When Intimacy Hurts: Understanding Painful Intercourse and What Can Help

SELF CAREWELLNESSPELVIC HEALTHLIFESTYLE

Jodi Bremner PT, Founder of Hervana Women's Wellness

7 min read

A thoughtful woman sits on a bed with text about understanding and helping painful intercourse and intimacy concerns.

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Why can sex become painful?

When I work with women experiencing pain with intimacy, I often find that the reason is layered. The body is wonderfully interconnected, and discomfort in one area can be influenced by muscles, hormones, tissue changes, emotions, past experiences, and the nervous system.

Pelvic floor tension and protective guarding

Your pelvic floor is a group of muscles at the base of your pelvis. These muscles support your pelvic organs and contribute to bladder and bowel function, movement, and sexual comfort.

Sometimes, these muscles become tense or overactive. They may tighten in anticipation of pain, during penetration, or even when you are thinking about intimacy. This is often called guarding.

Guarding is the body’s way of trying to protect you. If your nervous system has learned that penetration may hurt, the pelvic floor can respond by bracing, just as you might tense your shoulders when you expect something uncomfortable.

This protective response can then become part of a cycle:

Something hurts.
Your body anticipates that it may hurt again.
The pelvic floor tightens.
The increased tension creates more discomfort.

This does not mean the pain is “in your head.” It means your body and nervous system are communicating, and both deserve care.

Postpartum changes and scar tissue

Pregnancy and birth can create significant changes in the pelvic floor, vaginal tissues, and surrounding areas.

A tear, episiotomy, surgical incision or other birth-related injury may leave scar tissue that feels tight, sensitive, or less mobile. Even when a scar appears healed from the outside, the deeper tissues may still feel tender or restricted.

The pelvic floor may also remain tense after birth, especially if labour was difficult, or traumatic, recovery was painful, or you experienced pain during the early postpartum months.

Breastfeeding can contribute, too. Low estrogen levels during breastfeeding may lead to vaginal dryness and increased sensitivity. These changes are common, but that does not mean you have to accept discomfort as your new normal.

Perimenopause, dryness, and hormonal shifts

During perimenopause, hormone levels can fluctuate in ways that affect vaginal tissue, natural lubrication, sensitivity, and elasticity.

You may notice:

More dryness during intimacy
Burning or irritation
A feeling of friction or tenderness
Light bleeding after sex
New discomfort with penetration
A longer time needed for arousal and lubrication

These symptoms are often part of genitourinary changes associated with menopause, and it is important to discuss them with your primary care provider or gynecologist. Medical support may include vaginal hormones, vaginal moisturizers, lubricants, or various other treatment options when appropriate.

Pelvic floor physiotherapy can be a helpful part of care, particularly when muscle tension, pain sensitivity, or fear of movement has become part of the picture. I have written more about this transition in Pelvic Floor Health After 40: Perimenopause Is the Time to Check In.

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Pelvic Floor Physiotherapy

Upcoming Experiences

A thoughtful woman in a knit sweater sits on her bed looking out a sunny window in a cozy, rustic bedroom.

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When intimacy becomes uncomfortable

There are few things more tender than realizing intimacy no longer feels the way it once did.

Perhaps penetration feels painful at the beginning. Maybe there is burning, pressure, pulling, or aching deeper in the pelvis. You may notice discomfort only sometimes, or every time. You may have started avoiding intimacy altogether, not because you do not want closeness, but because you are quietly preparing for pain.

If this is part of your experience, I want you to know something first: you are not alone, and your body is not failing you.

Pain with sex is common. It can happen during many different seasons of life, and it often has more than one contributing cause. Most importantly, it is not something you simply have to endure.

Painful intercourse, sometimes called dyspareunia, can be a signal that your body needs more support, more information, or a gentler pace. It is not a sign that you are broken.

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Stress and the nervous system

When life feels full, the body often holds more than we realize.

Stress, fatigue, anxiety, relationship strain, and the mental load of caregiving can all affect arousal, lubrication, muscle tone, and the nervous system’s sense of safety. If your body is already living in a state of alertness, relaxing into intimacy may feel difficult.

This is not a matter of simply “trying to relax.” Your body may need time and repeated experiences of safety before it is ready to soften.

Past experiences

Past painful experiences, medical procedures, birth trauma, unwanted sexual experiences, or other forms of emotional distress can influence how the body responds to touch and penetration.

