An Unspeakable Pain…Or The Pain No One Wants to Speak About

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By: Rivki Chudnoff PT, MSPT

12:30 am on a Tuesday night, and my phone buzzes with a new text message. I glance over at my phone, “We did it!!!”

A few months earlier, the sender of this text sat in my office in tears. She was 22 years old, married for six months to a guy she loved, and they were not able to have intercourse. Every time they tried, she had unbearable pain. She was convinced that there was no way it was ever going to happen for her. She was skeptical that there was anything that could be done to help her situation. Not being able to have intercourse had put a strain on her relationship with her husband. She felt he no longer even made attempts to be intimate with her because he didn’t want to hurt her. She was devastated...and that is when our work together began...

Pelvic pain is one of those issues that often goes unspoken about in our community. Women frequently suffer silently and mistakenly assume that intercourse is meant to be painful. They find themselves avoiding physical intimacy with their husbands, because who really wants to do something that is painful? They wonder to themselves, ‘Everyone else seems to be able to do this—what’s wrong with me?’

This can cause stress and tension in an otherwise peaceful marriage. Feelings of resentment, rejection, inadequacy, disappointment, frustration, shame, and despair can fester in this pile of unresolved physical pain for the couple. Often, women are not aware that there is help and treatment for these issues. Painful intercourse, while not normal, is much more common than people think. Sometimes referred to as Vaginismus, Vulvodynia, Vestibulitis, or Vulvar Vestibulitis, approximately one in seven women suffer from pelvic pain.

As newlyweds, women may experience pain or discomfort with initial attempts at intercourse. For some women, the initial discomfort may quickly resolve, but for others, ongoing pain may prevent them from being able to tolerate full penetration. Frequently in these cases, the pain gets worse with each attempt. Women describe feeling like their husband is “hitting a wall inside” when he tries to enter. The pain can feel like burning, stinging, throbbing, or sharp pain, and may last for hours afterwards. Gone untreated, couples can be married for months, and in severe cases even years, without having ever had full penetration due to this excruciating pain. In other cases, women endure tremendously painful intercourse, telling their husbands to “just do it” or “get it over with”, even though they are screaming in pain. Unfortunately, without physical therapy intervention, the pain often gets worse each time. The human body doesn’t forget painful experiences, and may start to tighten and spasm in anticipation of intercourse, creating a cycle of pain.

Often, women feel alone in their pain and are ashamed that they can’t “just do it like everybody else”. They don’t know who they can speak to about this very personal issue, and doubt that there is anyone out there who can help them. They are worried they will be judged, looked down on, or worse, told it is all in their head.

Sometimes, women who have never experienced pain with intercourse in the past can develop pelvic pain after childbirth, tearing or episiotomy, with hormonal changes that occur with menopause, or following cancer treatments. They find themselves struggling with pelvic pain for the first time in their lives. In these cases, tissue in the vaginal area can become injured, scarred, dry, or thinned, causing painful intercourse. Women often complain that they don’t enjoy or desire intercourse, or that they lack arousal. While there are many contributing factors to decreased arousal, it is certainly difficult to enjoy intercourse or desire it when it causes excruciating pain.

Physical therapists trained in pelvic health and rehabilitation are a great resource for women experiencing pelvic pain. The pelvic floor (if you’re not sure where it is, it’s what you’re sitting on) is made of muscles and nerves just like the rest of the body. For this reason, it often responds well to physical therapy techniques just like any other part of the body that is experiencing pain or spasm.

Finding a practitioner who specializes in this area can be an important step toward recovery. Over the years, I have treated many women who have walked into my office at the point of despair over their circumstances. Physical therapy empowers them to take control over their bodies. As I tell all my patients, “I am not here to fix your problem; I am here to guide you in this process and teach you how to heal yourself.” Pelvic rehabilitation gives women the tools to help themselves.

One of the most common questions women ask is, “How long is this going take to fix?”

The answer to this question is that each person is different, but generally, the longer the pain has been going on for, the longer it takes to resolve. Reaching out for help with painful sex can take a lot of courage. Often, women put off seeking treatment because they find the idea of sharing personal issues with a complete stranger embarrassing. For this reason, it is key to choose a physical therapist who is experienced in treating women with pelvic pain. While this may be a women’s first experience with pelvic pain, there is likely very little she can tell a therapist with years of experience that she has not yet  heard from other patients many times before.

Don’t wait; get help! Often these things don’t get better on their own, and early treatment can save months, if not years, of unnecessary suffering. Speak to your doctor, seek out a trained pelvic floor physical therapist, and let them guide you on your journey to healing…and then text me with your good news!

 
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Rivki Chudnoff PT, MSPT

is a NY/NJ licensed physical therapist with over 20 years of experience. Rivki specializes in women’s health-related issues and pelvic floor dysfunction, with a focus on pelvic pain, unconsummated marriages, incontinence, pregnancy, and postpartum rehabilitation. Rivki has presented at marriage workshops, community events, and to sexual educators and kallah teachers. She is a faculty member at the Herman & Wallace Pelvic Institute, where she provides continuing education for healthcare professionals. Rivki sees patients at her private practice, Hamakom Physical Therapy in Teaneck, NJ. Contact her at rivkichudnoff@gmail.com, visit her website at www.hamakompt.com and follow her on Instagram @rivkichudnoffpt.

Rochel LazarChudnoff; Rivki