By Dr. Katie Spruell, PT, DPT, CSCS, PCES | Amplify Physio | Maryville, TN
Pain during sex is more common than most people realize – and yet it’s one of the things women are least likely to bring up with a health professional. Whether it’s a sharp sting on entry, a deep ache, or discomfort that lingers afterward, pain with intercourse (known clinically as dyspareunia) is not something you just have to live with.
If you’ve been quietly putting up with it, or wondering whether it’s “normal,” this post is for you.
You Are Not Alone
Research suggests that up to 1 in 5 women experience pain with intercourse at some point in their lives. Yet many go months – or even years – without seeking help, often because they feel embarrassed, unsure who to see, or worried they’ll be dismissed.
The truth is, dyspareunia is a well-understood condition, and there is a lot that can be done to help!
What Does Dyspareunia Feel Like?
Pain with intercourse isn’t one-size-fits-all. It can show up as:
- Superficial pain — burning, stinging, or soreness at the entrance of the vagina during or just after penetration
- Deep pain — an aching or pressure deep in the pelvis during or after sex
- Pain with arousal — discomfort even before penetration
- Vaginismus — an involuntary tightening of the pelvic floor muscles that makes penetration difficult or impossible
Some women experience this only at certain times (such as after childbirth or during menopause), while for others it’s been present their whole adult life.
What Causes It?
Dyspareunia can have several contributing factors, and often it’s a combination of more than one:
Pelvic floor muscle tension is one of the most common culprits. When the muscles of the pelvic floor are too tight or don’t coordinate well, penetration can feel painful or impossible. This can develop after childbirth, surgery, stress, or even just years of unconsciously holding tension in that area – it’s often very common in the athletic population.
Hormonal changes can cause vaginal dryness and thinning of the vaginal tissues, making sex uncomfortable or raw-feeling – particularly around menopause, breastfeeding, or with use of certain contraceptives.
Scar tissue from episiotomies, tears, or caesarean sections can alter the sensitivity and flexibility of pelvic tissues.
Endometriosis can cause deep pelvic pain during sex, particularly with certain positions.
Pelvic organ prolapse can also contribute to discomfort during intercourse. If you haven’t already, take a read of our post on pelvic organ prolapse and exercise – it covers how the pelvic floor is involved and what you can do to support it.
Psychological and nervous system factors – past experiences of pain, anxiety around sex, or trauma can sensitize the nervous system over time, meaning the body learns to anticipate and guard against pain, even when the original physical cause has resolved.
How Can Pelvic Floor PT Help?
Pelvic floor PT is one of the most effective treatments for dyspareunia – and yet most women don’t know it exists as an option.
A pelvic floor physio will:
- Assess your pelvic floor – always with your consent – we’ll thoroughly explain what a pelvic exam entails and you are in control at every step. An internal pelvic exam allows us to assess muscle tone, coordination, strength, and any areas of tension or tenderness – but if you’re not comfortable with an internal exam, that is completely okay. We can still do a great deal of meaningful work through breathwork, pressure management, and an external assessment
- Identify the contributing factors specific to you – because no two cases are the same
- Treat the physical drivers – using hands-on techniques, breathwork, and progressive exercises to release tension, improve tissue health, and restore normal muscle function
- Guide you through a graduated return to comfortable intimacy – at your own pace, with clear goals along the way
- Support the nervous system side – helping to break the pain-anticipation cycle that can keep dyspareunia going even after the physical issues have been addressed
If you’ve also noticed leaking when you exercise or sneeze, it’s worth knowing the pelvic floor is involved in that too. My previous post on stress urinary incontinence explains more about how the pelvic floor works and why it sometimes needs a little retraining.
When Should You Seek Help?
The honest answer? Sooner rather than later. The longer dyspareunia goes on, the more ingrained the protective muscle patterns and nervous system responses can become – which makes recovery take longer.
You should see a pelvic floor physio if:
- Sex has been painful for more than a few weeks
- You’ve noticed any avoidance of intimacy due to fear of pain
- You’ve had a recent birth, surgery, or significant hormonal change
- You’ve been told “everything looks normal” but something still doesn’t feel right
You deserve to feel comfortable in your body – and that includes during intimacy.
A Personal Note — From Me to You
I don’t share this lightly, but I share it because I think it matters.
I grew up in purity culture. There’s a lot of good that came from that upbringing, and I hold it with respect – but one thing it didn’t give me was any real education about my body, my pelvic floor, or what healthy intimacy could feel like. Pain with sex was just something I quietly accepted. I didn’t have the language for it, and honestly, I didn’t know help existed.
It wasn’t until six years into my marriage – when I was 10 weeks pregnant and started experiencing some pelvic floor leakage – that I finally sought out a pelvic floor physio. I’d been doing all the kegels I’d ever heard of, convinced I was doing the right thing. But when I was assessed, it turned out I was actually hypertonic – my pelvic floor was too tight, not too weak. All those kegels had been making things worse.
Learning to lengthen, breathe, and downtrain those muscles changed everything. For the first time in my life, I experienced pain-free intimacy. The leakage resolved completely. And when it came time to give birth to our daughter, I pushed only about five times. I know my labor and birth would have been a very different experience without that preparation.
This is deeply personal to me – which is also why I bring it into my work with patients every day. If you’re sitting with something you’ve never said out loud, I want you to know there is no judgment here. Just someone who has been there, and who knows that it doesn’t have to stay that way!
Pelvic Floor Physical Therapy in Maryville, TN and Surrounding Areas
If you’re dealing with pain with intercourse and you’re in Maryville, Alcoa, Louisville, Knoxville, or anywhere in Blount County, we can help. At Amplify, we do a thorough evaluation to understand exactly what’s driving your symptoms — and we build a plan that helps you feel like yourself again, in every area of your life.
You shouldn’t have to keep putting this off.
Schedule Your Free Discovery Call →
Prefer to talk first? Call or text us at 865-233-3533.
Pain with intercourse is common – but it is not something you have to accept. Help is available, and recovery is absolutely possible.
Dr. Katie Spruell is a Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and Pelvic Health specialist serving Maryville, Alcoa, Louisville, Knoxville, and Blount County, TN. To schedule an appointment at Amplify, call 865-233-3533.