Pain during Sex. What causes it, and what can we do about it?

If pain while having sex is something you are experiencing or have experienced in the past, you are not alone. Pain during sexual intercourse is far more common than we think and, for some women, the norm. Sexual intercourse should be enjoyable and helps to create a connection between partners. According to statistics from the American College of Gynecologists and Obstetricians, 75% of women experience painful sex during some point in their lives. Unfortunately, because it is not a subject easily discussed, many women never seek help, worsening their pain and intimacy issues. If you have painful sex, a good idea is to have a pelvic floor physical therapist evaluate you to find out what is causing your pain.

So, what causes pain with sex?

 There are several contributing factors to painful sex. The first one is the physical aspect. Physical therapists call muscle hypertonicity, in other words, pelvic floor muscle tightness, one of the number one contributors to painful intercourse. This means those muscles have difficulty going through a full range of motion, as they tend to stay more contracted instead of being able to lengthen and relax—fun fact: strong pelvic floor muscles can also help you orgasm.
Pelvic floor physical therapists are professionals who have been trained to treat what we call dyspareunia, the medical term for painful sex. Pelvic floor physical therapists can help to release pelvic floor muscle trigger points that are causing pain, decrease tone and teach you how to lengthen the pelvic floor muscles. They can also teach you stretches and exercises to improve overall lower extremity mobility and core strength, leading to a more functional pelvic floor. To learn more about pelvic floor physical therapy and how it can help, by contacting an ask an expert such as Dr. Krisia.

women kneeling behind another woman holding her hips while she lifts one leg


The second contributing factor is your breathing. If we hold our breath during sex, our pelvic floor muscles will stay in a tightened position, making intercourse more painful. You may have heard that the actions of your diaphragm, which is your primary breathing muscle, are directly correlated to the efforts of the pelvic floor. When the diaphragm descends as we take a deep breath through our belly, pelvic floor muscles lengthen. When the diaphragm ascends as we breathe out, the pelvic floor muscles also ascend and shorten. Therefore, not being able to take a full diaphragmatic breath in and out can lead to limited ability to lengthen the pelvic floor. Also, diaphragmatic breathing can help our nervous system calm down, which may make sex more enjoyable. Make sure you take deep, diaphragmatic breaths before and during intercourse to decrease pain.


The third contributing factor is lubrication. Some women may have more of a need for lubrication than others. Lubrication depends on your hormonal state, birth control, what period of your cycle you are on, and medications. The feeling of “pinching” in the pelvic floor during intercourse is many times a sign of needing more lubrication. Find a water-based natural lubricant; you can also use something as simple as coconut oil.
And last but not least is your mental state. Being able to enjoy sex requires being in a calm state of mind and being comfortable with your partner. Some mental health professionals are experts in this field and teach you techniques to manage anxiety and enjoy intercourse. Speak to a mental health professional if you are struggling with a lack of enjoyment during sex. If you have been suffering from painful intercourse and have tried all the above and realize it has to do with your state of mind, please reach out to someone who can help. There is hope for better and pain-free sex life, and you deserve that!

About The Author

This article was written by Dr Krisia. She specializes in pelvic floor dysfunction, cancer rehabilitation and orthopedic conditions. In addition, she has passion for the pregnant and postpartum population, as well as clients with pelvic dysfunction and persons who have undergone cancer treatment. Please contact her at for more information.