There are multiple reasons why someone might experience painful sex. Before getting into what those are, just to be very clear – when I say painful sex, right now I’m referring to pain with insertion during vaginal intercourse. This pain can be deep in the vagina or at the vaginal opening. Sometimes it feels like a pelvic pressure during sex. Other times, the pelvic floor muscles are so tight or painful that it can prevent intercourse from happening completely. You may see this worded as pain with penetration. I personally prefer not to use the wording of penetration, as I believe that infers the idea of pushing through something and the idea that there is a barrier to get past. With intercourse, I like to shift to the idea of the vagina engulfing or welcoming insertion rather than the words inferring the space is being pierced or pushed past (such as in “pain with penetration”). Medically, pain with sex is referred to as dyspareunia.
A little disclaimer: This is not medical advice and you should always discuss your symptoms with a medical provider. That being said, I know there are many barriers to doing so. We offer coaching services and can also help you navigate the medical system in these sessions, and we have a directory page to help you find in person care for pelvic pain during sex.
Now let’s briefly review some common causes of painful sex:
Vaginal Dryness
If things feel dry, irritated, or scratchy, it’s possible you have dryness in the vagina or vulva. This can happen from lack of lubrication, low estrogen levels in the tissue, medication side effects, medical condition side effects (ie. skin disorders such as Lichen sclerosus), and more.
Infections
If there’s a urinary tract infection (UTI), sexually transmitted infection (STI), bacterial infection, or yeast infection, you may experience a side effect of pain with intercourse.
Irritation/Reaction
Similar to dryness, sometimes the tissue is having a reaction to something and is feeling irritated. For example, if you’re using a highly scented soap, this can irritate the vulva. This may feel scratchy, itchy, or burny at the vulva.
Other Medical Causes
Medical causes such as fibroids, ovarian cysts, endometriosis, or adenomyosis can cause pain with intercourse. Additionally if you have any scar tissue from previous injuries, this can make the tissue more sensitive or tight. This may often come with a deep pressure pain during sex. Prolapse can also cause this kind of discomfort, which is where the pelvic organs are descending down into or out of the pelvic floor.
Trauma
This can be a physical trauma like a car accident if the body was injured in a way affecting the pelvic floor (the whole body is connected, so it’s often involved even when you don’t realize it!). Another example of physical trauma may be scar tissue from a perineal tear during vaginal delivery. However pain with intercourse or even limited ability to insert anything, can also follow sexual, emotional, or verbal abuse/trauma.
Shame
When we feel shame around our genitals or sexuality, our body internalizes that. Sometimes that can present as closing off that area, making insertion painful or very limited. This can even happen as a result of lack of education around sexuality or anatomy. If topics are not discussed, or considered taboo, they carry a weight of background shame. This can impact in subtle ways we may not always be conscious of.
Chronic Stress and Anxiety
When the body is in a state of chronic stress and anxiety, it can put the body into a chronic state of clenching. Muscles that are more tense, can have tender trigger points. Additionally when in a stressed or anxious state, the body can interpret sensation as a threat or pain, rather than neutral or pleasure. This can especially cause discomfort when this tension happens at the vaginal walls or around the entrance to the vagina, making it difficult to insert anything. Learn more about anxiety and the pelvic floor here.
Pelvic Floor Muscle Tension
Pelvic floor muscle tension can be caused by many factors, such as some of the above listed factors. Excessive tension in the pelvic floor muscles may be referred to as hypertonicity (think hyper= high, excessive; tone= the state of a muscles contraction at rest). When the pelvic floor muscles are chronically tight, this can signal a guarding protective response in the brain, which then may signal to pair that sensation with fear, then creating pain with touch or pressure of these muscles. Read more on hypertonic pelvic floor muscles here.
Now we could dive deeper into all of these, but this is just a quick list so that you can better understand possible causes behind your pain with sex. This is a non exhaustive list, as in you might have a reason not listed here. It’s also possible to have a combination of the above. Once you have a better idea of what’s behind your pain, you can more easily address it.
