Reclaiming Intimacy: How to Address and Alleviate Painful Sex

Sex is supposed to feel good—but what if it doesn’t? What if something meant to bring connection and pleasure instead brings discomfort or pain? Pain during sex (also called dyspareunia) is more common than many realize, yet it’s rarely talked about openly. Maybe penetration feels impossible, perhaps you feel burning or tightness, or maybe sex just isn’t enjoyable anymore, and you’re not sure why. If you’ve ever felt discomfort or pain during intimacy, know that you’re not alone—and more importantly, it’s not something you have to live with.

In this week’s blog, we’re diving into what causes pain with sex, how you can start addressing it, and the steps to reclaim intimacy on your terms. Let’s get into it!

What is Dyspareunia or “Painful Sex”?

Pain with sex isn’t just in your head—and it’s more common than you think. Dyspareunia, the medical term for painful sex, can occur for many reasons and show up in different ways. Some people feel discomfort only during penetration, while others experience lingering pain after intimacy. Symptoms can include:

• Sharp, burning pain with initial penetration
• Deep aching or pressure during or after sex
• Muscle spasms in the pelvic region that make penetration difficult
• Pain with orgasm or discomfort that lingers afterward
• Weakened or hard-to-reach orgasms

Everyone’s experience with painful sex is different, so if your symptoms don’t match this list exactly, don’t be discouraged—your pain is still real, and you deserve support.

Despite how common this is, dyspareunia is often misunderstood or dismissed, leaving many to struggle in silence with a problem that affects both physical and emotional well-being. But the good news? There are ways to address and alleviate it.

How Common is Pain with Sex?

You might be surprised to learn just how common painful sex is. Studies suggest that up to 75% of women experience pain with sex at some point in their lives, while around 10-20% deal with persistent, recurring pain. People of all genders can experience painful intimacy, though the underlying causes and contributing factors may vary.

Despite its prevalence, dyspareunia is often underreported and misunderstood. Many people assume discomfort is “just part of the experience” or feel too embarrassed to talk about it—even with a doctor. We’ve heard it all: 

“I thought it hurt for everyone.”

“Just have a glass of wine before!”

“It’s normal after kids, right?”

These misconceptions not only dismiss real pain but also prevent people from seeking help. Others may not even realize that treatment exists, leading to prolonged discomfort, frustration, and relationship challenges. Pain with sex isn’t just a physical issue—it can cause stress, avoidance of intimacy, and even feelings of guilt or isolation. But the good news? You don’t have to live with it, and help is available.

Causes of Dyspareunia

A single factor rarely causes pain with sex. Often, it’s a combination of physical, hormonal, and neurological influences contributing to discomfort. Below are some of the most common causes:

Painful sex isn’t “just in your head.” There are real, treatable causes—hormonal shifts, muscle tension, past trauma, endometriosis, and more. Identifying the root cause is the first step toward relief.

• Pelvic Floor Muscle Tension
• Vaginal Dryness
• Scarring
  • From surgery, childbirth, or injury
• Hormonal Changes:
  • Pregnancy
  • Postpartum
  • Perimenopause & Menopause
  • Birth Control
• Post-Surgical Changes: 
  • Hysterectomy
  • Endometriosis Excision
  • Prolapse Repair
  • Bladder Repair
  • Prostatectomy
• Endometriosis
• Interstitial Cystitis 

Other Potential Contributors:

• Recurrent UTIs or Vaginal Infections: 
  • Yeast, Bacterial Vaginosis, etc
• History of Painful Vaginal or Pelvic Exams
• History of Sexual Trauma
• Chronic Pelvic Pain Conditions
• Certain Medications: 
  • Antidepressants, Birth Control, Chemotherapy, etc

How Did I Get Here?

For some, pain with sex has always been present, while for others, it developed over time without a clear trigger. Pain is complex and highly individualized, but here are some of the most common contributors:

Pelvic Floor Muscle Tension: 

You can read up on all things pelvic floor tension in our blog post HERE, but the gist is:

When muscles hold onto chronic tension, they get stuck in a cycle of tightness and irritation. Imagine carrying a case of water all day—your arms would ache, right? The same thing happens with your pelvic floor muscles! Since the pelvis plays a key role in stabilizing the trunk, chronic tension in this area can lead to:

• Muscles that won’t fully relax or contract properly
• Reduced blood flow, which impacts sensation, arousal, and orgasm
• Pain signals during penetration due to built-up tension

Sometimes, this muscle tension develops from stress, past trauma, poor posture, or even compensating for other weaknesses in the body.

Hormonal Changes & Vaginal Dryness:

Hormones control lubrication, tissue elasticity, and overall vaginal health. When estrogen levels drop (during postpartum, breastfeeding, perimenopause, or menopause), vaginal tissues can become thinner, drier, and more sensitive to friction.

• Pregnancy & Postpartum → Estrogen drops, tissues become thinner, and lubrication decreases.
• Breastfeeding → Keeps estrogen levels low, sometimes leading to vaginal dryness.
• Perimenopause & Menopause → Declining estrogen reduces vaginal moisture and tissue suppleness, increasing irritation and discomfort.

