Do you have painful sex? If so, you aren’t alone; one in five women will experience pain with sex at some point in their lifetime. Despite this, women are often told “just relax” or “drink a glass of wine,” even when reporting symptoms to their doctors. This can lead to pain not being accurately diagnosed and being left untreated. In addition, untreated pain with sex can lead to feeling embarrassed, ashamed, or something is wrong with you (it’s not). Today we’re going to dive into the top 5 reasons why you might be experiencing pain with sex. Plus, we’ll give you tips on how to get back on track to pain-free and pleasurable sex!
Why are you having painful sex?
There are numerous physical, psychological, and emotional reasons that pain with sex may occur. From a physical perspective, pain can be due to infection, hormonal imbalance, nerve entrapment, scar tissue, tense pelvic floor muscles, or various other causes. Your pelvic floor muscles, the muscles in your vagina, are the source of painful sex. Unfortunately, these are often not considered a source of painful sex, leading women to suffer for months or even years. When I see these women in my clinic, they are often exhausted, depressed, deflated, and even traumatized. They are on an endless journey to figure out why their vaginas hurt.
Reason #1 – Something is off with your pelvic floor
Your pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs, keep pee and poop until you are ready to empty and play a role in sexual activity. However, these muscles are like any other muscle in your body. They can get short and tight, go into spasms and be too tense. This can cause vaginal penetration to be brutal and, sometimes, impossible. Pain can also occur with deeper penetration, orgasm, or even after intercourse is over. A pelvic physical therapist can help lengthen and relax these muscles to their normal resting state. A PT will guide you through breathing exercises, yoga and stretching, massage, and educate you on pain, posture, and returning to enjoyable sex.
Reason #2 – You might have vaginismus
Vaginismus is a muscle spasm of the outer third of the pelvic floor muscles preventing pain-free penetration into the vaginal canal by a finger, tampon, speculum, or during vaginal intercourse. Some ways to treat vaginismus include breathing exercises, stretches to relax the pelvic floor muscles and using lubricant. It is also recommended to work with a pelvic floor PT for a specific plan and guidance. In addition, working with mental health or sexual health therapist can be an ideal combination to address vaginismus’s physical and psychological connections.
To practice belly breathing, slowly inhale and puff your belly outward and exhale slowly; let it fall. Performing this technique for 5 minutes once to twice a day can help your pelvic muscles relax and decrease overall tension in your body. I recommend a water-soluble lubricant or natural oil (my fave is coconut oil) during intercourse.
Reason #3 – You just had a baby
You might be ready to go emotionally, but your body may not be! Injuries from pregnancy and childbirth delivery, such as perineal tearing/scarring and cesarean scarring, can lead to overactive tissues causing pain. In addition, hormone fluctuations during pregnancy, after delivery, and while pumping or breastfeeding can make things a little drier, leading to painful sex. Check out my favorite lubes here.
Reason #4 – You have another medical condition
Many other medical conditions can be the culprit, including vulvodynia (discomfort at the vulva causing burning, rawness, and itching with no known cause that has been three months or longer), endometriosis, fibroids, ovarian cysts, or cervix irritation. In addition, a vulvar or vaginal infection, such as lichen sclerosis, bacterial vaginosis, or yeast infection, can cause vaginal pain and irritation before, during, and after intercourse. Treatment of these would include seeing a medical provider or physician.
Reason #5 – Hormones are to blame
I love to blame everything on hormones, and, in my defense, they are the reason to blame a lot of the time! Hormonal changes from hormonal contraceptives during lactation or breastfeeding and/or menopause can cause vaginal atrophy, drying, and thinning, resulting in painful intercourse.
Men can have painful sex, too
The anatomy of the pelvic floor is almost the same for all genders, which means everyone and anyone is susceptible to pelvic floor dysfunction and can experience pain with sex.
Common causes of painful sex in those with male anatomy include:
- Pelvic floor muscle tension
- Peyronie’s disease: repetitive penile trauma that causes scar tissue inside the penis that causes a painful and curved erection
- Prostatitis: swelling of the prostate
- Erectile dysfunction: inability to get or maintain a firm erection
Tips to help painful sex
Here are some ideas that may be helpful to start getting your muscles to relax and decrease pain with sex. And did you know we have another blog post that dives a bit deeper into some things you can be doing if you experience pain with sex. Check it out here.
- Practice belly breathing daily. Slowly inhale and puff your belly outward and exhale slowly let it fall. Performing this technique for 5 minutes once to twice a day can help your pelvic muscles relax and decrease overall tension in your body.
- Use lube. Lots of it. I recommend a water-soluble lubricant (my fave is Slippery Stuff) or a natural oil (my fave is coconut oil) during intercourse.
- Get vaginal dilators. Dilators look like a set of tampons of increasingly larger diameter. Inserting these into the vagina can help desensitize your vaginal tissues, relax your muscles, and massage any scar tissue at the vaginal opening resulting from an episiotomy or tear.
- Massage with a pelvic wand. This looks like a dilator with a curved tip at the end. It can apply pressure to the tender, tense muscles to help them relax. Pretty much a vagina massage.
Don’t hesitate to reach out
These tips may help if muscles are a source of your pain. Consult with a physician (a good one) and a pelvic health physical therapist if you are having pain with sex and want to know if muscles are a piece of the puzzle.
If you have pain in your parts, Download this free guide to find out if pelvic floor tightness might be to blame—and what to do about it.
Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.
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