CASE STUDY: Pain With Intercourse

Client History: Gail (not her real name) came to see me, and she had never had a baby. Yes, I do see clients other than pregnancy and postpartum clients! She was in her mid-20s, and she was complaining of both insertional and deep thrusting pain with intercourse. She had been experiencing this pain for her entire sexual experience. There were no other issues or significant history contributing to this issue other than an ACL repair 10 years prior. She did share that her first two sexual experiences and partners were not great, and she was currently in a new relationship.

Assessment and Findings: I always start externally on the body to allow the body to get used to my touch. During my assessment I found that the client’s pelvic mobility and alignment only had a hardened right ischial tuberosity possibly from her ACL injury. Her uterus was a little restricted in the right broad ligament. As she got comfortable with my touch, her body felt ready and willing to do intravaginal work.

During the internal assessment, the client complained of a bit of burning at the opening, so I was curious about vulvar vestibulitis; however, her tissues did not support that curiosity. My only objective finding at the entrance was a significant muscular tone in the first layer of pelvic floor muscles, which are the superficial upper urogenital triangle. The client’s transverse perineal and bulbo muscles had increased tone bilaterally. I did not feel I should go any deeper and worked at the entrance of the vagina with my fingertip.

Treatment: As I tuned into the tissues, my intuitive sense was that the vaginal tightening was the body trying to keep things out. The client, too, was aware of this tension and felt fear was being held in these tissues. As the client got curious about it, she started sharing her beliefs about sex. Growing up, her parents gave her the messaging that sex was shameful and bad. As we worked to shift the limiting belief around sex, we started by having her say, “sex is bad”, however, she quickly blurted out that “sex was shameful!” This was the limiting belief that needed to be shifted. With that done, we both noticed a softening of the first layer of muscles. However, the tissues still weren’t fully relaxed, so I knew something else needed to be resolved.

I had also gotten an intuitive hit that there was something about the client’s partners and sex being more for her partner and not her. As I asked the client about her feelings about pleasure, she said she could masturbate. When asked about the dynamics with a partner, the client said she felt it had to be all about the man and that she really didn’t feel she had any say in her sexual experiences.

With all this discovery and reconnection to this area through my touch and helping the client become aware of the tissue softening, her layer one pelvic muscles felt better, but the entire pelvic space felt heavy and dead. I guided her through a pelvic bowl visualization. That brought a little bit more lightness to the area, but I still sensed that she didn’t have access to her root voice, the voice from the pelvic space, not her head.

We worked together to try and help her feel the difference in her body between a YES and a NO and what that felt like in her body, particularly in her pelvic space. She could feel a sense of tightening with a NO and a relaxation with a YES. As she became aware of this, I noticed that my finger pad, which stayed only at her opening, layer one, was being pulled in deeper.

As I helped her to feel this drawing in, and that was her body saying YES to me and wanting more, I could explore her deeper structures. Her cervix was off to the left, and her left uterosacral ligament was restricted. Both released nicely. The rest of her pelvic floor muscles had normal tone and good strength. I worked with her to make sure she could contract, relax, and bulge, which she was able to do. She was also pleasantly surprised she had no pain with the insertion of two fingers.

Client Outcome: After this session, the client felt more grounded and connected to her body in a way she hadn’t experienced before. This session was more profound than expected, and she was gratefully surprised. I gave her some resources to explore her pleasure and sexuality on her terms. I also encouraged her to be curious about how this session may influence her current relationship.

I did instruct the client to purchase a vibrator or dilator set to help her muscles learn to relax, so she could experience insertion without pain. I am curious to see how she does and what happens with her current relationship.

Conclusion: Learning to help our clients disentangle the messaging they received from their childhood around sex is a vital part of helping our clients reconnect with their pelvic space in a more empowering way. Also, learning to hear the voice of our root and feel the responses of yes and no in the body are essential to helping guide us in our lives.

As practitioners, feeling the tension in the pelvic floor muscles and knowing when something more is being held is vital to helping our clients get better faster. When deeper issues are at play, the muscles won’t respond easily to trigger points, MFR, pressure, dilators, or whatever else you throw at them. When these issues are addressed, you can treat what remains and get better results. If you want to learn how to help discover what might be held in the tissues, how to shift them, and limiting beliefs, please check out the Birth Healing Intensive program coming in February 2024. Details to be released in November 2023.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com