Is Sex Painful for You? Here's How to Change Your Symptoms.
Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Women’s Health Clinical Specialist.
Pain With Sex: Understanding Deep and Superficial Dyspareunia
Do you feel pain during initial vaginal penetration or deeper penetration?
Do your vulvar or pelvic symptoms change depending on body position during sex?
Pain with sex is more common than most people are told—and it is treatable.
The medical term for pain during or after sexual activity is dyspareunia.
Vulvar and pelvic pain can show up in different ways throughout sexual experience. You may notice burning, sharp or stabbing pain, spasming, aching, or a sense of tightness or restriction. Symptoms can be immediate, positional, or delayed, and these details are clinically useful.
“Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in people who experience it.”
Types of Dyspareunia (Pain With Sex)
Pain with sex is often described using the following categories:
Superficial dyspareunia
Pain at the vulva or vaginal entrance, often associated with vulvodynia, vestibular sensitivity, or pelvic floor muscle guarding.Deep dyspareunia
Pain felt deeper in the pelvis, near the cervix, bladder, or lower abdomen. This is often described as deep sex hurts or sharp pain during sex.Primary dyspareunia
Pain present from the beginning of sexual activity.Secondary dyspareunia
Pain that develops later, often after childbirth, surgery, hormonal changes, trauma, infection, or prolonged stress.
If any of these resonate with you, know that pain with sex rarely has a single cause.
Why Pain With Sex Is Complex
Sex pain exists at the intersection of muscles, nerves, connective tissue, hormones, movement patterns, and nervous system states.
Pelvic health is influenced by structural, inflammatory, infectious, traumatic, hormonal, and psychosocial factors. Symptoms may fluctuate depending on arousal, emotional safety, position, stress, and fatigue.
This is why effective pain with sex treatment often requires a multidisciplinary approach, which may include:
Gynecology or urogynecology
Dietician for gut distress
Pelvic floor physical therapy
Sex therapy
Pain-informed mental health care
A pelvic floor physical therapist evaluates musculoskeletal contributors, considers your medical history, and collaborates with your broader care team.
What Helps With Pain With Sex Treatment?
A 2023 meta-analysis from the Women’s Health Group at Boston Medical Center found that:
“The combination of pelvic floor muscle training with other treatment strategies in a multimodal intervention yields the best results for improving sexual function.”
What a Multimodal Approach Often Includes
Most people with dyspareunia benefit from a combination of:
Pelvic floor relaxation and coordination training
Diaphragmatic breathing
Pain education
Exploring arousal quality, desire, and sexual appreciation sensuality options
Manual therapy
Nervous system resourcing
Together, these approaches can:
Reduce pain intensity during sex
Improve pelvic floor mobility and blood flow
Decrease sexual distress
Improve arousal, lubrication, orgasm, and sexual satisfaction
Research shows these benefits can persist for at least six months after completing care.
Manual Therapy for Pain With Sex
Pelvic floor physical therapy often includes hands-on treatment to:
Improve blood flow
Reduce nerve compression
Address trigger points
Restore mobility to vulvar, pelvic, and visceral tissues
Targeted manual therapy may include treatment to:
The pelvic floor muscles (superficial and deep)
Abdomen and diaphragm
Iliopsoas, piriformis, and hip rotators
Studies show that even brief, targeted manual therapy—five minutes weekly over four weeks—can significantly reduce pain during sex.
What About Kegels?
Pelvic floor strength alone is rarely sufficient for pain with sex.
Research shows no significant improvement in sexual function when pelvic floor muscle training is performed in isolation.
The greatest reductions in pain occurred when pelvic floor training was combined with:
Manual therapy
Education
Electrotherapy (such as TENS)
Supervised, progressive exercise
Your pelvic floor muscles need coordination, adaptability, and recovery, not just strength.
Biofeedback and Electrotherapy
Biofeedback uses a vaginal probe to show when pelvic floor muscles are contracting and relaxing. It can be helpful if you:
Have difficulty sensing your pelvic floor
Tend to over-recruit or stay tense
Learn best with visual feedback
Be cautious with consumer devices that cue squeezing without teaching relaxation. Training means learning both.
TENS (Transcutaneous Electrical Nerve Stimulation) may also be used as part of pain with sex treatment. High-frequency TENS works by modifying how pain signals are processed before they reach the brain.
Pain, Orgasms, and Pelvic Floor Function
Pain with sex and difficulty reaching orgasm often coexist.
Pelvic floor muscle coordination—especially in muscles supporting the clitoral erectile tissues—plays a role in arousal and orgasmic response. A well-designed pelvic floor therapy program can address both pain and pleasure by improving ease and breath support.
When Pelvic Floor Therapy Is Not Accessible
If you do not have access to pelvic floor physical therapy locally, you may benefit from:
Restorative or trauma-informed yoga
Qigong or Tai Chi
Guided breathing and posture practices
Telehealth pelvic floor therapy can also be effective and allows for guided education, exercise progression, and biofeedback instruction when available.
Ischiocavernosus and bulbocavernosus muscles supporting the clitoris in yellow.
A Final Note on Pain With Sex
Dyspareunia is not only a physical condition—it carries emotional, relational, and psychological weight. Working with a trusted mental health professional alongside pelvic floor therapy can improve outcomes and quality of life.
Pain with sex is real. It is not a personal failure. And it is treatable with the right support.
Pelvic Floor Therapy for Vulvodynia & Pain With Sex in Oakland, CA
If you are in the state of California, you can book a discovery call to learn more about pelvic floor therapy for pain with sex, deep dyspareunia, and vulvodynia. We offer Telehealth and in-person visits in Oakland, CA.
Reference
Fernández-Pérez P, Leirós-Rodríguez R, Marqués-Sánchez MP, Martínez-Fernández MC, de Carvalho FO, Maciel LYS. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health. 2023 Jul 24;23(1):387. doi: 10.1186/s12905-023-02532-8. PMID: 37482613; PMCID: PMC10364425.
