Exercise

Pain during sex? Here’s why, and what you can do about it

Dr. Sara Reardon, Board-Certified Pelvic Floor Physical Therapist and founder of The Vagina Whisperer  |   10 Nov 2023


Originally published on The Vagina Whisperer blog, written by Sara Reardon. 

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

Painful sex is a common problem affecting 18% of people worldwide, regardless of gender. Dyspareunia (the medical term for painful sex) is often neglected due to various reasons. People may not know who to talk to or may not want to tell their medical provider about it. Or even if they do, they may not be taken seriously.

If you have pain during sex you’re not alone! Pelvic floor pain during sex is common, and luckily, 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.

Hormonal changes

I blame hormones for a lot of things, and they are often the reason behind it! Changes from hormonal contraceptives during lactation or breastfeeding, menopause, or estrogen-deprivation treatments for cancer can cause:

  • Vaginal atrophy
  • Vaginal dryness and thinning
  • Decreased sexual desire

Scar tissue from childbirth

You might be ready to go emotions-wise, but your body may not be!

Many women experience painful sex postpartum – most wait until after their 6-week physician check-up to get the okay to return to intercourse. Some women may want to start having sex sooner than that. I do encourage you to let your body heal during this time.

If pain occurs and persists after a few attempts to have sex, scar tissue from a perineal laceration or even scar tissue from a Cesarean scar can be to blame. 

Tense pelvic floor muscles

Your pelvic floor muscles, the muscles in your vagina, are likely the source of painful sex. These muscles sit at the base of your pelvis. They support your pelvic organs, keep pee and poop in until you are ready to empty, and play a role in sexual activity.

Yet, these muscles are like any other muscle in your body. They can get short and tight, causing vaginal penetration to be painful and, sometimes, impossible. 

torso-massage

Vaginismus is a muscle spasm of the outer third of the pelvic floor muscles. This condition prevents pain-free penetration into the vaginal canal. Pain occurs upon insertion of a finger, tampon, speculum, or during vaginal intercourse.

Infection

Inflammation and irritation to the vulvar and vaginal tissues can often be the first sign of infection. If you experience a sudden and new onset of pain with sex, check in with your medical provider to rule out the possibility of infection. 

What are some things I can do to relieve 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.

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 natural oil such as coconut oil. But, oil and latex don’t mix – so if you use oil-based lubricant, avoid using a latex condom as it may tear.

#3 Check your C-Section Scar

C-section scars can often be the culprit of painful intercourse. Yes, even if you did not have a vaginal delivery. The vaginal muscles have decreased blood flow and may get tense causing pain with sex.

A pelvic floor physical therapist can perform external and internal massage. This will help the vaginal muscles relax and improve blood flow.

#4 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

Pelvic floor exercises for painful intercourse

Here are some stretches that help the 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.

#1 Knee to chest stretch

To perform, start in a lying position on your back. Put your hands on the outside of one knee and slowly pull it in towards your chest. If you’re doing a single, keep the other foot flat on the floor.

Hold the stretch. Then, switch sides. Or, place your hands over both knees to perform a double.

Knee to chest

#2 Happy baby stretch

To perform, begin lying on your back. Bend your knees. Keep your feet flat on the floor. Take hold of the outsides of your feet with your hands, keeping your knees wider than hip-width apart. Draw your legs towards you, using the strength of your arms and hands to deepen the stretch.

You should feel a comfortable sensation in the inner thigh area, without any sharp pain or strain. Once you feel settled in the pose, use your breath to help relax further into the stretch. Remain here for at least five full breaths. You should feel the stretch deepen with each exhalation.

happy-baby-pose

#3 Child’s pose

To perform, begin by sitting back on your heels with your toes together.

Then, keep your feet flat on the floor and lean forward, stretching out the arms in front of you. Ensure your arms are close together and parallel with the floor – do not let them spread too wide.

Your forehead should rest on the floor and your back should be straight. Hold this position for 30-60 seconds, breathing throughout.

childs-pose

#4 Deep squat

To perform, begin by standing with feet wider than shoulder-width apart. Point your toes outward. With your hands in front of you, lower into a squat. Bend at the hips and knees to do so.

Keep your chest lifted and your back straight. Make sure to keep the knees in line with your toes, and avoid letting them roll inward or out. Hold the squat position for a few seconds and then rise back up to the starting position. 

deep-squat-stretch

You deserve great sex

If you have pain during sex, your pelvic floor may be to blame. Download this free pelvic floor tension guide to find out if pelvic floor tightness might be to blame—and what to do about it.

Then check out my V-Hive Membership’s Relaxation Series. By practicing these stretches and exercises for just a few minutes each week, you can ease pelvic floor tension, get relief from pain, and restore pleasure to sex. Stop suffering and start living. Your first week is on me!

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