Painful Sex

Sex is not supposed to hurt

One in five women can experience pain with sex at some point in their lifetime. Despite how frequently this occurs, women are often told to “just relax” or “drink a glass of wine” when they report it to their doctors.  This is bullshit.* Sex is not supposed to hurt… at all. It’s supposed to be pleasurable and enjoyable. Because this pain is not accurately diagnosed and often goes untreated, women continue to unnecessarily suffer, experience pain, or avoid intercourse altogether. Their relationships become rocky; their partners get frustrated; they feel embarrassed, ashamed, inadequate, and like something is wrong with them. It’s not.

Why are you having pain with sex?

There are numerous physical, psychological, and emotional reasons that pain with sex may occur. From a purely physical perspective, the pain can be due to infection, hormonal imbalance, nerve entrapment, scar tissue, tense pelvic floor muscles, or a variety of other causes. I’m going to focus on one cause that is often overlooked but commonly a source of the pain: your muscles. The ones in your vagina. These are often not considered as a source of painful sex, leading women to suffer for months or even years. By the time I see these women in my clinic they are often exhausted, depressed, deflated, and even traumatized by what has seemed an endless journey to figure out why their vagina hurts.

How does my pelvic floor play into this?

Your pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs, keep in pee and poop until you are ready to empty, and have a role in sexual activity. However these muscles are like any other muscles in your body. They can get short and tight and go into spasm. This can cause vaginal penetration to be difficult and sometimes impossible. Pain can also occur with deeper penetration, with orgasm, or even after intercourse is over. These muscles need to be lengthened and relaxed to their normal resting state. A pelvic physical therapist can help by guiding you through breathing exercises, yoga and stretching, performing massage, and educating on pain, posture, and returning to sex that is pain-free and pleasurable.

Here are some quick tips that may be helpful to start getting your muscles to let go and help decrease pain with sex:

1. 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.

2. 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.

3. 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. 

4. Massage with a crystal wand. This looks like a dilator with a curved tip at the end. It can be used to apply pressure to the tender, tense muscles to help them relax. Pretty much a vagina massage.

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.

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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