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Ouch upon Orgasm: Understanding and Treating Dysorgasmia

Aug 18, 2023 | Pelvic Floor Therapy, Sex & Relationships

Written by Dilini Mohan - One Huddle Pelvic Floor Expert
Dilini Mohan – One Huddle Pelvic Floor Expert

As women, we often have complicated relationships with our bodies…and often, with sex too.  Usher and Ludacris sing about how they want “a lady in the streets, but in a freak in the bed”; magazines are constantly talking about the top 10 ways to please your man; and we’re all told that we need to get right back to firm sexy bodies immediately once we’ve had our babies.  And rarely do these messages talk about how women can find and prioritize pleasure for themselves as well.  It’s not fair.  And it sets up the expectation that our bodies are meant to look pretty and serve others, maybe even when it hurts us.  Let’s talk about painful orgasms.

Let me get something out of the way. 

First, if you’re experiencing pain with orgasms, there is nothing wrong with you as a human being.  Yes, Anastasia Steele had mind-blowing sex in 50 Shades of Grey, but I bet she still had to go and pee afterward to prevent a yeast infection.  She just did it off screen in the movies.  Real life is all the stuff that happens off screen too.  Women often feel pain with orgasm at times, but it’s definitely not how our bodies normally function.  And frustratingly, this can happen even if you’re actually enjoying your sexual experience!  The good news is that while this is common, it’s certainly not the norm and you can take steps to help bring pleasure for yourself back into the bedroom – or any other room you choose to use!

Second, you’re worth it!  Sometimes the reason why we put off talking to someone about problems with sex – or with our pelvic area at all – is because we have a million and one other things piled on us that require our time and attention.  Your little one needs new clothes, dinner needs to be made, you need to coordinate a playdate, the laundry hasn’t been done in 2 weeks, and something is growing at the back of the fridge…so we put our gloves on to fight that moldy beast, and again put ourselves at the bottom of the list.  The truth, though, is that if you feel good – in that deeply satisfying way that sex can make you feel seen – then you might even whistle as you clean that mold.  To be clear, orgasms are not the be all and end all of fulfilling sex, but ultimately, they should be pleasurable, not painful.  So, if you’re feeling pain, it’s worth checking out to make sure you understand what that pain means and what your body is trying to communicate to you.

Pleasurable orgasms vs. painful orgasms (dysorgasmia)

Quick reminder that pelvic floor muscles are the group or “hammock” of muscles that support your pelvic organs.  If you cup your hands between your leg with the heel of you hand to the front and fingertips to the back, you’ve found the “hammock”.  Your pelvic floor muscles work just like any other muscle.  Orgasms involve physiological and neurological stimulation that climax in an involuntary muscle spasm or contraction.  Try making a fist and squeezing.  When you release that squeeze, do you notice how your hand naturally loosens and relaxes?  Like that, in orgasms there is a contraction and a natural release.

Painful orgasms, or dysorgasmia, follow the same general mechanism of orgasms, so they are often related to the contraction of muscles of the pelvic floor and uterus.  The pain may be due to multiple factors, including your pelvic floor dysfunction, changes in pelvic organ tissues, and/or emotional or psychological causes.  

What do painful orgasms feel like?

Painful orgasms can feel different to different people, but it can be in the ballpark of menstrual cramps, abdominal cramps, endometrial pain, or ovulation pain.  It can feel sharp, achy, tight, or dull .  It can happen right when you climax, minutes later, or hours later.  It can settle quickly or last for hours.  It’s like an a la carte menu for something you don’t want to order.

Why do painful orgasms happen?

Pelvic floor Muscle Imbalance 

Think:  tight muscles and scar tissue

How to know if this may be you:  Difficulty with inserting a tampon or at the beginning of sex; chronic constipation; painful orgasms started after vaginal or cesarean births.

Who might help:  Pelvic floor therapist can help you understand how your pelvic floor relates to your core so you can stretch and release muscles to balance your muscle tone.

Pelvic floor imbalance or dysfunction is the most common cause of painful orgasm.  When the pelvic floor muscles are too short and tight or when they are being pulled by scar tissue that may have formed following a vaginal or cesarean birth.  

Changes in Pelvic Organ Tissues

Think:  underlying conditions

How to know if this may be you:  blood work and imaging to understand your body

Who might help:  Family doctor

These conditions may include:

  • Endometriosis
  • Adenomyosis
  • Pelvic inflammatory disease
  • Uterine fibroids
  • Ovarian cysts
  • Interstitial cysts
  • Crohn’s disease
  • Irritable bowel syndrome

Emotional or psychological causes

Think: mind-body connection

How to know if this may be you:  previous emotional or sexual abuse or trauma

Who might help:  Psychotherapist; sex therapist

So Mamas, however painful orgasms show up in your life, they don’t have to be there.  Let’s prioritize our own pleasure!

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