Sex. A topic that for myself, personally, growing up was not a topic of conversation in our house. Yes, I had sex education courses throughout school that taught basic anatomy and the general logistics of what sex is. My sex education classes required signatures from my parents stating they discussed the unit with me in hopes to open conversation between the child and their parents about sex. But, as a 13-year-old, talking about sex with your parents? No thank you. The sole thought of talking about it with anyone made me embarrassed and uncomfortable, and I think this is relatable to a lot of men and women in our society still today–awkward teenage years or not.
And why is this? Why is talking about sex so difficult for many people? Sex education courses seem to focus on the mechanics of sex, but the reality of it is, sex is so much more complex! There is so much that goes into sex that isn’t addressed in sex education such as what sex should feel like, what typical body reactions can occur during or after sex, and how emotions play a role into sexual performance. Believe it or not, our cultural beliefs and family beliefs begin to shape this idea of sex well before we even get the chance to explore sex and our sexuality.
Many of us aren’t taught the complexity that factors in to sharing this normal and pleasurable experience with another human being. Society has basically left us as sitting ducks to figure out the “norms” of sex and this terrifies people because many of us were never taught what “normal” is. So, let’s step out of our comfort zone and let’s talk about it. Let’s talk about what factors in life can affect our sexual function that could potentially lead to sexual dysfunction. Let’s talk about what sexual dysfunction is, how common is it, and what signs may indicate we should seek help from a physical therapist.
What is sexual dysfunction?
First, let’s start by defining what sexual dysfunction means. Sexual dysfunction, according to the Cleveland Clinic, is a problem occurring in any phase of sex that prevents an individual or the couple from experiencing satisfaction from the sexual activity.
Okay, let’s pause and rewind—there are phases of sex? Yes, believe it or not there are four phases of sex: excitement, plateau, orgasm, and resolution. Any of these phases of sex can be affected by psychological or physical causes resulting in sexual dysfunction.
How common is sexual dysfunction?
Sexual dysfunction is very common. So common that nearly 43% of women and 31% of men report some form of difficulty with sex. Reminder: these are not low percentages! Don’t think because you are having difficulty during sex with your partner that you are alone. Let’s face it. We are all humans, and it is a natural part of our species to have a desire to feel wanted, feel loved, and reproduce. When this is disturbed or not functioning like we expect, we begin to think something is wrong with our bodies due to the lack of ability to perform like we may have wanted.
But, the fact of the matter is there are so many factors in life that can affect our sexual arousal, sexual pleasure, or sexual desire. In today’s world, our days are filled with work, school, family, chores, and right now the stress of a global pandemic. You name it, at any time of day many of us have something scheduled to be doing that require our full mental and physical attention. With our constant busy schedules, our bodies experience anxiety, stress, lack of sleep, and a whole spectrum of other emotions that have become such a natural part of our days, many of us don’t realize we are experiencing them. Then, when we do have that small window of free time to enjoy sex, our bodies have taken a toll from the hectic schedule of life that it doesn’t perform like we wish. And what happens then? More emotions such as shame of not being able to perform, fear of it happening again, or tension between you and your partner are added to the mix.
What causes sexual dysfunction?
On the physical side of things, maybe you experience pain during sex (dyspareunia), which could lead to associating sex as not the fun and pleasurable experience it should be. Nearly 3 out of 4 women experience dyspareunia. Sorry women, unfortunately painful intercourse is more common on our end of things compared to men. Dyspareunia in women could be due to hormonal imbalances, endometriosis, vaginal dryness, stress, pelvic inflammatory disease (PID), irritable bowel syndrome (IBS), the list goes on. Or maybe you aren’t experiencing painful intercourse, but you just went through a pregnancy or menopause and your body doesn’t feel the same during sex as it did before.
Men, don’t worry, I haven’t forgotten about you. It’s not just women that can experience sexual dysfunction. Erectile dysfunction (ED) is the most common sexual dysfunction in men. ED affects 33% of all men and that percentage only goes up with age. ED is especially common after prostate cancer treatment but other risk factors for ED include diabetes, high cholesterol, heart disease, alcohol use, etc. Again, there could be a laundry list of different “technical difficulties” that could happen with sexual activity, some of which most us will experience at some point throughout our life. When that point comes, or maybe it has, keep in mind the resources you have to help with these difficulties such as a physical therapist.
Physical therapy for sexual dysfunction
We’ve gotten this far, so now the question is: What can a physical therapist do to help with sexual dysfunction? Let me tell you, when I first decided to pursue the physical therapy field, I did not know physical therapists could help treat sexual dysfunction. How I didn’t figure that one out from the start, I’m not quite sure because lo and behold sex does involve the human body, a physical therapist’s specialty. But if I didn’t know physical therapists could treat sexual dysfunction, and I wanted to pursue the physical therapy field, how are others searching for help supposed to figure it out?
A physical therapist approach to treatment with complaints of painful intercourse or inability to have sex includes a detailed history to understand the many factors that could impact the sexual function. These include things such as health concerns, limitations in positioning or the mental and emotional aspects of sexual activity. A physical exam is performed to determine the strength and tone of the pelvic floor muscles along with any soreness to the muscles. Treatment techniques utilized by a physical therapist include providing education about the condition, pelvic floor muscle strengthening and relaxation with tools such as biofeedback and manual therapy to decrease pain and improve the tissue mobility. Breathing and mindfulness exercises are frequently included as part of the holistic approach to connect the mind and body. In some cases, the use of dilators may also be appropriate. The physical therapist with additional training in urogynecological examination and treatment serves as an integral role in the healthcare team for improving sexual health.
If you are experiencing difficulties with sexual dysfunction, our therapists at the Des Moines University Physical Therapy Clinic are specially trained for pelvic floor rehabilitation for men, women, and children. If you have pain, leakage or sexual dysfunction, our physical therapists are more than happy to set up an appointment simply to discuss and listen to what you are experiencing to help guide you in determining the best course of action for your health. Visit our website or call 515-271-1717 to schedule your appointment.
