Pain with sex. Painful intercourse. Dyspareunia. Vaginismus. Whatever you call it, when your partner is in pain, having intercourse can be extremely difficult or impossible. Pain with penetrative intercourse is one of the top things that we as pelvic floor physical therapists help our patients overcome.

Typically, patients experiencing pain with intercourse have significant pelvic floor muscle tightness or pelvic floor muscle spasm. When the muscles are tight, they are painful. When something is painful, it leads to more clenching, tension, and spasm. When something is painful, we typically don’t want to keep doing it and therefore when sex is painful, sexual desire plummets. This vicious cycle is seen way too often in the pelvic health world. So what leads to this cycle in the first place?

Pelvic floor muscle tension can be caused from a number of different things: mental or emotional stress, nutrition or hydration status, hormonal changes (such as those that occur during or after pregnancy or with menopause), overuse injuries (the pelvic floor muscles take over for other weaker muscles), and physical trauma all can cause pelvic floor muscle spasm or tightness. 

Mental or emotional drivers can make pain with sex complicated. Sometimes the person experiencing pain has a history of adverse childhood experience, or was brought up by a family that opposed and shunned sex. Sometimes the person experiencing pain suffered from adult trauma like that from an unwanted sexual encounter, a high stress job, or even had a significant degree of pregnancy or birth trauma. The key to resolving painful intercourse is understanding the emotional and mental factors that might be playing a role.

We’ve all heard the saying “never tell someone that needs to calm down, that they need to calm down”, because this in fact, does the opposite. The same holds true for someone that is having painful intercourse. Telling them that they need to relax, typically does not do the trick. 

Understanding why someone is holding tension, fear, and avoidance is the key to helping to resolve it. Sometimes it’s deep rooted because of mental or emotional trauma.

The best thing you can do is honor your partner. Let her take the time she needs to get her body and mind in a relaxed state. 

Besides mental and emotional factors, there are some physical factors to pain with sex, and sometimes it’s that your partner may need to learn to relax the pelvic floor muscles. Sometimes this involves letting her do some yoga or deep breathing prior to engaging in penetrative intercourse and not rushing into penetration. 

Something else to think about is lubricant. Inadequate lubrication is one of the top reasons that sex is painful, especially if your wife is postpartum or nearing/in menopause (in her late 40s+) Stay away from anything that warms, tingles, smells, or promises anything other than lubrication. You also want to stay away from anything that has glycerin/glycerol (which is sugar and can lead to infection). 

We always recommend a water based lubricant (like Slippery Stuff), or a silicone based lubricant (like Uberlube) if no allergies. Just know that you may have to reapply water based lubricants because they may dry up in about 5-10 minutes, and silicone lubricants can’t be used with silicone toys/products because it can breakdown the silicone. 

If lubricant isn’t helpful, think about foreplay- especially if the pain is upon initial insertion. Remember that many women cannot jump right into penetration. Clitoral stimulation or penetration with a finger or a toy may help to relax your wife’s outer pelvic floor muscles and bring proper blood flow to them.

If foreplay isn’t helpful, try changing positions- let her take control and guide positions that are more comfortable for her. Know that she may not know what makes her comfortable, or may not be able to communicate that effectively. She may also need to take some breaks or proceed slowly with any position change.

If you are still lost, please, please, please recommend that she see a pelvic floor physical therapist. This is what we specialize in! We help women overcome painful intercourse all the time! Click here to learn more about pelvic floor therapy.

Please understand too, that many of us choose to not partner with insurance companies because insurance companies don’t consider pain free intercourse as a functional goal. So, support her in the journey of finding a pelvic floor therapist whom she is comfortable with, in a setting that she is comfortable with, and please understand that it may cost a little bit out of pocket, but will be worth it in the long run! Click here to learn more about out of network insurance.

Looking for help? We do virtual consultations and would be happy to chat! Click here to find out more.

Other resources for painful intercourse:

• Post-Hysterectomy Intimacy: Addressing Painful Intercourse After Hysterectomy

• Sharp Pain During Sex In Females.