When sex is a pain in the butt

When sex is a pain in the butt

Talli Y Rosenbaum, PT
tallir@netvision.net.il
www.physioforwomen.com



While usually not a topic of conversation in polite company, bowel
problems are a part of life. Bowel problems can include constipation,
diarrhea, bloating and/ or gas, and when they occur, sexual activity is
often curtailed. When everything works normally, these symptoms
generally occur infrequently and therefore, should not affect one's sex
life. However, chronic anal, rectal, or bowel problems can certainly
affect intimacy and the reverse may be true as well, in that certain
sexual activities may be a trigger, or be a cause, of ano-rectal or
bowel dysfunction.

Some women experience rectal urgency or gas during sexual
intercourse. This may occur because of a rectocele, a condition in
which the rectum has dropped slightly towards the vaginal canal.
Penetration during vaginal intercourse then stimulates the bowel,
which sometimes causes discomfort or a strong urge to defecate. In
these situations, it is best to engage in sexual intercourse after a
bowel movement, when the rectum is empty. It is also advisable in
the event that occasional flatulence is triggered by sex, to relax and
greet it with a sense of humor.

Irritable Bowel Syndrome, (IBS) is a condition characterized by
chronic bouts of abdominal pain, constipation and diarrhea.
Women and men with irritable bowel syndrome (IBS) often
experience difficulties with sexuality and intimacy. Long hours spent
in the bathroom, inability to allow any pressure on the abdomen, and
fear of constantly expelling unpleasant gaseous odors are only some
of the factors that can inhibit intimacy. In these cases, it is best to
stick to intimate activities which are pleasurable and relaxing and

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avoid activities which may cause anxiety, discomfort or pain for either
partner.

Other ano-rectal conditions affecting sex include levator ani
syndrome and proctalgia fugax. The former condition refers to
tightness and tension of the pelvic floor muscles which contribute to
constipation as well as the difficulty relaxing the sphincters, which can
make vaginal penetration difficult. The latter refers to a condition of
sharp, fleeting pains in the rectal area, which is related to
contractions of the smooth muscle of the anal sphincter. In people
who enjoy anal sex, both these conditions can severely limit the
ability to enjoy painless penetration.

Whether the receptive partner in anal sex is a man or a woman, it is
important to keep in mind the physiological differences between the
anus and vagina. The anus is comprised of an internal and external
sphincter which contract in order to prevent fecal incontinence. With
penetration, the internal sphincter immediately closes. In order that
penetration not be painful, the receptive partner must be able to
control the pace and depth of penetration. Furthermore, injury to the
anal sphincters from repeated penetration against a contracted anal
sphincter can lead to fecal incontinence and chronic anal pain.

Chronic anal pain appears to be a common condition amongst men
who receive anal sex. This condition has been referred to in the
literature as ando-dyspareunia and some studies have suggested
that its incidence is as high as 14% amongst gay men. Several
possible causes for anal pain during sex have been suggested.
Physical causes include anal fissures, which are tiny cuts in the skin
around the anus that occur from overstretching, large partner penis
size , lack of lubrication, insufficient arousal, or uncomfortable
positioning. Irritation during penetration of a pelvic nerve known as
the pudendal nerve may cause anal and pelvic pain. Anismus, a
condition of increased tension of the muscles of the anus is a
condition that can cause physical pain as well as constipation, but
may also be related to psychosexual causes, such as anxiety or fear.
Some studies have suggested a higher incidence of anal pain in gay
men who are ambivalent about their sexual identity or are in the
closet. Other possible psychosexual factors may relate to imbalance
of power in the relationship or relationship dissatisfaction.

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Psychoanalytic or somatic mind/body approaches may draw a
parallel between the physical findings of anal muscle tension and
anal retentive behavior.


Treatment for all these conditions should be multidisciplinary.
Medical possibilities such as infection or disease should be ruled out
and treated by a physician. Musculoskeletal aspects, such as tight
and tense pelvic floor muscles can be treated by a pelvic floor
specialist with techniques such as stretching exercises, trigger point
massage, pelvic floor relaxation and biofeedback, as well as general
relaxation and breathing techniques. Relationship and psychosexual
factors should be explored and addressed as well.

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