Painful Intercourse: Reclaim Comfort and Intimacy

People with vaginas may experience pain in one or multiple areas during sexual activity. Some experience pain around the vulva or vaginal opening during touch or initial penetration, often described as burning, stinging, or tightness. Others experience a deeper aching or tenderness during penetrative sex.

Understanding where your pain occurs, what it feels like, and when it happens can provide important clues to identifying the underlying cause.

Why Do I Have Pain During Sex?

Pain during intimacy can have many different causes. Physical factors often play a role, but our emotions and past experiences can also influence how our bodies respond to intimacy. In many cases, several factors contribute at the same time, which is why a comprehensive pelvic health physical therapy evaluation can be so helpful.

Some of the most common physical causes include:

• Pelvic floor dysfunction and increased muscle tension
• Vaginal dryness
• Scar tissue or soft tissue restrictions from pelvic or abdominal surgery, gender-affirming surgery, previous injuries, endometriosis, or fibroids
• Anatomical differences, such as a tilted uterus

Common Types of Painful Intercourse

If you've talked with your healthcare provider or searched online, you may have come across some of these medical terms. While these diagnoses help describe the type of pain you're experiencing, they don't always explain why it's happening. A pelvic health physical therapist and your healthcare provider can work together to identify the underlying cause.

Dyspareunia

A broad medical term for pain during intercourse that may occur with penetration or deeper during sex.

Vaginismus

Involuntary tightening or spasms of the pelvic floor muscles that can make penetration difficult or painful.

Vulvodynia

Chronic burning, stinging, or pain around the vulva without a clear identifiable cause.

How Can Pelvic Health Physical Therapy Help?

Pelvic health physical therapy is one of the most effective conservative treatments for painful intercourse because it addresses the musculoskeletal causes of pain.

During your evaluation, we'll assess your pelvic floor muscles, identify areas of tension or poor coordination, and develop a personalized treatment plan based on your symptoms and comfort level.

Treatment may include:

• Internal and external pelvic floor muscle assessment (only with your consent)
• Hands-on techniques to reduce muscle tension
• Breathing exercises and pelvic floor relaxation strategies
• Stretching and individualized movement exercises
• Pelvic floor coordination training
• Education about lubricants, vaginal moisturizers, and when it may be appropriate to discuss options like vaginal estrogen with your OB/GYN
• Guidance on when working with a mental health professional may be helpful as part of your overall care

Our goal is to help you better understand your body, reduce pain, and feel more comfortable and confident during intimacy.

When Should You Seek Help?

If pain during intimacy is causing frustration, anxiety, or keeping you from enjoying sex, it's time to seek help.

Whether you've experienced pain with intercourse for the first time or you've been living with it for years, pelvic health physical therapy can help identify the underlying cause and create a personalized plan to reduce pain and improve comfort. You deserve to enjoy intimacy without fear or discomfort.

– Dr. Laney Romero

• Burning, stinging, or pain with penetration
• Deep pelvic pain during or after intercourse
• Tightness that makes intimacy difficult or impossible
• Pain related to pelvic floor dysfunction, vaginal dryness, childbirth, surgery, or menopause
• Ongoing pain that is affecting your relationship, confidence, or quality of life

Many people experience significant improvement with pelvic health physical therapy—even if they've been living with painful intercourse for months or years. Finding the underlying cause is the first step toward lasting relief.