It’s Supposed to be Fun, But Why Does Sex Hurt?


Couple experiencing painful penetration

Painful Penetration – A Distressing Problem

Hey everyone! I wanted to make a quick blog about painful penetration because a lot of our patients come in asking the question, “Why does sex hurt”? We’ve talked a lot in previous blog posts about the numerous roles of the pelvic floor, but I want to specifically cover the sexual function here. During sexual arousal, the pelvic floor muscles relax and facilitate blood flow to the genital area, contributing to sexual pleasure and arousal. They also contract rhythmically during orgasm. With painful intercourse dyspareunia, typically overactive pelvic floor muscles, the muscles lose the ability to relax and assist with optimal blood flow to the area. They also can cause pain during penetration by losing the ability to relax and lengthen. Experiencing pain during penetration, also known as dyspareunia, can be an emotionally and physically distressing problem.

So How Did This Happen?

While there can be various causes for painful penetration, some of the most common are related to issues with the pelvic floor, such as:

  • Pelvic Floor Muscle Tension: High levels of tension in the pelvic floor muscles, known as pelvic floor muscle dysfunction, can lead to pain during penetration. This tension can result from stress, anxiety, past trauma, or improper muscle habits.
  • Vaginismus: Vaginismus is a condition where the pelvic floor muscles involuntarily contract and tighten when penetration is attempted1. It can be an involuntary response to the anticipation of pain, past trauma, or fear associated with penetration.
  • Pelvic Floor Weakness: On the other hand, pelvic floor muscles that are weak and lack proper tone may also contribute to painful penetration, as they may not provide adequate support and control during sexual activity.
  • Scar Tissue: Scar tissue from past surgeries or injuries in the pelvic area can also cause painful penetration, restricting movement and causing discomfort.
  • Lack of lubrication: Among the reasons listed above, another common cause for painful sex in women (or people with vulva’s) is a vaginal dryness. Although, for those with penises attempted rectal penetration, another common culprit of painful intercourse is attempting to do so without any type of lube.

Seeking Help and Treatment Options

If you experience painful penetration or suspect an issue with your pelvic floor, it’s essential to see a pelvic floor physical therapist, as we can give you a thorough and proper evaluation to find out why penetration is painful and what you specifically need to improve, whether is mobilizing scar tissue, improving the movement of the pelvic floor, decreasing your muscle tone, etc. Some of the techniques we may use in pelvic PT include:

  • Specific breathing techniques and patterns to improve the mobility and relaxation of your pelvic floor (Pro Tip: Read our last blog post and one of the most important things for pelvic floor health!)
  • Massage or myofascial release to the muscles surrounding your pelvic floor. The muscles of your abdomen, lower back, inner thigh, and back of your thigh work similarly to wires where if they have too much tension, they refer some tension to the structures they’re connected to (such as, your pelvis and pelvic floor!)
  • Internal muscle release or dilation may be used to treat specific muscles in your pelvic floor that can be the culprit of getting in the way of your sex life, and dilation can help relax and desensitize tissues to prepare them for sexual activity.
  • Corrective exercises can also be given! This may sound odd considering I mentioned how too much tone can contribute to painful penetration, but imagine this: if there is instability or weakness in your hip or pelvis, your pelvic floor can actually tighten to try and compensate for this instability. Therefore, corrective exercises for these muscles may help the pelvic floor not work as hard and be able to relax!
  • CBD Lubes & 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 ForiaSimple Solace CBDVella, and GoLove

So, What Now?

Understanding the pelvic floor and its role in sexual function is vital to addressing issues related to painful penetration. While I listed some treatment techniques that may be used, some techniques will be more helpful than others depending on the patient, while other techniques may be downright detrimental! Because of this, seeking professional guidance and support can lead to effective treatments, empowering you to regain control over your sexual health and overall well-being. If you struggle with this, or know of someone that does, let us know how we can help! We’ve treated people with penises and vulvas who have painful penetration with both vaginal and anal penetration, and our goal is always to empower and help people get their lives back! 😊

Dr. Lance Frank PT, DPT, MPH (He/Him)

Pelvic health for penises, vaginas, and everything in between. Serving as Midtown Atlanta’s pelvic health clinic for frustrated folx with pelvic floor dysfunction.

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