Many people ignore these changes, assuming they’re just “normal” after kids or aging—but solutions exist!

Bladder Conditions & Recurrent Infections:

Conditions like interstitial cystitis (IC) and chronic UTIs can cause ongoing inflammation, making the bladder and surrounding pelvic structures more sensitive. People with IC may often experience:

• Pain with penetration, deep thrusting, or after intercourse
• Urinary urgency and frequency
• Bladder irritation that worsens with certain foods or drinks

Even recurrent yeast infections or bacterial vaginosis can lead to irritation, changes in vaginal pH, and discomfort with sex.

Scarring from Surgery or Childbirth:

Scar tissue from C-sections, episiotomies, tearing during childbirth, or pelvic surgeries can affect how tissues move and stretch. Scar tissue can:

• Reduce flexibility of vaginal tissues
• Cause pulling sensations during intercourse
• Create areas of hypersensitivity or numbness

Some people don’t even realize scar tissue is an issue until they start experiencing discomfort months or years later.

Post-Surgical Changes:

Surgeries like hysterectomy, endometriosis excision, bladder repairs, or prolapse surgery can alter the way pelvic tissues and muscles function. Some people experience:

• Nerve irritation or hypersensitivity in the pelvic area
• Changes in vaginal depth or angle that make sex feel different
• Tightness from scar tissue or internal adhesions

These changes do not mean sex will be permanently painful—but it may take some rehab and adjustments to feel comfortable again.

Bringing It All Together

Pain with sex isn’t just about the physical—it’s deeply connected to hormones, past experiences, and overall pelvic health. The good news? There’s help available! If any of this resonates with you, know that you’re not alone, and a pelvic floor therapist can guide you toward the relief and support you deserve.

How Can This Affect Daily Life? 

Dyspareunia isn’t just about the physical—it touches every part of a person’s life. From relationships to self-esteem, the effects can be far-reaching and often unexpected. When pain enters the equation of sexual intimacy, it can send ripples throughout daily life. Let’s break down the physical and emotional impacts.

Painful sex isn’t just a “physical issue”—it can impact your entire life. From avoiding intimacy to dealing with chronic fatigue, the effects are more than just discomfort. But here’s the good news: solutions exist.

Physical Impacts of Pain with Sex:

• Chronic Discomfort: Pain during intimacy can linger even after sex, causing discomfort in everyday activities like sitting, exercising, or using the restroom. Conditions like pelvic floor dysfunction, muscle spasms, or inflammation can perpetuate this cycle of tension.
• Avoidance Behaviors: The fear of pain can lead to avoiding intimacy altogether, which can intensify muscle guarding and tightness in the pelvic floor, creating a loop of discomfort and anxiety.
• Sleep and Fatigue: Ongoing pain often disrupts sleep, leading to chronic fatigue. Lack of restful sleep makes it harder to manage stress and can take a toll on your overall health and well-being.

Emotional Impacts of Pain with Sex:

• Self-Esteem: Struggling with pain during intimacy can leave you feeling broken or inadequate. It’s common for people to internalize this issue, believing they’re the only ones experiencing it, which can erode confidence and self-worth.
• Shame and Isolation: The topic of painful sex is still not talked about enough, which can create feelings of shame and isolation. We’re here to assure you there’s no need to hold back. With a pelvic floor therapist, there’s no such thing as “TMI”—we want to know all the details so we can treat you as a whole person.
• Mental Health Struggles: Persistent pain often correlates with increased anxiety and depression. The frustration of not being able to fully enjoy intimacy adds to emotional distress, which can compound feelings of isolation and helplessness.

Impacts on Relationships:

Pain during sex can put a strain on your relationship in a variety of ways. It can cause breakdowns in communication, loss of intimacy, and growing mistrust or misunderstandings between partners. Partners may feel rejected or frustrated, while the person experiencing the pain might struggle to communicate their needs effectively.

For those trying to conceive, dyspareunia can add an extra layer of stress to the process, complicating conception and family planning. Without open communication, one partner may misinterpret the other’s avoidance as a lack of desire or affection, leading to further tension and strain.

With the proper support, healing is possible. A pelvic floor therapist can help you navigate this journey, and at our clinic, we encourage partners to come in with you during sessions. That way, they can learn how to assist with tools, help keep you accountable, and better understand what you’re experiencing. This added support can make a huge difference in your healing process. When looking for a pelvic floor therapist, finding someone open to including your partner in the journey is essential. They play a vital role in your recovery, and their involvement can help bring comfort, confidence, and connection back into your intimate relationships.

Why is it Important to Take Action?

Ignoring pain with sex will not make it go away. In fact, for some, it can lead to a dissociated experience and even resentment towards intimacy. Psychological factors like anxiety, trauma, or fear of pain can also play a significant role, creating a cycle that reinforces the discomfort.

As we mentioned earlier, dyspareunia doesn’t have one single cause, and it’s essential to address all the factors contributing to it. Working with a pelvic floor therapist helps you take a comprehensive approach to healing and breaking that cycle.

Pain leads to tension, tension leads to restricted movement, movement loss leads to weakness… and the cycle continues. But here’s the thing—this cycle can be broken with the right approach.

