Pain With Sex

Painful Sex Is A Symptom, Not A Diagnosis: Causes and Treatments

Painful sex is often a symptom of an underlying problem. It is not a diagnosis itself. At any given time, several personal, interpersonal, social, medical, cultural, and situational factors influence sexual health. Sometimes, it could be an underlying infection, muscle spasm, a fear of sex, atypical anatomy, or a number of other things. Because every effective solution starts with first understanding the exact cause of the problem, your pain needs to be investigated (and most likely by a trained professional).

Painful sex is a deeply personal and often distressing issue – and one that affects both the individual and their relationships. It’s a symptom that shouldn’t be dismissed lightly, as it can signify greater underlying concerns. In this blog post, we’ll explore the symptoms, causes, myths, and treatment options surrounding penetrative pain.

image of a woman sitting on the end of a bed with her head in her hands

Recognizing the Symptoms of Painful Sex

The symptoms of painful intercourse can vary from person to person, but we do know that painful sex is common. According to the American College of Obstetricians and Gynecologists, 3 out of 4 women – or 75% of women- experience painful sex. While the severity and duration of symptoms may very, they often include:

  1. Sharp or burning pain during penetration.
  2. Persistent discomfort during or after intercourse.
  3. Muscle spasms in the pelvic floor.
  4. Vaginal dryness or inadequate lubrication.
  5. Anxiety or fear associated with sexual activity.

These symptoms can significantly impact an individual’s quality of life, self-esteem, and intimate relationships.

Unraveling the Causes of Painful Sex

Painful sex can stem from a multitude of physical, psychological, and relational factors. Here is a handy list of things that can cause painful sex:

Medical Conditions

Many medical conditions can cause painful sex. These include:

  • Endometriosis
  • Pelvic inflammatory disease (PID)
  • Vaginal infections (like BV or yeast)
  • Vaginismus or vulvodynia (pelvic muscle issues)
  • Lichens sclerosus
  • Muscle tear
  • Scarring
  • Menopause
  • Tailbone Injury
  • Surgeries
  • Irritable Bowel Syndrome (IBS)
  • Pregnancy or postpartum recovery

Hormonal Imbalances

Fluctuations in estrogen levels, especially during menopause, can also lead to vaginal dryness and discomfort during sex.

Psychological Factors

Stress, anxiety, depression, past traumatic experiences, or negative beliefs about sex (including cultural or religious beliefs) can contribute to pain during intercourse. Work stress can also play a role in this.

Relationship Issues

Lack of communication, unresolved conflicts, or emotional distance between partners can manifest as physical discomfort during sex. Interpersonal issues outside of the relationship can also play a factor.

*Note: As you read through this list, please know that this is not meant to be a conclusive “why” explanation. Only the common causes made this list. The actual list of causes is pretty long, so you need a doctor to sort through the options with you, as they are the best suited to perform a full diagnosis.

Dispelling the Myths

If you’ve suffered from painful sex or vaginismus, you’ve probably heard a wide range of stories and opinions from friends and family, and even outdated advice from doctors which has left you confused, frustrated, and unable to get long-term relief.

Here are some of the most common sex-pain-related myths people who visit our Seattle clinic have been told, which have actually made their pain much worse and delayed their recovery:

#1. It’s Normal to Have Pain During Sex

Women are often told that it’s normal to have some pain during sex as it means you’re a good woman and your vagina is tight. (And don’t get me started on the many taboos around the tightness of the vagina.)  We often hear “the tighter, the better.” The problem is that it’s not accurate information. 

When someone is in pain during sex, it tells us – scientifically – that their body is denying pleasure at the minute, and it’s our job to be curious and find out why. Pain is a symptom and not a diagnosis, because it’s like the tip of the iceberg. We often ignore it just like Titanic ignored it, and we all know what happened.

Painful sex can have many underlying causes. Think of pelvic muscles as muscular underwear inside the body. For a woman, this muscular underwear would have 3 holes: a pee hole, an anus, and a vaginal hole. Tight muscles limit your ability to open those holes. 

