Painful intercourse and IC: The unspoken symptom

With interstitial cystitis (sometimes called IC or even painful bladder syndrome), we generally think first of chronic pelvic pain and abdominal pain along with urinary symptoms like bladder pain, urgency, urinary frequency, and getting up at night to go to the bathroom.  However, one of the most common symptoms seen with interstitial cystitis is rarely discussed and has nothing to do with bladder symptoms. In fact most doctors don’t even ask about it!  

Painful sexual intercourse has been reported in up to 90% of women diagnosed with interstitial cystitis. Yet women with interstitial cystitis often aren't even asked about this symptom during doctor’s appointments!  Men also experience pain with intercourse and sexual dysfunction with interstitial cystitis and chronic prostatitis.  

While often overlooked, painful sexual intercourse has a major impact on relationships and quality of life. Sexual dysfunction caused by interstitial cystitis, along with pelvic pain and bladder pain, makes this chronic disease one that has serious potential for making female patients absolutely miserable.  Almost one-quarter of women with IC report not being sexually active – a rate nearly 3 times higher than the average population.  When a pain syndrome has that much of an impact on normal sexual function, it’s a major problem - and one that needs to be addressed and taken more seriously by the world’s medical professionals.

What Causes Painful Intercourse with IC?

Sexual dysfunction and sexual pain is not due to bladder pain or anything else to do with the bladder – like many symptoms of IC, it is caused by pelvic floor dysfunction instead.  This is why many professionals disagree with categorizing interstitial cystitis as a “painful bladder” syndrome, instead referring to it as a more generalized pain syndrome. The muscles in the pelvic floor control arousal, the physical act of intercourse, and orgasm for both genders.  When these muscles are tight, strained, and irritated, they can cause significant pelvic pain and also flare up other symptoms, leading to sexual dysfunction in ways that bladder pain simply doesn’t.  

In women with IC, this pain syndrome leads to penetration that is often painful, both in the moment and often for days afterwards. Intercourse can cause long-lasting flares, and fear of intercourse can amplify the problem.

For men, painful intercourse often manifests as pain with erection or ejaculation, which can also last for days afterwards. Men may also struggle with erectile dysfunction or other types of sexual dysfunction as a result of pelvic floor dysfunction and interstitial cystitis.

How is Painful Intercourse Treated?

Sexual dysfunction in the form of painful intercourse can be a major stressor in your life, as it denies you one of the core components of your sexuality. Thankfully, there are things that can be done to minimize the impact of painful intercourse and lead to a better quality of life for those who suffer from IC. 

Pelvic floor physical therapy, a proven method for reducing pain and discomfort associated with vaginal penetration due to interstitial cystitis, works to address the underlying pelvic floor dysfunction that causes pain with intercourse. Manual therapy alleviates the trigger points that form in the pelvic muscles.  

Self-care techniques designed to treat female sexual dysfunction or impaired sexual function can also make a major difference. 

For women with IC, a dilator set can let the body become used to penetration in a safe environment and work to stretch the vaginal tissues.  A tool such as  Intimate Rose's patented pelvic wand can be used to work on internal trigger points in both men and women.  

Stretching either before or after intercourse can alleviate some of the tension within the pelvic floor muscles (you can try the IC Stretching Regimen). A warm bath – either before or after female sexual activity or sexual intimacy – can also help those muscles relax.

Home Tips for Overcoming Painful Intercourse

You should always seek professional medical help from a physical therapist, sex therapist, or medical doctor. Everyone’s body is different, and there may be complicating factors that could materially change how you need to be treated for painful intercourse. That being said, these at-home tips can help augment your treatment of sexual difficulties safely and effectively.

• Take it Slow - Make sure to have an open dialogue with your partner, knowing they will take it slow or stop if it becomes painful or uncomfortable. Trust is key, and so is communication!
• Lubrication - A lubricant that is good for sensitive skin can be an important aid to pain-free intercourse. Water-based lubricants, or those based on natural oils, are ideal - as long as they are free of additives like parabens or fragrances.
• Change Positions - Some positions put less strain on the pelvic floor, especially for women. Lying on your back with your legs drawn up (like the Happy Baby stretch) can relax the pelvic floor, while being on top gives you more control over the depth and speed of penetration.  Again, open communication with your partner is important here in finding sexual activity and positions that allow you to be relaxed and comfortable with a minimum of pain and discomfort.
• Stretching and Deep Breathing - The muscles of the pelvic floor have to clench during intercourse and orgasm, and sex puts strain on the pelvic floor.  Stretching out afterwards - especially with the Happy Baby position - can help the pelvic floor to relax again.  Deep breathing can help relax the nervous system and alleviate any anxiety associated with intercourse - and emotional stress can be one of the biggest risk factors for painful sex, right up there with physical stress!
• Take a Bath - Like stretching, the warmth of the water can help the pelvic floor relax, either before or after intercourse. Plus, it just feels good - especially if you take a warm bath.
• Other Ways to Express Affection - Sometimes, intercourse may just not be a possibility at a particular time in your healing journey. Finding other ways to express affection and show intimacy can help. Some couples cook together, take a walk, exchange back rubs, or simply cuddle on the couch to regain that feeling of closeness. If it works, it works - and that’s what’s important.

In Conclusion

Painful intercourse is an extremely common symptom with a chronic pain syndrome like interstitial cystitis - don't be afraid to mention it to your doctor or physical therapist. While common, painful intercourse is never normal, and something that you can address to restore intimacy to your relationship, treat sexual dysfunction, get some symptom relief, and regain a pain-free sex life.