You never have to share more than you want to. A compassionate pelvic floor physiotherapist will meet you where you are and will not ask you to move faster than your body allows. Sometimes, additional support from a trauma-informed counsellor or sex therapist can be an important part of healing.

There can also be physical causes of pain, including infection, skin conditions, endometriosis, pelvic inflammatory disease, or other gynecological concerns. A complete assessment helps make sure these possibilities are not overlooked. The Cleveland Clinic’s overview of painful intercourse is a helpful starting point for understanding the range of possible causes.

Your body may be protecting you, not failing you

I often remind women that pain is information, not a personal failure.

The body may be saying:

Something here does not feel safe yet.
Something needs more time.
Something needs support.
Please listen.

This perspective can create a meaningful shift. Instead of feeling frustrated with your body, you may begin to meet it with curiosity.

That does not mean you have to accept pain. It means we can respond to it without blame or force.

What does a pelvic floor physiotherapy assessment feel like?

If you have never seen a pelvic floor physiotherapist, it is understandable to feel uncertain about what will happen.

At Hervana Women’s Wellness, I begin with a conversation. We talk about your symptoms, your health history, your experiences with intimacy, your goals, and what you hope will feel different.

You are always in charge of your care.

An assessment may include looking at your breathing, posture, movement, hips, abdomen, pelvis, or external tissues. An internal assessment may be helpful for many women, adding additional information to guide treatment, but it is never automatic and never required.

If we proceed with internal work, I explain what I am doing and why. I ask for your clear informed consent. You can say no, pause, change your mind, or stop at any moment.

There is no forcing. No rushing. No expectation that you should tolerate discomfort to prove you are ready.

Treatment may include:

Breath and nervous system regulation
Gentle external or internal manual therapy, with permission
Scar tissue mobility work
Education about pelvic floor function
Movement and positioning strategies
Gradual, supported approaches to comfortable touch or penetration
Communication tools for talking with a partner
Coordination with your physician, gynecologist, or other providers when needed

As I describe in Choosing a Pelvic Floor Physiotherapist, the right care is not about applying a routine to your body. It is about building a relationship where you feel heard, informed, and safe.

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Gentle things you can try now

There is no single right way to begin. You might start with one small practice that helps your body feel less pressured.

Breathe without forcing

Lie down or sit comfortably. Place a hand on your lower belly and notice whether your breath can move gently into that space.

You do not need to make your pelvic floor relax on command. Simply notice what happens when you breathe slowly and allow your jaw, belly, and shoulders to soften.

Use lubrication

Lubricant can reduce friction and make intimacy more comfortable. Look for a product that works well for your body and avoid ingredients that cause irritation. If dryness is persistent, speak with your physician or gynecologist about additional options.

Slow everything down

Arousal and comfort cannot be rushed. More time, more communication, and more non-penetrative intimacy may help your body feel ready.

There is no requirement that penetration be the goal of every intimate experience.

Explore positions that give you more control

Many women feel more comfortable in positions where they can control depth, speed, and movement. Pillows for support may also help reduce strain through the hips and pelvis.

Communicate clearly

You might say to your partner:

“Can we slow down?”
“I need more time.”
“That position is uncomfortable.”
“Please pause.”
“I want closeness, but I do not want penetration tonight.”

Your comfort matters. Permission to stop is part of intimacy.

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When should you seek support?

You deserve support if pain is recurring, worsening, or changing your relationship with intimacy.

Please connect with a healthcare provider if you experience:

Persistent or severe pain
Bleeding after sex
Unusual discharge, itching, or burning
Fever or new pelvic pain
Pain after childbirth that is not improving
Significant vaginal dryness during perimenopause or menopause
Fear or anxiety that makes intimacy feel inaccessible
Pain that causes you to avoid closeness or sexual activity

You do not need to wait until the pain becomes severe. You do not need to prove that it is “bad enough.”

At Hervana Women’s Wellness, pelvic floor physiotherapy is a partnership. I am not here to correct you or force your body into a particular outcome. I am here to listen, help you understand what may be happening, and support you as you reconnect with comfort and choice.

If you would like to explore care, you can learn more about pelvic health physiotherapy or contact me directly.

Pain with sex is common. But enduring it silently does not have to be.

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If intimacy has begun to feel like something you must brace for, let your next small step be a quiet conversation with someone who can help you feel safe again.