PAIN DURING SEX. TELEHEALTH ACROSS THE UK.

Sex hurts and you still have no explanation.

Most pelvic floor advice treats weakness. Pain during sex usually comes from a pelvic floor that has been holding for years and cannot let go on demand, so the work is teaching it to release.

Emma Bird, a registered nurse specialising in pelvic floor function, talking with a patient in a warm wood-and-linen room

I am Emma Bird, a registered nurse specialising in pelvic floor function, working online and 1:1 with women across the UK.

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Cover of the free PDF: The Questions Nobody Asked You, 7 questions about sex and why you find it painful, by Emma Bird

FREE PAINFUL SEX GUIDE

The 7 questions no one asked you about sex and why you find it painful.

And the one that explains your pain is usually the one you would never think to mention.

What you have already been told

Most women come to The Pelvic Floor Clinic having been told:

“Your scan is normal, so there is nothing wrong.”
“You are probably just stressed.”
“Try to relax more.”
“Have a glass of wine first.”
“Use more lubricant.”
“Keep doing your Kegels.”

None of it was said to hurt you. Ten minute appointments have no room for a pelvic floor history, so the tension is easy to miss. Your pain has a cause and a name. Nobody has looked for it yet and that's where I come in.

What you are actually living with

These are the things nobody connects

Pain during penetration and nobody has asked you exactly where

Pain at the entrance, pain on the vulva and pain deep inside are three different problems with three different causes. Nobody has asked you which one yours is and every plan you have been given was built without knowing. It is the first thing I ask.

Burning and urinary symptoms that keep testing negative

Months of being treated for thrush and cystitis, courses of antifungals and antibiotics and dipsticks that come back clear each time. A pelvic floor that is holding refers pain into the urethra and the vulva. It is the same muscle that hurts during sex and nothing you were prescribed was aimed at a muscle. One cause and it can be worked on.

Tampons that hurt, or will not go in at all

Something far smaller than sex is already too much and it is the same muscle at the same entrance. A smaller tampon or a different brand gets you through the week and the muscle stays exactly where it was. Teach it to lengthen and both get easier.

Dilators bought, tried alone and put in a drawer

Dilators are a tool, not a treatment. When used without breathing and downtraining, they teach the body to brace and then to dread, so sex can get more painful. Abandoning them was a reasonable response to a set of instructions that skipped the part that makes them work.

A stressful few months and everything got worse

A hard stretch at work or at home and the symptoms climb. Sex gets more painful and some women start leaking when they sneeze or run. That is the same muscle bracing under pressure. But life is always busy and a muscle that has learned to let go handles it differently.

Kegels done properly for months and things got worse

Strengthening a muscle that is already clenched makes the clench stronger and a tighter pelvic floor hurts more during sex. Doing them faithfully and getting worse is not a sign you did them badly, it is a sign they were the wrong instruction for your body. Your pelvic floor needs to learn to lengthen, not squeeze.

Sex avoided and the guilt and distance that follows

Turning away before it starts, planning around it and the slow strain that puts on a relationship you care about. That is your nervous system predicting pain. It says nothing about how you feel about your partner. Avoiding sex protects you in the moment while the muscle stays exactly as it is.

Two years of appointments and still no answer

Normal scans, referrals that went nowhere and a long wait for the next one. Muscle tension does not appear on imaging, so a normal result rules some things out and leaves this one untouched. We can start work on it while you wait.

Constipation that does not make sense

Soft stools you still have to strain to pass and nothing you have been given for constipation has helped. That is not a stool problem. It is a muscle that will not let go and it is the same one that will not let anything in during sex.

These are not separate problems collected over two years. They are the same pelvic floor, holding, showing up in every situation that asks it to lengthen. Sex is one of those situations and the pain eases as the pelvic floor learns to release. Nothing you have tried so far has asked it to do that.

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HOW THIS IS DIFFERENT

A pelvic floor that has been holding for years

When you inhale the diaphragm drops and the pelvic floor lengthens underneath it and when you exhale they both return. A breath that stops at your chest, or one that lifts your shoulders towards your ears, takes that movement away, so the pelvic floor spends the whole day short and never gets a reference for what letting go feels like.

This is why sex hurts. A muscle with no practice at lengthening will not lengthen on demand and penetration is a demand.

The habits keeping it short are usually ones you have never connected to any of this. The stomach pulled in since your twenties. The jaw clenched when you're late and sitting in traffic. The glutes squeezed every time you stand up.

Which is why there is no generic exercise sheet

Two women can book a consultation for pain during sex and both can have a holding pelvic floor, and they got there by completely different routes. One through giving birth, one through fifteen years of standing a particular way at work. The same instructions will not work for both of them and neither of them is served by whatever the internet hands out to everyone.

Working out your treatment takes a proper history. That is what the first hour is for.

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The two things that usually stop people booking

Both of them are reasonable and both of them deserve a straight answer.

Paying privately after years of free appointments

You have already spent money on lubricants, dilators, supplements and appointments that went nowhere, so another cost is a real decision rather than a small one. The consultation is sixty minutes and it stands on its own. You leave knowing what I think is going on and where to start, whether or not you go any further and nothing here asks you to commit to a programme first.

Being dismissed one more time

You will not be told this is in your head. You will be asked where the pain is, what happens with tampons, what happened when you tried dilators and what you were told each time. Where something needs a physical examination, I will name it and point you to the right route for it.

"[I've seen] improvement of the tone of pelvic floor muscles and now no discomfort during intercourse."
Anonymous

Start with sixty minutes and an explanation you can hold on to.

Everything I need is in your history and getting to it properly takes an hour. You leave knowing what I think is going on, in plain language and where to start.

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