Painful intercourse and IC: The unspoken symptom

With IC, we generally think first of pelvic and abdominal pain along with urinary symptoms like urgency, frequency, and getting up at night to go to the bathroom.  However, one of the most common symptoms seen with IC is rarely discussed – most doctors don’t even ask about it!  

Painful intercourse has been reported in up to 90% of women diagnosed with interstitial cystitis. Yet women 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 intercourse has a major impact on relationships and quality of life.  Almost one-quarter of women with IC report not being sexually active – a rate nearly 3 times higher than the average population.  

What Causes Painful Intercourse with IC?

Painful intercourse is not due to the bladder – like many symptoms of IC, it is caused by pelvic floor dysfunction instead.  The pelvic floor muscles control arousal, the physical act of intercourse, and orgasm for both genders.  When these muscles are tight, strained, and irritated, they can cause significant pain and also flare up other symptoms.  

In women, penetration 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 as a result of pelvic floor dysfunction and interstitial cystitis.

How is Painful Intercourse Treated?

Pelvic floor physical therapy 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 can also make a major difference. 

For women, a dilator set can let the body become used to penetration in a safe environment and work to stretch the vaginal tissues.  A Therawand or other self-release tool 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 sexual activity – can also help those muscles relax.

Home Tips for Overcoming Painful Intercourse

While you should always seek professional medical help from a physical therapist, sex therapist, or medical doctor, these at-home tips can help augment your treatment.

• 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!
• Lubrication - A lubricant that is good for sensitive skin can be an important aid to pain-free intercourse.
• 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.  Open communication with your partner is important in finding sexual activity and positions that allow you to be relaxed and comfortable.
• 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.
• Take a Bath - Like stretching, the warmth of the water can help the pelvic floor relax, either before or after intercourse.
• 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.
  

In Conclusion

Painful intercourse is an extremely common symptom with 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 and regain a pain-free sex life.