Sexual dysfunction is defined as persistent, recurrent difficulty with sexual response, desire, orgasm, or pain. The pelvic floor muscles are intimately involved in sexual function. In men, they help maintain the rigidity of an erection, and in both sexes, they rapidly and repetitively contract during orgasm, and under normal circumstances, they do not hurt before, during, or after sexual activity and are a source of pleasure for people. When pelvic floor dysfunction arises sexual pleasure is often replaced with pain and loss of normal function. The symptoms are understandably distressing for people, but the good news is, pelvic floor physical therapy can help. 

The Facts

  • One in three premenopausal women will experience painful sex at some point during her life
  • 15 -72% of men under 40 years old report symptoms of erectile dysfunction
  • 52% of men aged 40 -70 years old experience mild to moderate erectile dysfunction 
  • Up to 80% of men have erectile dysfunction after prostatectomy
  • 60% of women in menopause do not report painful sex to their doctors because they are embarassed
  • Medications such as oral contraceptive pills and acne medications can cause vulvar pain and decreased ability to naturally lubricate
  • 65% of postpartum women still experience painful sex 18 months after delivery

The Facts

  • One in three premenopausal women will experience painful sex at some point during her life
  • 15 -72% of men under 40 years old report symptoms of erectile dysfunction
  • 52% of men aged 40 -70 years old experience mild to moderate erectile dysfunction 
  • Up to 80% of men have erectile dysfunction after prostatectomy
  • 60% of women in menopause do not report painful sex to their doctors because they are embarassed
  • Medications such as oral contraceptive pills and acne medications can cause vulvar pain and decreased ability to naturally lubricate
  • 65% of postpartum women still experience painful sex 18 months after delivery

Symptoms

*Cisgender Male Sexual Dysfunction

  • Erectile dysfunction: poor quality, inability to achieve erection, inability to maintain erection, premature ejaculation
  • Decreased force or inability to ejaculate
  • Climacturia (incontinence with orgasm)
  • Post ejaculaory pain: tip and/or shaft of penis, perineum, scrotum
  • Discoloration in penis/scrotum/perineum

*Cisgender Female Sexual Dysfunction

  • Inability or decreased ability to lubricate
  • Pain upon vaginal penetration, with deep penetration only, and/or continuous pain with penetration
  • Clitoral pain, hypersensitivity to touch 
  • Pain and/or burning after sexual contact
  • Inability to orgasm, diminished orgasm
  • Urinary incontinence during sexual activity
  • Climacturia (incontinence with orgasm)

Postpartum Sexual Dysfunction

  • Decreased lubrication during breastfeeding
  • Perineal pain with touch from episiotomy or perineal trauma
  • Diminished or absent orgasm
  • Incontinence during orgasm or intercourse
  • Painful sex

Menopausal Sexual Dysfunction and Post-gynecologic cancer treatment 

  • Decreased ability to lubricate
  • Inability to achieve or difficulty with vaginal penetration
  • Painful sex: during and/or after 
  • Diminished or absent orgasm

Symptoms

*Cisgender Male Sexual Dysfunction

  • Erectile dysfunction: poor quality, inability to achieve erection, inability to maintain erection, premature ejaculation
  • Decreased force or inability to ejaculate
  • Climacturia (incontinence with orgasm)
  • Post ejaculaory pain: tip and/or shaft of penis, perineum, scrotum
  • Discoloration in penis/scrotum/perineum

*Cisgender Female Sexual Dysfunction

  • Inability or decreased ability to lubricate
  • Pain upon vaginal penetration, with deep penetration only, and/or continuous pain with penetration
  • Clitoral pain, hypersensitivity to touch 
  • Pain and/or burning after sexual contact
  • Inability to orgasm, diminished orgasm
  • Urinary incontinence during sexual activity
  • Climacturia (incontinence with orgasm)

Postpartum Sexual Dysfunction

  • Decreased lubrication during breastfeeding
  • Perineal pain with touch from episiotomy or perineal trauma
  • Diminished or absent orgasm
  • Incontinence during orgasm or intercourse
  • Painful sex

