(646) 355-8777

Herman & Wallace Blog

How Sexual Pain Impacts Sexual Function

In a previous post on The Pelvic Rehab Report Sagira Vora, PT, MPT, WCS, PRPC shared that "cognitive-behavioral therapy appears to play a significant role in improving sexual function in women". Today, in part three of her ongoing series on sex and pelvic health, Sagira explores how sexual pain affects sexual dysfunction in women.

After having explored what allows for women to have pleasurable sexual experiences including pain-free sex and mind-blowing orgasms, we now turn towards our cohort that have pain with sex and intimacy. How does this group differ from women who do not have pain with sex? Are there some common factors with this group of women, and perhaps understanding these factors may help the pelvic floor therapist render more effective and successful treatment?

There are few studies exploring sexual arousal in women with sexual pain disorders. However, their findings are remarkable. Brauer and colleagues found that genital response, as measured by vaginal photoplethysmography and subjective reports, was found to be equal in women with sexual pain vs. women who did not have pain, when they were shown oral sex and intercourse movie clips. This and other studies have shown that genital response in women with dyspareunia is not impaired. Genital response in women with dyspareunia is however, effected by fear of pain. When Brauer and colleagues subjected women with dyspareunia to threat of electrical shock (not actual shock) while watching an erotic movie clip they found that women with dyspareunia had much diminished sexual response including diminished genital arousal. But Spano and Lamont found that genital response was diminished by fear of pain equally in women with sexual pain and women without sexual pain.

Fear of pain also resulted in increased muscle activity in the pelvic floor. However, this increase was noted in women with pain and women without sexual pain equally and was noted with exposure to sexually threatening film clips as well as threatening film clips without sexual content. The conclusion, then, from these results is that the pelvic floor plays a role in emotional processing and tightening, or overactivity is a protective response noted in all women regardless of sexual pain history.

The one difference that was noted was with women who had the experience of sexual abuse. For them, pelvic floor overactivity was noted when watching sexually threatening as well consensual sexual content. Women without sexual abuse history did not have increased pelvic floor activity when watching consensual sexual content.

In summary, evidence supports the hypothesis that women with sexually adverse experiences tend to have impaired genital response when in consensual sexual situations, however, women who do not have sexual abuse histories and but have sexual pain tend to have appropriate genital response. Both groups, however, have increased pelvic floor muscle activity in consensual sexual situations. This increase in pelvic floor muscle activity leads to muscle pain, reduced blood flow, reduced lubrication, increased friction between penis and vulvar skin and hence leads to pain.

This brings us to our next questions, how does the cohort that has had adverse sexual experiences present? How do women with history of sexual trauma process sexual experiences? How does the pelvic floor present or respond to consensual sexual situations when a woman has been abused in the past? Please tune in to the next blog for answers…


Blok BF, Holstege G. The neuronal control of micturition and its relation to the emotional motor system. Prog Brain Res. 1996; 107:113-26
Brauer M, Laan E, ter Kuile MM. Sexual arousal in women with superficial dyspareunia. Arch Sex Behav. 2006; 35:191-200
Brauer M, ter Kuile MM, Janssen S, Lann E. The effect of pain-related fear on sexual arousal in women with superficial dyspareunia. Eur J Pain: 2007; 11:788-98
Spano L, Lamont JA. Dyspareunia: a symptom of female sexual dysfunction. Can Nurse 1975;71:22-5

PTSD and Pelvic Floor Dysfunction
Compiling the essential manual therapy skill set

Upcoming Continuing Education Courses

Pediatric Functional Gastrointestinal Disorders - Remote Course

Feb 27, 2021 - Feb 28, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Mequon, WI (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Level 2A - Garden City, NY Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Level 2A - Bozeman, MT Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 2A - Annapolis, MD Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Encompass PT

Pelvic Floor Level 2A - Louisville, KY Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: KORT - Kentucky Orthopedic Rehab Team

Postpartum Rehabilitation - Remote Course (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Fort Smith, AR Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Arkansas Colleges of Heatlh Education

Pelvic Floor Level 2A - Marietta, GA Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2A - Little Rock, AR Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Core Pelvic Physical Therapy

Pelvic Floor Level 2A - Torrance, CA Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2A - Toledo, OH Satellite Location

Feb 27, 2021 - Feb 28, 2021
Location: ProMedica

Pelvic Floor Level 2A - Asheville, NC Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Cornerstone Physical Therapy

Pelvic Floor Level 2A - Self-Hosted (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2A - Cranford, NJ Satellite Location (SOLD OUT)

Feb 27, 2021 - Feb 28, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2A - Metairie, LA Satellite Location

Feb 27, 2021 - Feb 28, 2021
Location: East Jefferson General Hospital

Bowel Pathology and Function - Remote Course

Feb 28, 2021 - Mar 1, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Mar 1, 2021 - Mar 2, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Brooklyn, NY Satellite Location (SOLD OUT)

Mar 1, 2021 - Mar 2, 2021
Location: Prime Fitness Physical Therapy

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Mar 5, 2021 - Mar 6, 2021
Location: Replacement Remote Course

Mobilization of Visceral Fascia 2: The Reproductive System - Valencia, CA Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Henry Mayo Newhall Memorial Hospital

Mobilization of Visceral Fascia 2: The Reproductive System - Medford, OR Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia 2: The Reproductive System - St. Louis, MO Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Mercy Hospital St. Louis

Mobilization of Visceral Fascia 2: The Reproductive System - Jackson, WY Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Four Pines Physical Therapy

Male Pelvic Floor - Satellite Lab Course

Mar 6, 2021 - Mar 7, 2021
Location: Replacement Remote Course

Male Pelvic Floor - St Paul, MN Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Regions Hospital

Male Pelvic Floor - Kenosha, WI Satellite Location

Mar 6, 2021 - Mar 7, 2021
Location: Aurora Health Care