So You’re Experiencing Painful Sex?

It sucks, but you’re not alone. It’s actually quite common, particularly for people with endometriosis. Dyspareunia, vaginismus, vulvodynia, vestibulodynia—big words for something incredibly frustrating and distressing: painful sex.

There are many causes and varying experiences of painful sex. It can feel different for everyone, occur at different stages of life (postnatal, postmenopausal, or in the late teens/early 20s), and be caused by a wide variety of both external (emotional) and internal (physical) factors.

For some, painful sex also makes inserting tampons or menstrual cups difficult, and pap smears feel near impossible.

A Quick Anatomy Lesson

When discussing the anatomy of the outside of the female genitalia, we use the word vulva. The vulva includes everything visible externally: the clitoris, labia, urethral opening, and the vaginal opening.

The vagina is the tube that connects the uterus and cervix to the outside world, through the vulva. It’s the middle passage of the three passages—urethra, vagina, and anus.

Types of Painful Sex: Entry Pain vs Deep Pain

Dyspareunia is pain experienced when something is inserted (or attempted to be inserted) into the vagina. It can be classified into two categories:

Entry Pain

Pain around the entrance of the vagina or in the first half of the vaginal canal. Causes include:

• Insufficient lubrication, due to hormonal changes or lack of arousal.

• Infections or skin disorders, such as eczema, psoriasis, vestibulodynia, thrush, dermatitis, lichen sclerosus, or lichen planus.

• Vaginismus, which is involuntary spasming of the pelvic floor muscles. This can be a response to trauma, recurrent infections, stress, or anxiety.

• Pudendal neuralgia, which is nerve pain from damage or irritation in the pelvis.

Deep Pain

Pain felt in the lower abdomen or pelvis during penetration. Causes include:

• Endometriosis

• Cystitis (inflammation of the bladder)

• Irritable bowel syndrome (IBS)

• Pelvic inflammatory disease (PID)

• Pelvic organ prolapse

• Uterine fibroids

• Past surgeries, such as hysterectomy or prolapse repair

• Chemotherapy or radiation therapy

The Role of Emotions in Painful Sex

Regardless of the physical diagnosis, emotional factors often play a role too. Even one episode of painful sex can set off a pain cycle:

1. The nervous system remembers the pain and triggers anticipatory anxiety before intimacy.

2. The body reacts by contracting the pelvic floor muscles to prevent penetration.

3. If penetration occurs with tight muscles, it causes more pain, reinforcing the cycle.

Emotional contributors to painful sex can include:

• Stress

• Past negative experiences

• Emotional trauma

• Body image concerns

• Anxiety or depression

• Fear of intimacy

Some people with dyspareunia have a history of physical trauma, including sexual or emotional abuse.

Getting the Right Diagnosis and Treatment

Finding the right treatment starts with finding the root cause. The first step is to visit your GP, who can check for medical issues and run initial tests. They may refer you to:

• A gynaecologist – for conditions like endometriosis, prolapse, or fibroids.

• A dermatologist – for skin disorders affecting the vulva.

• A colorectal specialist – for bowel-related issues like IBS, haemorrhoids, or prolapse.

• An endocrinologist – for hormone-related conditions.

• A pelvic floor physiotherapist – for chronic pain, pelvic floor dysfunction, and bladder/bowel issues.

• A psychologist or sex therapist – for support with emotional, relational, or sexual well-being.

Research has shown that in most cases, a multidisciplinary approach (seeing a combination of medical, physiotherapy, and mental health professionals) is the gold standard for treatment.

Healing takes time. Painful sex rarely disappears overnight, and progress with treatment is often gradual.

Pain-Free Sex: It’s Possible, But Stop If It Hurts

The most important thing to remember is:

Sex should not be painful.

If it hurts, stop.

There’s no need to "grit your teeth and bear it" or "lie back and think of England." Each painful episode can make you more sensitive, reinforcing the cycle of pain.

So, close up shop. Avoid penetrative sex until you’ve seen your GP and a pelvic floor physiotherapist. That’s the first step to having pain-free, fulfilling sex.

Why Pelvic Floor Physiotherapy Helps

Since most causes of painful sex involve vaginismus (involuntary tightening of the pelvic floor muscles), pelvic floor physiotherapy is often key to recovery. Many people with vaginismus describe the sensation as:

• “I feel too tight for penetration.”

• “It feels like something is hitting a wall.”

• “It’s like there’s something blocking the entrance.”

Pelvic floor physiotherapy can include:

• Education on pelvic floor function and relaxation techniques.

• Vaginal dilators to gradually help the muscles adjust to touch and movement.

• General exercise guidance for improving pelvic and core function.

• Bladder and bowel advice, since dysfunction can contribute to pelvic pain.

• Full-body assessment and individualised exercises to address muscle imbalances.

• Referral to other specialists, such as psychologists, sex therapists, or pain specialists.

Final Thoughts

Painful sex is common but not normal. The good news? It’s treatable.

If you’re experiencing painful sex, don’t push through it. Seek support, explore treatment options, and remember that sex does not have to be penetrative to be enjoyable. You may need to try new techniques or approach intimacy differently, but a mutually fulfilling sex life is possible.

You deserve pain-free, pleasurable sex. If that feels out of reach right now, know that help is available—and that you’re not alone.