Pelvic & Vaginal Pain

Pelvic & Vaginal Pain

Pain in the pelvic floor and pelvic area can be both frustrating and difficult to understand. You may experience burning, tightness or pain during sex – or simply feel that something isn’t quite as it used to be. You’re far from alone. Many women experience pelvic pain at some point in their lives, but it’s still something we don’t talk about enough.

Here, we look at what can cause pelvic and pelvic floor pain, what it can feel like and, most importantly, what you can do about it.

What is pelvic and pelvic floor pain?

Pelvic and pelvic floor pain refers to pain or discomfort around the vagina, rectum, perineum and lower abdomen. It may feel like burning, pressure, tightness, soreness or a sharper, stabbing pain.

It isn’t always easy to tell exactly where the pain is coming from. The pelvic floor is a complex area where muscles, nerves and organs are closely connected. This means pain may be felt in one particular area or spread to places such as the lower back or hips.

The pelvic floor muscles also have several important jobs: they support the pelvic organs, help with bladder and bowel control and play a role during sex. When these muscles aren’t working as they should – whether they’re too tense or too weak – it can cause pain and discomfort. And for many women with pelvic floor pain, the problem isn’t weakness at all. In fact, the muscles may be too tense.

What causes pelvic and pelvic floor pain?

There’s rarely just one cause. For most women, several things can play a part, including the muscles, surrounding tissues and strain on the area over time.

One common cause is a tight or overactive pelvic floor. Many of us tense these muscles without realising it, and if they don’t properly relax again, tight and tender areas can develop in the muscles. This can lead to ongoing pain and create a vicious cycle: pain causes tension, and tension causes more pain.

Other common causes include:

• Pregnancy and childbirth, which stretch and put strain on the tissues
• Scar tissue after childbirth or surgery
• Pain during sex, which can cause the body to tense up
• Bladder or bowel problems, for example frequent urination or constipation
• Conditions such as endometriosis, vulvodynia or vaginismus
• Stress and anxiety, which can cause us to hold tension in the pelvic floor
  

Signs of a tight or overactive pelvic floor

As mentioned above, a tight or overactive pelvic floor isn’t necessarily weak. Instead, the muscles are working too much and find it difficult to relax.

You may feel constant tension in your pelvic area or notice that you tense your pelvic floor without realising it throughout the day. Many women first notice this in situations where the muscles need to relax – for example during sex or a gynaecological examination, when it may feel tight or painful.

If the muscles stay tense for a long time, they can become sore and overworked. This can cause ongoing pain, burning or a more general feeling of soreness in the pelvic area.

The tension can also affect your bladder and bowels. You may feel the need to pee frequently without being able to empty your bladder completely, or find it difficult to pass stool even when you need to go.

Another common sign is that symptoms get worse during periods of stress or anxiety. When your body tenses up, your pelvic floor often does too.

Pain during sex or penetration

Pain during sex or penetration is one of the common signs that something may be going on with your pelvic floor. You may feel burning or stinging around the vaginal opening, tightness or resistance, or a deeper pain during sex. For some women, it only happens in certain situations. For others, it happens every time.

A tight or overactive pelvic floor is a common cause. If the muscles don’t relax enough to allow penetration, it can feel as though your body is closing off – even though you want to have sex.

But there can be other causes too, such as vaginal dryness, scar tissue after childbirth or conditions including vulvodynia and vaginismus.

Whatever the cause, pain during sex is worth taking seriously. It isn’t something you should simply get used to – and there are often ways to help once you understand what’s causing the pain.

How is pelvic floor pain treated?

Treatment depends on what’s causing the pain. For many women, the aim is to help the pelvic floor muscles find a better balance between tightening and relaxing.

If your pelvic floor is tight or overactive, the focus isn’t on strengthening it. Instead, it’s about helping the muscles relax. This can include breathing and relaxation exercises, as well as targeted treatment of tight and tender areas in the pelvic floor muscles.

A pelvic health physiotherapist can assess what’s going on and help you find the right approach. Treatment may also include working with scar tissue, advice on toilet habits or helping you feel more comfortable and confident in your body if the pain started after childbirth or in connection with sex.

Most importantly, treatment should be based on your body and your symptoms.

What can you do yourself?

There are several things you can do to help ease pelvic floor pain, particularly if muscle tension is part of the problem. For many women, the biggest change is realising that the answer isn’t necessarily to do more – but to do something different. If your pelvic floor is already tense, more pelvic floor contractions aren’t what it needs. The focus should be on helping the muscles relax.

You can start with slow, relaxed breathing, allowing your abdomen and pelvic floor to move freely rather than holding tension. It can also help to notice when you tense your body during the day – e.g. when you’re stressed or physically active.

Heat can help soothe sore, tense muscles, and taking small breaks throughout the day may help if you tend to hold tension without noticing it. Try to avoid straining when you go to the toilet too, as this can make both tension and pain worse.

And if certain activities trigger the pain – for example sex, exercise or sitting for long periods – it can help to adjust what you’re doing and give your body some time to settle while you work on the tension. Small changes can make a real difference. But if the pain persists, it’s important to get help so you don’t get stuck in a cycle of tension and pain.