Pelvic Floor Pain During Sex

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Woman holds two dilators and looks into the camera

Do you have pelvic floor pain during sex? Sex should be enjoyable, pleasurable, and painless. It should not be painful… (unless you want it to be). If you experience pain, you may be wondering what’s normal, what’s not and what can help? 

First of all, know that you aren’t alone – one in five women will experience pain with sex or pain in the pelvic region at some point in their lifetime. Pelvic floor pain during sex is common but not normal. Fortunately, pelvic floor pain during sex is treatable.

What could be causing pelvic floor pain during sex?

There are many physical, psychological, and emotional reasons you may feel pain during or after sex. These include:

Pelvic floor muscle tension

Your pelvic floor muscles, the muscles in your vagina, can often be the source of pelvic floor pain during sex. These muscles sit at the base of your pelvis, support your pelvic organs, and have the opening to the vagina. Because these muscles are like any other muscle in your body, they can get tight, tense and spasm leading to difficulty or pain with insertion of something into the vaginal canal. 

Pelvic floor pain with sex can occur with initial insertion, deeper insertion, certain positions, with orgasm or even after sex. If you experience pain with initial insertion, also known as vaginismus, you may feel like something is hitting a wall with attempts to insert into the vagina. Pain can occur upon insertion of a finger, tampon, speculum, sex toy or during vaginal intercourse.

Postpartum pelvic floor dysfunction

After giving birth and receiving the 6-week “all clear” to return to sex and exercise, you may not feel quite ready emotionally or physically to return to sex. Injuries from pregnancy and childbirth delivery can lead to overactive pelvic floor muscles, perineal scar tissue from a laceration or episiotomy, or cesarean scar tissue restriction.

Hormonal changes 

I love to blame everything on hormones, and, in my defense, they are the reason to blame a lot of the time! But hormonal changes, particularly decreased estrogen level due to oral contraceptive use, lactation or breastfeeding, or menopause can cause vaginal dryness and thinning. This can lead to a raw or tearing sensation during sex causing significant pain and even bleeding. 

Other medical conditions

Many other medical conditions may be the culprit:

These conditions require diagnosis and management by a physician, however pelvic floor tension or overactivity can persist even after the condition has been treated. Working on relaxing and releasing tense pelvic floor muscle is often the first step in getting relief from pelvic floor pain during sex.

Tips to relieve pelvic floor pain during sex

#1 Practice diaphragmatic breathing

Diaphragmatic breathing helps to calm the nervous system and reduce muscle guarding. It does this through good mobility, blood flow, and relaxation to the pelvic floor and abdomen. How to do it:

  1. Place one hand on your chest and the other on your abdomen and relax your jaw and shoulders.
  2. Take a slow, gentle breath, letting the abdomen and rib cage expand. You want your stomach and ribs to move the same in all directions. Blow like you are opening an umbrella with your rib cage. Then breathe out and let your abdomen fall back downwards.

#2 Use lots of lubrication

Moisture is important to reduce friction, tearing, and rawness during intercourse. Less estrogen can decrease self-lubrication. This can happen during breastfeeding, in or post-menopause, or when using birth control. Not all lubricants are the same! Ingredients that you want to avoid in lubricants are:

  • Glycerin
  • Nonoxynol-9
  • Petroleum
  • Propylene glycol
  • Chlorhexidine gluconate

I recommend two water-based lubricants that rarely cause irritation. These brands are also safe with latex and non-latex condoms. They are Slippery Stuff & Good Clean Love. You can also use a natural oil such as coconut oil. But, oil and latex don’t mix well, so if you use oil-based lubricant, avoid using a latex condom as it may tear.

#3 Try CBD lube and suppositories

These can be game changers for pelvic floor tightness. The CBD acts alongside the pelvic floor muscles to help them relax. There are different brands out there with different ingredients and amounts of CBD. You can even make your own! ⁣Our favorites are from Foria, Simple Solace CBD, Vella, and GoLove

#4 Experiment with other positions

Try sidelying, lying on your back with pillows supporting your knees relaxed open, or you on top. These positions may offer pelvic floor relaxation and feelings of more control. Experiment with what feels best for you.

#5 Use dilators or a pelvic wand

Our favorite brands for both dilators and pelvic wands is Intimate Rose. Pelvic wands look like a dilator with a curved tip at the end. These apply pressure to specific trigger points deep in the pelvic floor muscles. This helps the muscles relax. Dilators look like a set of tampons, large in diameter. Inserting these into the vagina can help:

  • Desensitize your vaginal tissues
  • Relax your muscles
  • Massage any scar tissue at the vaginal opening resulting from an episiotomy or tear

#6 Pelvic floor physical therapy 

Relaxation strategies for painful intercourse will help you lengthen and relax those muscles to their normal resting state with breathing exercises, yoga and stretches and massage. With just a couple of easy stretches, you can majorly help your pelvic floor lengthen and relax. Add 4-5 diaphragmatic breaths to each stretch, and your pelvic floor will thank you. 

You can do these daily and immediately before intercourse! There are a couple simple stretches you can do to relax your muscles and relieve pelvic floor pain during sex.

If you feel ready for more exercises to transform your pelvic floor, check out the relaxation series inside my V-Hive Membership!

Join The V-Hive

Online pelvic floor fitness programs from a board-certified Women’s Health Physical Therapist. Your first week is free.

Free Pelvic Floor Guides

Download these free guides for some simple, do-able, totally-not-weird tips to take better care of your down there.

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