Menopausal Sexual Dysfunction and Post-gynecologic cancer treatment 

  • Decreased ability to lubricate
  • Inability to achieve or difficulty with vaginal penetration
  • Painful sex: during and/or after 
  • Diminished or absent orgasm

Associated Diagnoses

Diagnoses such as Endometriosis, Vulvodynia, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Chronic Pelvic Pain Syndrome/Male Pelvic Pain, Lichen Sclerosus, Lichen Planus, Pelvic Floor Dysfunction, post-prostatectomy complications, and Genitourinary Syndrome of Menopause are all associated with sexual dysfunction and pelvic pain.

Associated Diagnoses

Diagnoses such as Endometriosis, Vulvodynia, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Chronic Pelvic Pain Syndrome/Male Pelvic Pain, Lichen Sclerosus, Lichen Planus, Pelvic Floor Dysfunction, post-prostatectomy complications, and Genitourinary Syndrome of Menopause are all associated with sexual dysfunction and pelvic pain.

Causes of Sexual Dysfunction

  • Pelvic pain syndromes associated with pelvic floor dysfunction (above)
  • Childbirth
  • Medications
  • Obesity
  • Cardiovascular disease
  • Menopause
  • Jelqing
  • Genital mutilation, genital cutting
  • Surgically-induced
  • Pelvic Floor Reconstruction
  • Prostatectomy
  • Gender affirming surgery
  • Episiotomy
  • Vestibulectomy
  • Pudendal Nerve Decompression
  • Mesh excision

Causes of Sexual Dysfunction

  • Pelvic pain syndromes associated with pelvic floor dysfunction (above)
  • Childbirth
  • Medications
  • Obesity
  • Cardiovascular disease
  • Menopause
  • Jelqing
  • Genital mutilation, genital cutting
  • Surgically-induced
  • Pelvic Floor Reconstruction
  • Prostatectomy
  • Gender affirming surgery
  • Episiotomy
  • Vestibulectomy
  • Pudendal Nerve Decompression
  • Mesh excision

Diagnostic Challenges

A recent study showed that the majority of medical providers are not comfortable talking to their patients about sex, and similarly, patients are not comfortable talking to their doctors about sex. Studies also show the LGBQT community is often discriminated against and their sexual health suffers as a result. As a medical community we must do better. It is our mission at PHRC to make sure all of our patients feel safe and supported in all aspects of pelvic health. Many people do not realize sexual health has become a medical specialty itself and help is available! Sexual pleasure involves the body and mind and the best care to improve function is often interdisciplinary, involving medical management, behavioral health services/psychologists, and pelvic floor physical therapy. 

A recent study showed that the majority of medical providers are not comfortable talking to their patients about sex, and similarly, patients are not comfortable talking to their doctors about sex. Studies also show the LGBQT community is often discriminated against and their sexual health suffers as a result. As a medical community we must do better. It is our mission at PHRC to make sure all of our patients feel safe and supported in all aspects of pelvic health. Many people do not realize sexual health has become a medical specialty itself and help is available! Sexual pleasure involves the body and mind and the best care to improve function is often interdisciplinary, involving medical management, behavioral health services/psychologists, and pelvic floor physical therapy. 

Treatment:

How We Can Help You

If you are experiencing sexual dysfunction you will benefit from an evaluation with a pelvic floor physical therapist to determine the role your pelvic floor may be playing in your symptoms. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most people are frustrated by the time they get to see us. During the physical examination the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the examination is complete your therapist reviews your findings with you. The physical therapist creates an assessment which explains how you developed your symptoms and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to compliment your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life! 

Treatment:

How We Can Help You

If you are experiencing sexual dysfunction you will benefit from an evaluation with a pelvic floor physical therapist to determine the role your pelvic floor may be playing in your symptoms. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most people are frustrated by the time they get to see us. During the physical examination the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the examination is complete your therapist reviews your findings with you. The physical therapist creates an assessment which explains how you developed your symptoms and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to compliment your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!