Some of us try to power through to get better because our moms and Google tell us that it’s normal, and it gets better the more you do it. My question is: if you’ve been having painful sex for a long time, and it didn’t get better by the same things, why are you doing this to yourself?  If it’s not working, try something else.

These muscles have one job – to keep you safe. If it hurts, your brain and body are going to tighten muscles even more to protect you. When you try to push harder to power through, it makes it worse. You need the help of an expert to get to the root cause of what it is that makes your muscles react that way. We understand how the nervous system works with our muscles, and we know how to use pelvic floor physical therapy to help you get better so that you can experience the mind-blowing sex that you’ve been missing.

#2. Physical Therapy Won’t Work for Pelvic Healthcare

Physical therapists are experts who are skilled at solving muscle problems like painful sex, constipation, and pelvic pain problems. As physical therapists, we are trained to do our job well, so you can trust us and know that we can help you. 

The puzzle of painful sex often involves pelvic muscles as one of the core components. There is no one better than a pelvic floor physical therapist to solve it. Maybe you’ve tried pelvic floor physical therapy before and were let down by another practitioner. I get that. However, you can look at my success stories and years of experience to see that I am truly capable of helping women recover from pain and return to being sexually active. Get in touch with us today and book a free discovery visit or a telephone consultation to find out whether we can help you. It won’t cost you anything, and you’ve got nothing to lose.

#3. It’s Just This One Problem

People often think that their pelvic problem is just that, and that there are no other issues with their health. What they forget is that hole health is your whole health. We may experience other sexual or pelvic health issues like fertility problems, yeast infection, constipation, etc. These are all difficult to talk about because they’re private. 

The intimate nature of these problems makes us hide those problems. However, the more I know about you the better I can help you. Pelvic muscles are all connected, so maybe you’re having painful sex due to constipation or other pelvic issues I need to be aware of in order to help you as best as I can. Sex problems aren’t just sex problems, sometimes they are other health problems showing up as sex problems.

Exploring the Options to Becoming Pain-Free

Treating painful sex often requires a comprehensive approach that addresses both the physical and psychological aspects of the condition. Research shows the most effective treatments are a trifecta of finding a physician, pelvic physio, and a psychologist. Among those three, you should have the unique approach that best suits your situation.

There is no protocol here for the best way to treat painful sex, and it can easily become overwhelming to choose between different options. There are different recipes for success, and a whole lot of it is just “trying it out.” Considering using the BRAIN acronym to analyze your choices and pick the one that is best for you:

BenefitsWhat are the benefits of this treatment?
RisksWhat are the risks or side effects?
AlternativesWhat are some alternative choices?
IntuitionWhat is my gut feeling (intuition) telling me?
NothingWhat happens if I do nothing?

This allows you to think through, discuss with your providers, and select the best treatment that resonates with you. Here are some potential treatment options that may be suggested:

  1. Medical Intervention: Consulting a healthcare provider to identify and treat underlying medical conditions or hormonal imbalances.
  2. Pelvic Floor Therapy: Physical therapy techniques aimed at relaxing and strengthening the pelvic floor muscles can alleviate discomfort during intercourse. (I can help with this!)
  3. Counseling or Therapy: Seeking support from a therapist or sex therapist to address psychological factors contributing to painful sex and improve communication within relationships.
  4. Lifestyle Changes: Incorporating relaxation techniques, mindfulness practices, and stress-reduction strategies can help manage anxiety and improve sexual experiences.
  5. Lubricants and Moisturizers: Using water-based lubricants or vaginal moisturizers can alleviate dryness and enhance comfort during intercourse.


Painful intercourse is more than just a physical discomfort—it’s often a symptom of deeper physical, psychological, or relational issues. By recognizing the symptoms, understanding the causes, dispelling myths, and exploring treatment options, individuals can take proactive steps toward reclaiming their sexual health and well-being.

Remember, seeking professional help and open communication with partners are vital aspects of addressing painful intercourse and nurturing fulfilling and satisfying relationships. Let’s work together to break the silence and stigma surrounding this important issue.

If you want to learn more about this topic and how to address it head-on (and informed!), explore my new book Girlfriend’s Guide to Pain-Free Sex!

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