Sex and Aging, for people who have Vulvas with Chloe Cox
The year is 2022. You can buy vibrators at cotton on. Your sexual partner may even know where your clitoris is. Life is good. Unless of course we address the fact that up to 70% of Vulva owners will experience sexual pain at some point in their lifetime. We may be in the midst of a sex positive movement; but what’s the point if we are not educated on the barriers we could face while trying to have a good time?
In most sex ed classes we have been taught how to keep the “dick up inside” without receiving a child as a souvenir. But vulva owners’ pleasure is never a priority. So, what can we do ourselves to improve sex through the lifespan?
The number one tip? Education. Without knowing what could be going wrong and why, it is difficult to get the right help. From Menarche (first menstrual cycle) the main impact on sexual function are conditions like Vaginismus or Vulvodynia/Vestibulodynia. Vaginismus describes tightening of the superficial pelvic floor muscles which can feel like a brick wall when you try to insert a tampon or have penetrative sex. Vestibulodynia and Vulvodynia are pain of the Vulva or Vestibule (area around vaginal entrance). This can feel like a burning pain with either penetration or even activities like wearing tight pants/riding a bike. In clinic we often see these conditions in conjunction with other conditions such as Endometriosis.
Sexual pain is multifaceted, and as a result constructing a great team around you is the best approach. Feeling comfortable talking to your practitioners, without judgement, about any sexual concerns you have is important, but doesn’t often happen. GP’s and gynaecologists who specialise in sexual pain can help you through the medical aspects.
The hard part (excuse the pun) about these conditions is that even though you may want to have penetrative sex, your body thinks it is doing you a favour by not allowing it. Your central and peripheral nervous system work like a supercomputer scanning and adjusting your every move. The downside of this is that they can prompt a reactive tightening response to perceived threat in situations where there has been pain previously.
If we look to later life, pregnancy and menopause/perimenopause both bring changes that can complicate sexual function. If you decide to have children – the main concern we tend to see is returning to sex postpartum. And this is regardless of mode of delivery. With Caesarean sections the pelvic floor can tighten causing discomfort. Whereas with a vaginal delivery there may be stitches, bruising and healing times to respect.
From a hormonal perspective, during both postpartum and menopause, estrogen levels drop which can leave the vulvovaginal region feeling as dry as the Sahara. In menopause this can also result in vaginal atrophy where the walls of the vaginal canal become thin, dry and inflamed – not a fun time when attempting penetration. This can also be a time where pelvic floor strength decreases, and symptoms of prolapse/incontinence become more pronounced. Neither of which help you feel great in the bedroom.
So, what can we do to manage these symptoms and keep our WAP fully functioning? Sexual pain is multifaceted, and as a result constructing a great team around you is the best approach. Feeling comfortable talking to your practitioners, without judgement, about any sexual concerns you have is important, but doesn’t often happen. GP’s and gynaecologists who specialise in sexual pain can help you through the medical aspects. The involvement of conditions like endometriosis or post birth complications also warrant gynaecology review. sexologists and psychologists can work alongside you to increase confidence in the bedroom and work through any fear/trauma based barriers. Finally, a pelvic physiotherapist will educate you on the science and triggers behind your sexual pain. They will also work with the pelvic floor muscles to decrease the reactive tightening response – or work on strengthening as needed. Individualised assessment and treatment is key. Just do your Kegels or have a glass of wine and relax? It’s simply not good enough. The key takeaway? Sexual pain is common, but not normal. If you are struggling – reach out. You deserve the best sex possible, and remember, age is only a number.
Want to know more? Check out these resources!
● “The Sex Ed You Never Had” by Chantelle Otten
● “Come as you Are” by Emily Nagoski
●“The Vagina Bible” by Dr Jen Gunter
● Jean Hailes Website
In person appointments at: Embrace Physio and Pilates, 84 Wattletree Rd, Armadale, VIC, Australia.
In person and Telehealth appointments (State-Wide): Australian Institute of Sexology and Sexual Medicine, 504 Victoria Pde, East Melbourne VIC. You can book and find more educational info via my Instagram: @chloe_pelvic_physio or email enquiries to firstname.lastname@example.org