How do I Restore Connection and Intimacy?

First, let me start by saying this: YOU ARE NOT BROKEN! Physical intimacy is often an essential way couples connect emotionally, and when pain enters the equation, it can create distance. This emotional disconnect can leave both partners feeling isolated, but the good news is that pain with sex can be addressed. Healing is possible and can help you reconnect with yourself and your partner.

Remember, this is a journey—it takes time, but progress is achievable. Here are a few steps you can start today:

1. Ask for help → Seeking guidance is always the first step in your recovery. Schedule an appointment with a pelvic floor therapist to begin understanding and addressing the causes of your pain.
2. Open communication with your partner → Use phrases like:
   • “If you have time, I’d love for you to hear what I’ve been dealing with.”
   • “I’m exploring ways to work through this and would appreciate your support and patience.”
   • “I care deeply about our intimacy, and I’m taking steps to address this with the help of a professional.”
3. Reimagine intimacy → Can you connect without physical penetration? If you’ve never thought about it, now’s a great time to explore other ways to bond physically. Did you know the brain can even experience orgasms in sleep? Imagine what other forms of touch and connection you can explore to nurture intimacy.
4. Commit to the process → Healing from pain with sex is a journey, and it takes time. Be patient with yourself, and trust that with each step, you’ll be getting closer to the connection you desire.
5. Invest in yourself → The quickest way to rebuild your physical, emotional, and relational connections is by investing in your healing. Taking that first step can lead you back to a place of intimacy and self-empowerment.

By taking action today, you’re choosing to invest in your healing and reconnect with yourself and your partner. You deserve this journey, and we’re here to support you every step of the way.

How Do I Start My Pelvic Healing Journey?

The first step in healing is recognizing how the physical and emotional impacts of pain with sex are interconnected. Pelvic floor therapy offers a holistic approach to address both aspects, empowering individuals to regain control of their bodies and restore intimacy.

Pelvic floor therapists are trained in various specialized techniques, including pelvic tools, manual therapy, stretching, positioning adjustments, and exercises. These methods work together to alleviate pain with sex and improve overall pelvic health. The key is to work one-on-one with a therapist to develop a personalized plan that targets your unique needs.

If you’re experiencing pain during intimacy, please know that it’s not your fault—you don’t have to face this alone. There is hope, and practical solutions are available. Schedule an evaluation today, and let us create a treatment plan specifically tailored for you to help restore your well-being and reclaim your intimacy.

FAQ

“My doctor told me to just drink a glass of wine if sex is painful. Is that normal?”

No, and we don’t want to rely on temporary fixes like that! While a glass of wine might help with relaxation in the moment, it doesn’t address the root cause of the pain. There are both physical and emotional factors that can contribute to painful sex, and working with a pelvic floor therapist can help identify and treat them in a way that leads to long-term relief.

“Are there any positions we can try to alleviate the pain/discomfort?”

Yes! Many strategies, self-management techniques, and positional adjustments can help. However, pushing through the pain isn’t the answer—it can actually send mixed signals to your nervous system and worsen symptoms over time. Utilizing pillows or bolsters, experimenting with different positions, and openly communicating with your partner about what feels comfortable can make a big difference. Because everyone’s experience with pain is unique, working with a pelvic floor therapist will help you find the best options for your specific needs.

“Why is sex painful during pregnancy but not normally?”

Just like every pregnancy is different, your body’s response to intimacy during pregnancy can vary as well. There are many possible reasons why sex may become painful, including increased pelvic floor tension, hormonal shifts affecting muscle and joint laxity, or even an underlying prolapse (which affects about 1 in 3 women postpartum). Pain with sex can also persist into the postpartum period, especially for those who are breastfeeding, due to continued hormonal changes. Pregnancy places a lot of stress on the body, which is why working with a pelvic floor therapist should be a proactive part of your prenatal and postpartum care.

“Is it normal for sex to be painful after menopause?”

Let’s be honest—menopause can be a tough transition. Some people experience gradual changes, while for others, it feels like hitting a brick wall. If you’ve gone through medication-induced menopause (such as after hormone-driven cancers), the changes can be even more sudden. While pain with sex can be shared, that doesn’t mean it’s normal or something you just have to accept. Hormonal shifts impact the pelvic floor, vaginal tissues, and overall muscle function, which is why hydration, muscle activation, and pelvic floor care are crucial. Seeing a pelvic floor therapist before or during menopause can help you navigate these changes and maintain comfort and intimacy.

Ready to Take the Next Step?

“Tools that empower. From pelvic wands to dilators, we guide you on using tools to release tension and feel your best.”

If you’ve been reading this thinking, “Wow, this is exactly what I’ve been dealing with!” you don’t have to suffer in silence. Pain with sex is treatable, and you deserve to feel comfortable in your own body again. Let’s work together to get you the care you need.

Contact Us

Have questions or want to learn more about how physical therapy can help you enjoy intimacy again? Reach out—UpLift is here to guide you through your pelvic floor journey!

UpLift Physical Therapy Website

Phone: 210-468-7398

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