Painful intercourse affects men too, although it is discussed far less often. It may be felt in the perineum, the penis, the scrotum or deep in the pelvis, during intercourse, on ejaculation, or only some hours later.
The most common cause that responds to physiotherapy is excessive pelvic floor tension together with trigger points in the perineal and pelvic muscles. The mechanism is the same as in painful intercourse in women: pain triggers reflex tension, tension increases the pain, and the body learns to expect pain and tightens pre-emptively.
Before attributing the problem to muscles, however, causes that need medical treatment must be excluded - prostatitis and urinary tract infection, skin conditions, phimosis, sexually transmitted infections, Peyronie’s disease. That route goes through a urologist, and physiotherapy begins after it, or alongside his treatment.
Therapy
- Detailed history: when, where and for how long it hurts
- Functional examination of the pelvic floor and trigger points
- Releasing an overactive pelvic floor
- Manual therapy and dry needling of trigger points
- Learning conscious release
- Work on breathing and on the fear of pain
- A home programme
- Biofeedback and EMG