). Another incredibly common but frequently overlooked cause of pain during intercourse is pelvic floor injury or dysfunction.

A person’s pelvic floor injury will go undiagnosed and untreated simply because it is not discussed. We have been able to diagnose it in our office – so often as a result of a side conversation with the patient – and we have found a treatment that provides nearly instantaneous relief. Pelvic floor injuries can happen as a result of growing up playing athletic sports like gymnastics, cycling, soccer, dancing or cheerleading, or trauma to the pelvic area like childbirth. Athletic hernias –  when a small muscle tear causes scar tissue to form – sometimes occur and lead to impingement of important sensory nerves that run through that area.

The pudendal nerve is a main nerve in the pelvis that serves the lower buttocks, the area between the buttocks and the genitals (perineum), and the area around the anus and the rectum.  Neuralgia (pain in a nerve pathway) – specifically pudendal neuralgia – can be extremely painful when trying to return to physical activity. It is especially noticed when sitting on a bicycle or saddling a horse, and during intimacy. Pudendal neuralgia is often treated with stretching, rest and pelvic floor physical therapy. These modalities are all effective, but they can take time and don’t always offer pain relief. We have seen first-hand the difference that a procedure like hydrodissection can make on this pelvic floor pain.

Hydrodissection is the process of separating layers of fascia and scar tissue off of impinged structures (i.e. the pudendal nerve) by an ultrasound-guided injection of saline solution. The procedure takes around five minutes, and 9 times out of 10 the patient’s pain is immediately gone. We recommend 3 days of rest after the treatment – to allow the area time to heal – and then to either start or return to pelvic floor physical therapy the following week. Patients notice an improvement to their physical activities, including sexual intimacy, almost immediately afterwards. Many women have reported that both the sensation and overall enjoyment of the experience enhanced after they received hydrodissection. If you are avoiding intimacy due to physical pain and discomfort, it may be wise to talk to your medical provider. Pain during sex usually has a cause and once it has been identified, it is likely treatable. “I think as women, we often tend to blame ourselves,” Dr. Karyn Eliber, urologist of Cedars-Sinai says. “That can definitely contribute to the pain and to sexual dysfunction. I think the more resources we can make available, and the more we’re able to talk openly about these issues, the more beneficial it will be.



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