Pain With Sex? Pelvic Floor Physical Therapy Can Help!

Authored by The Bodyful PT and Wellness Team.

Pain With Sex, Deep Pain During Intercourse, or Pain After Orgasm?

Have you had pain with sex for more than two months, without an identifiable cause?

Do you struggle to understand why you have pain during sexual intercourse?

Do you also experience vulvar pain, difficulty wearing tight clothing, or sensations of burning, itching, or dryness at the vulva?

Pelvic floor physical therapy can help with unwanted and painful sex.

What Is the Pelvic Floor?

The pelvic floor is a bowl-shaped group of muscles that:

• Support your pelvic organs

• Prevent urine leakage when you sneeze or cough

• Lengthen to allow bowel movements or childbirth

• Play a key role in arousal, penetration, and orgasm

Whether you are penis-bodied, vulva-bodied, or any body in between and beyond—all bodies have a pelvic floor, and all bodies can benefit from pelvic floor education and treatment when symptoms arise.

Why Pain With Sex Happens

If you experience deep pain during sex and it is not caused by an acute injury or infection, it is often related to pelvic floor dysfunction.

Pelvic floor dysfunction means the muscles may:

• Not relax when they need to relax

• Over-tighten when relaxation is required

• Lack coordination between tension and release

This can contribute to pain during penetration, pain with certain positions, cervix pain during sex, or sharp pain during intercourse.

Pelvic Floor Tension, Vaginismus, and Painful Penetration

If you have pain with sex, you may have pelvic floor muscles that are tense and tight.

Tight muscles combined with fear or anticipation of pain can lead to vaginismus, a condition where vaginal penetration feels extremely difficult or impossible.

You may wonder:

“Why does my tampon hurt when I take it out?”

Pelvic floor physical therapy helps by:

• Gently retraining muscle relaxation and coordination with breathing

• Supporting nervous system safety

• Educating you so you can discern what your body is asking for

If your muscles are “too tight,” treatment often includes:

• Hip and low back mobility

• Breathing practices

• Pelvic floor awareness and relaxation training

These tools help you consciously soften the pelvic floor to tolerate the beginning of penetration—to offer you some space from any fear.

Vulvar Pain, Nerve Irritation, and Hormonal Changes

If you experience vulvar pain during penetration, pelvic nerves may be irritated, stretched, or compressed.

Pelvic floor PT can help you learn to:

• Improve blood flow

• Reduce nerve compression

• Restore soft tissue mobility

If you are postpartum, perimenopausal, or using hormonal birth control, and also experience dryness, itching, or irritation, hormonal changes may be contributing to pain during sex.

A pelvic floor therapist can inspect the vulva and refer you appropriately or suggest over-the-counter options such as vulvar moisturizers when indicated.

Do You Have Deep Pain During Sex?

Ask yourself:

• Do you avoid certain sexual positions?

• Do you experience cervix pain during sex?

• Do you also have low back or hip pain?

• Do you feel burning during or after sex?

If yes, the deeper pelvic floor muscles—closer to the pelvic organs, hip joints, and sacroiliac joints—may be tight, weak, or poorly coordinated.

Reduced blood flow to the nerves in these regions can make the body perceive threat, which registers as pain.

Pelvic floor therapy for pain with sex helps improve:

Hip and spine mobility

• Core support

• Pelvic floor movement and coordination

This can significantly reduce deep pain during intercourse.

Pelvic Floor Muscles and Orgasm

For all bodies, pelvic floor muscles naturally contract during arousal.

However:

• Pain after orgasm can occur if muscles are too tense

• Painful orgasm may result from restricted blood flow to pelvic nerves

• Difficulty reaching orgasm may happen if muscles cannot fully relax

If you must tense your entire body or hold your breath to orgasm, your pelvic floor may lack the range of motion needed for healthy arousal and release.

Pelvic floor PT helps restore this balance.

Pain After Ejaculation and Penile Symptoms

For people with penises, overactive pelvic floor muscles may contribute to:

• Erectile dysfunction – reduced blood flow

• Premature ejaculation – coordination and breathing challenges

• Burning after ejaculation (no STD) – nerve compression or trigger points

• Penile or testicular pain – often worsened by sitting, lifting, stress, or sex

• Rectal pain or pressure – often paired with straining during bowel movements

• Pain with rectal penetration – frequently linked to hip and back stiffness

• Hard flaccid - uncomfortable semi-erection, often associated with increased activity like running

These symptoms often point to pelvic floor tension rather than a problem with the genitals themselves.

Pelvic Floor PT and Gender-Affirming Care

If you are transgender, pelvic floor PT can support recovery after gender-affirming surgeries.

For example, dilators may be an important part of care after vaginoplasty, and pelvic floor physical therapy can support safe, effective rehabilitation.

What to Expect From Pelvic Floor Physical Therapy

During your first visit—online or in person—you will:

• Share your goals and concerns

• Receive a thorough pelvic health assessment

• Learn what is contributing to your pain

• Receive a clear plan of care

Your pelvic floor therapist will explain:

• Your PT diagnosis

• How long symptoms may take to change

• How many visits are recommended

• What you can do at home to support healing

Your therapist can also coordinate care with other providers and refer you to specialists when needed.

For integrative care, some people benefit from working with a psychotherapist informed in sex therapy alongside pelvic PT.

Your Body Is Expressive

Your body cannot be separated from emotion, memory, and meaning-making.

Pain with sex is not a failure—it is communication.

With the right support, your symptoms can change.

Work With a Pelvic Floor Physical Therapist

If you’d like to learn more about pelvic floor physical therapy for pain with sex, you can reach out to Bodyful Physical Therapy and Wellness.

We offer:

• Online pelvic floor therapy visits and education

• In-person pelvic PT at our office in Oakland, CA

Support is available—and you deserve care that honors your body and your story.