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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

What Our Patients Have to Say


Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

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