Pain With Sex: What’s Going On and Why Pelvic PT Helps

Pain with sex is one of the most common concerns I see in the clinic, and yet it is one of the least talked about. I had two evaluations TODAY for this and both said that I was the first person that they told other than a couple of extremely close friends. Many people keep quiet about it for months or years. Some assume it is normal after childbirth. Some think it is a hormone issue. Others worry something is wrong with them or that their body is simply not “built” for intimacy.

The truth is simple. Painful sex, also called dyspareunia, is common. It is not something you have to live with, ignore, or push through. It’s also almost always treatable.

Your body is asking for help.

What painful sex can actually feel like

Dyspareunia can show up in different ways. Some people describe sharp pain at the entrance. Others feel deep pressure or discomfort. Some feel a burning sensation. Some feel their body clamp down before penetration even starts. Others cannot tolerate pelvic exams or menstrual products.

Pain with sex can be caused by different things, but the experience is real. Your body is responding to something and trying to protect itself.

Why painful sex happens

This is where pelvic PT takes a big picture view. Pain with intimacy is not always about one muscle or one moment. It is often a combination of:

1. Pelvic floor tension

Many people have pelvic floor muscles that stay tight or guarded without them realizing it. When those muscles cannot relax, penetration becomes painful.

2. Nervous system protection

Stress, anxiety, fear, past experiences, or even a single painful moment can teach the body to brace. The pelvic floor follows the nervous system. If your brain senses a threat, even a small one, your muscles respond.

3. Hormonal changes

Low estrogen, birth control changes, postpartum shifts, and menopause can all change tissue health and lubrication. This makes penetration feel more sensitive.

4. Pain cycles

Pain changes the way we move and anticipate. If penetration has been painful before, the body may guard before anything even begins. This is a learned and pretty complex protection pattern.

5. Lack of comfortable positions or mobility

Sometimes the hips, low back, or core are involved. The pelvic floor never acts alone. When the rest of the system is stiff or compensating, intimacy can feel uncomfortable. This could just be range of motion restrictions, muscular tension, or scar tissue restrictions.

There is never one single cause. And there is never one single fix. That is why “just relax” or “just use more lube” or the infamous “just drink a glass of wine” advice does not solve the problem.

Why pelvic PT helps

Pelvic health physical therapy looks at the full picture instead of chasing one symptom. We assess how your pelvic floor is functioning, how your body responds to stress or pressure, what your muscles do under load, and how your system has adapted over time.

Treatment may include:

• gentle internal or external work to reduce muscle guarding

• mobility to support the hips and low back

• nervous system regulation strategies

• education that builds understanding instead of fear

• support with dilators or a pelvic wand when appropriate

• guidance on positions that reduce pressure

• coordination training

• restoring trust in your own body

The goal is not only to reduce pain, but also to help you feel comfortable, confident, and safe in your body again.

Pelvic floor physical therapy gives you a clear path forward so you are not guessing or hoping for the best each time intimacy comes up.

You deserve comfort and confidence

Pain with sex can affect more than the body. It can also affect relationships, identity, stress levels, and how you feel about yourself. You deserve support that honors all of that.

If intimacy has been painful, or if you have been avoiding exams or menstrual products because of discomfort, I want you to know there is nothing wrong with you. Your body is doing it’s number one job: Keep you alive and safe. But, with the right support we can shift this response and change the experience in and out of the bedroom.

Next step

If you are in Greenville, SC, or live anywhere in South Carolina through telehealth, pelvic physical therapy can help you understand what is going on and how to move forward.

👉 Book a consultation to talk through what you are experiencing and learn what your pelvic floor may be trying to tell you.