Additionally, if your vaginal or vulvar pain, or hypertonicity in your pelvic floor, is limiting insertion completely to the point where you cannot have sex, or cannot insert a tampon, or a receive a gynecological exam with a speculum, you may have a condition called vaginismus.
Is pain with sex normal?
Sex should never be painful (unless you’re consensually seeking pain!). It is not normal to have pain with sex - this includes experiencing pain with your first time. I repeat, it is not normal to have pain with sex during your first time having sex. It is common to experience pain with sex, but that’s different than normal in this sense. Pain with sex is never something your body needs to experience - which is what is meant by “not normal”. Your body however is having a normal response to something. Your body is always working to protect you. This also means that your body is not broken!! You are not abnormal, it’s not hopeless, and you can get relief.
As many as 75% (about 3 out of 4 women) experience pain during sexual intercourse at some point in their lifetime, according to the American College of Obstetricians and Gynecologists. Know you are not alone. This is incredibly common and conversations around painful sex need to continue to rise to decrease stigma and increase awareness around options to treatment. Women’s health and research for those with vulvas, uteruses, & vaginas is in continuous need for increased advocacy. As awareness continues to rise, there will hopefully be a continued increase in research and support for these gynecological issues.
Is there help for painful sex?
Yes, there are lots of options for support for painful sex! First step is being assessed by a medical provider (such as a gynecologist) to rule out some of the above causes. If there are medical concerns present, such as an STI or low estrogen, this will be followed up with treatment recommended by this medical provider. Next step is seeing a pelvic floor therapist. Pelvic floor therapy can be a crucial and incredibly beneficial step in addressing painful intercourse.
What does a pelvic floor therapist do for painful sex?
This depends on why you’re experiencing pain. A pelvic floor therapist perform a thorough assessment of your symptoms and pelvic floor, as well work your gynecologist. I can’t stress enough that you want your pelvic floor therapist to be trauma informed. Unfortunately, not all pelvic floor therapists are. Remember that you can always shop around or call and ask questions about a provider’s care.
At Anxious Pelvis, we have a clinic in Denver, CO for holistic pelvic floor therapy with a trauma informed provider, as well as virtual options accessible from anywhere for pelvic health coaching.
As the pelvic floor therapist at Anxious Pelvis, I am not only a certified clinical trauma specialist, but also a certified sexuality OT and trained in pelvic sex counseling. During treatment, I cater the approach to your specific needs and allow space for education and understanding on what is happening with your body and symptoms. This may including addressing scar tissue, assisting with medical treatment education and advocacy, trigger point release therapy, body work, mobility, breath training, somatic exercises, nervous system regulation training, training in the use of pelvic tools such as dilators or wants, sex counseling techniques, pain reprocessing, and more. As an occupational therapist, I take a holistic approach to pelvic floor therapy that also considers your values, roles, routines, and identity.
Chronic pain during sex can be so intertwined with your physical health, mental health, and physical health. Therefore a holistic and comprehensive approach can more effectively treat painful intercourse (or dyspareunia).
Getting help with painful sex can be life changing. Yes, it helps your marriage or relationships and confidence in dating, but it also helps you feel joy and connected to your body! The route to relieving painful sex can often bring a whole body transformation of the mind, body, and soul. It helps you take up space in this world and regain your confidence in all aspects of life. You don’t have to live in pain. You deserve a sex life that feels good!
If you’re having painful sex, check out our booking page or join our newsletter for continuous support!
Anxious Pelvis offers trauma-informed pelvic floor occupational therapy, virtual coaching, & education for pelvic pain, vaginismus, painful sex, bladder and bowel dysfunction, pregnancy, postpartum, perimenopause, and gender-affirming care.
Denver Clinic: 3801 E Florida Ave, Suite 915, Denver, CO 80210
Virtual care through our coaching & education services available worldwide.
By Anxious Pelvis | Pelvic Floor Occupational Therapy in Denver, CO & Virtual Coaching Worldwide
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. 