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Communicating with your partner about your sexuality may reduce your pelvic pain and increase your sexual function.

A 2016 study by McNicoll et al. suggests that Sexual Assertiveness, or the ability to communicate openly to your partner about your sexual experience, may reduce the pain experienced with provoked vestibulodynia (PVD), increase sexual function, and encourage your partner to communicate you in ways that help boost your sexual health.

How Sexual Assertiveness May Reduce Your Pain

Pelvic pain and pain with sex may come from several different avenues, including vaginismus, vulvodynia, vestibulodynia, endometriosis, or tissue changes caused by menopause. The 2016 study by McNicoll et al. specifically worked with women with provoked vestibulodynia.

There are many factors at play with Provoked Vestibulodynia, including biological, cognitive, behavioral, emotional and interpersonal dimensions. That’s to say that your pain can have a connection with your body, your brain, your emotional wellbeing, as well as the health of your relationship.

Being sexually assertive with your partner can help you focus on activities that feel good, decreasing pain provoking activities, and facilitate sexual desire, arousal, and partner intimacy. Enhancing intimacy through sexual communication has contributed to couples reporting greater sexual response, lower depression levels, lowered pain reception, and improved emotion regulation and pain coping (Cano & Williams, 2010; Rosen et al., 2014).

What is Sexual Assertiveness?

Sexual assertiveness refers to the degree to which a person is able to openly communicate his or her thoughts, choices and feelings about sexuality. Sexual assertiveness is further defined as being the ability to communicate about three different areas of your sexual experience (Loshek & Terrell, 2014):

  • Sexual initiation and communicating satisfaction
  • Ability to refuse unwanted sexual acts
  • Ability to communicate about sexual risk and history

Examples of Sexually Assertiveness

Adapted from the Sexual Assertiveness Questionnaire (Loshek & Terrel, 2014).

Examples of Saying “Yes”: Sexual initiation and communicating satisfaction

  • I let my partner know what I do not like in sex.
  • I feel uncomfortable telling my partner what feels good.
  • I feel comfortable telling my partner how to touch me.
  • When a technique does not feel good, I tell my partner.
  • I feel uncomfortable talking during sex.
  • I am open with my partner about my sexual needs.
  • I feel comfortable in initiating sex with my partner.
  • I let my partner know if I want to have sex.
  • I approach my partner for sex when I desire it.
  • I begin sex with my partner if I want to.

Examples of Saying “No”: Ability to refuse unwanted sexual acts

  • I refuse to have sex if I don’t want to, even if my partner insists.
  • I can say no when I do not want sex.
  • I do not do sexual things that I do not like.

Examples of Communicating about Sexual Risk and Health History

  • I would ask my partner about the AIDS risk of his or her past partners if I want to know.
  • I would ask if I want to know if my partner ever had a sexually transmitted infection.

Ways to Increase Sexual Assertiveness

  • Try to talk about subject of sex, it takes practice!
  • Find a support system to talk to about your sexual experience: friends, therapists, pelvic floor therapist.

How Pelvic Floor Therapy Can Help

While learning and practicing sexual communication can help improve pain levels and improve your relationship, it is important to also treat the body-based roots of your pain with a pelvic floor physical therapist.

Pelvic floor Physical therapy can help restore the various structures (muscles, tissues, and nerves) that can be contributing to your pelvic pain and pain with sex.

Some of the modalities used at Femina Physical Therapy can include (but are not limited to):

  • Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points

  • Internal pelvic floor manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like pain with sex, frequency and urgency of urination, and pain with bowel movements

  • Therapeutic exercises to release entrapped nerves or strengthen the pelvic floor

  • Biofeedback technology to help you focus on relaxing the pelvic floor

  • Photobiomodulation Therapy for pain relief and encouraging cellular healing and desensitization of scar tissue adhesions, tender trigger points, and muscle spasm pain.

  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function

  • Training in self treatment techniques so you can start to manage your symptoms at home. These techniques can include self pelvic floor massage using medical dilators

  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion

  • Patient Education and Empowerment

  • Lifestyle modificationslike sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake to control other factors that may be contributing to pelvic floor dysfunction.

To learn more about our total body approach approach to chronic pelvic pain, contact us here.

Also check out our latest article on involving your partner in your pelvic floor therapy here: https://feminapt.com/blog/how-to-involve-your-partner-in-your-pelvic-floor-therapy


Cano, A., & Williams, A. C. C. (2010). Social interaction in pain: Reinforcing pain behaviors or building intimacy? Pain, 149, 9–11. doi:10.1016/j.pain.2009.10.010.

Loshek, E., & Terrell, H. K. (2014). The Development of the Sexual Assertiveness Questionnaire (SAQ): A Comprehensive Measure of Sexual Assertiveness for Women. The Journal of Sex Research, 52(9), 1017–1027. doi:10.1080/00224499.2014.944970

McNicoll, G., Corsini-Munt, S., O. Rosen, N., McDuff, P., & Bergeron, S. (2016). Sexual Assertiveness Mediates the Associations Between Partner Facilitative Responses and Sexual Outcomes in Women With Provoked Vestibulodynia. Journal of Sex & Marital Therapy, 43(7), 663–677. doi:10.1080/0092623x.2016.1230806

Rancourt, K. M., Rosen, N. O., Bergeron, S., & Nealis, L. J. (2016). Talking About Sex When Sex Is Painful: Dyadic Sexual Communication Is Associated With Women’s Pain, and Couples’ Sexual and Psychological Outcomes in Provoked Vestibulodynia. Archives of Sexual Behavior, 45(8), 1933–1944. doi:10.1007/s10508-015-0670-6

Rosen, N. O., Bergeron, S., Glowacka, M., Delisle, I., & Baxter, M. L. (2012). Harmful or Helpful: Perceived Solicitous and Facilitative Partner Responses Are Differentially Associated with Pain and Sexual Satisfaction in Women with Provoked Vestibulodynia. The Journal of Sexual Medicine, 9(9), 2351–2360. doi:10.1111/j.1743-6109.2012.02851.x

Rosen, N. O., Rancourt, K. M., Corsini-Munt, S., & Bergeron, S. (2014). Beyond a ‘‘woman’s problem’’: The role of relationship processes in female genital pain. Current Sexual Health Reports, 6, 1–10. doi:10.1007/s11930-013-0006-2.

Smith, K. B., & Pukall, C. F. (2014). Sexual Function, Relationship Adjustment, and the Relational Impact of Pain in Male Partners of Women with Provoked Vulvar Pain. The Journal of Sexual Medicine, 11(5), 1283–1293. doi:10.1111/jsm.12484

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** This information is for educational purposes only and is not intended to replace the advice of your doctor. **

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      I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be. It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally...

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      Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and...

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