Is Pain During Sex Normal?

Sex shouldn't be something you have to push through because it's painful.
Pain during or after sex is relatively common, but ongoing or significant pain isn't something you simply have to accept. There are many possible reasons for pain during sex, and pelvic health physiotherapy can help when pelvic floor muscle tension, weakness or other musculoskeletal factors are contributing.
If sex is painful, you're not alone—and it's okay to ask for help.

What does painful sex feel like?
Pain during sex, sometimes called dyspareunia, can feel different for everyone.
You might experience:

• Pain or burning at the vaginal opening
• A feeling of tightness or difficulty with penetration
• Deeper pain within the pelvis
• Pain with certain positions
• Pain that continues after sex
• Pelvic aching or cramping afterwards
• Pain when using tampons or undergoing a vaginal examination
• A feeling that your pelvic floor is "too tight"

Pain can occur with attempted penetration, during sex or afterwards.

Is pain during sex normal after having a baby?
Some discomfort can occur while your body is recovering after pregnancy and childbirth, particularly in the early postpartum period.
Changes following childbirth, including perineal tears, episiotomy, scarring and changes to the pelvic floor muscles, can contribute to discomfort.

However, ongoing pain with sex isn't something you have to simply accept as part of having had a baby.
If you're experiencing persistent pain after childbirth, a pelvic health physiotherapist can assess the factors that may be contributing and help guide your recovery.

What causes pain during sex?
There isn't one single cause of painful sex.
Possible contributing factors include:

• Pelvic floor muscle tension or difficulty relaxing
• Changes following pregnancy and childbirth
• Scar tissue following a tear, episiotomy or surgery
• Pelvic pain conditions
• Endometriosis
• Vaginal dryness or hormonal changes
• Vulval or vaginal conditions
• Bladder or bowel conditions
• Previous painful experiences or fear of pain
• Changes during menopause

Sometimes several factors are contributing at once.
Because there are many possible causes, an assessment may involve working alongside your GP, gynaecologist or other healthcare professionals where appropriate.

How can pelvic health physiotherapy help?
A pelvic health physiotherapist can assess whether the muscles, joints and tissues around your pelvis may be contributing to your pain.
Depending on your symptoms, treatment may include:

• Pelvic floor relaxation and coordination
• Breathing and relaxation strategies
• Gentle mobility exercises
• Treatment of muscle and soft tissue tension
• Scar management where appropriate
• Gradual exposure to comfortable movement or penetration
• Education about pain and pelvic floor function
• Individualised exercises to support your recovery

Pelvic floor strengthening isn't always the answer. If your pelvic floor muscles are already tense or overactive, learning how to relax and coordinate them may be more appropriate than doing more strengthening exercises.

Will I need an internal assessment?
Not necessarily.
Your physiotherapist will first discuss your symptoms and what you're comfortable with. An internal pelvic floor assessment may be recommended if it would provide useful information about your symptoms, but it is only performed with your informed consent.
You can always discuss your concerns, ask questions or choose not to have an internal assessment.

What if I'm worried that the pain is "all in my head"?
Pain is real, even when there isn't an obvious injury or structural problem.
Pain can be influenced by many different factors, including the nervous system, previous experiences, muscle tension, stress and fear of pain. This doesn't mean that your pain isn't physical or that you're imagining it.

A pelvic health physiotherapist can help you understand the different factors that may be contributing and work with you at a pace that feels comfortable.

When should I seek help?
Consider talking to your GP or pelvic health physiotherapist if:

• Sex is regularly painful
• Pain is stopping you from having sex
• Pain is affecting your relationship or confidence
• You have persistent pain following childbirth
• Penetration is difficult or impossible
• You experience pain alongside bladder or bowel symptoms
• Your symptoms are getting worse rather than improving

You don't need to wait until the pain becomes severe before seeking help.

What if I'm embarrassed to talk about it?
It's completely understandable to feel uncomfortable discussing intimate symptoms.
Pelvic health physiotherapists have conversations like this regularly. You don't need to know exactly what's causing the pain or even know the correct terminology to describe it.
You can simply explain what you're experiencing, and your physiotherapist can guide the conversation from there.

Pain during sex can be treated
Pain during sex is common, but that doesn't mean you have to accept it as your normal.
Whether your symptoms started after childbirth, developed gradually or have been present for a long time, understanding what's contributing to your pain is the first step towards finding an appropriate treatment approach.

If pain during sex is affecting your comfort or quality of life, our pelvic health physiotherapists at Better Bodies Physiotherapy in Palmerston North can help.