Pain after sex: What to know
Pain after sex (dyspareunia) is a common condition that affects many women and can stem from multiple causes, including pelvic floor muscle tension, insufficient arousal, hormonal changes, infections, endometriosis, or scar tissue. While occasional discomfort may be normal, persistent pain after intercourse is not something you should ignore or accept as inevitable. A pelvic floor physical therapist can assess your specific situation to determine whether your pain is related to muscle tension, muscle coordination, tissue restrictions, or other underlying conditions, and develop a personalized treatment plan. Pelvic floor therapy treatment often involves pelvic floor muscle relaxation, manual therapy, breathing techniques, and addressing any contributing factors like constipation. If you're experiencing pain after sex, know that you're not alone and that effective treatment options are available.
If you're experiencing pain after sex, I want you to know right away that you're not alone, and this is definitely not something you just have to live with.
Pain after intercourse (also called dyspareunia) is incredibly common, but it's often not talked about openly. Many of my patients have suffered in silence for months or even years before finally reaching out for help. Sometimes, patients I see for dyspareunia have seen other providers and have received advice like "just have a glass of wine" before intercourse or have been told to just avoid it altogether.
But here's the thing, pain after sex is almost always treatable! I'm so lucky to work with and help so many folks who have experienced this.
In this blog post, I'll walk you through the most common causes of pain after sex and explain how pelvic floor physical therapy can help you get back to enjoying intimacy without discomfort.
Understanding pain after sex
First, let's talk about what we mean by "pain after sex."
This can look different for everyone, but some common descriptions I hear from patients include:
Burning or stinging sensations
Deep aching or throbbing pain
Soreness that lasts for hours or even days after intercourse
Sharp, stabbing pain
Pressure or fullness in the pelvis
The pain might start during sex and continue afterward, or it might only show up after you're done.
Either way, if you're experiencing pain, your body is trying to tell you something. And it's important to listen.
Common causes of pain after sex
Just like with urinary incontinence, pain after sex isn't just one simple problem with one simple cause. There are actually many different reasons why you might be experiencing pain, and sometimes it's a combination of several factors.
Below, I'll walk through the most common culprits I see in my practice.
Pelvic floor muscle tension
This is probably the most common cause of pain after sexual activity that I see in my practice.
When the pelvic floor muscles are too tight or tense, penetration can be uncomfortable or painful. And then during intercourse, those already-tense muscles get stretched and used in ways that can cause them to become even more irritated.
After sex is over, those muscles might go into a protective spasm, which can cause that burning, aching, or throbbing sensation that lingers for hours or days.
I will often use a balled up fist to describe the way in which the pelvic floor muscles are existing for some folks. If your pelvic floor muscles are stuck in that tense, contracted position, they're not going to be able to relax and lengthen properly during intercourse. And just like trying to forcefully open a fist that's clenched tight, this can cause pain.
The good news is that pelvic floor physical therapy can help you learn to relax and release those tense muscles, which often significantly reduces or eliminates pain.
Insufficient arousal and/or lubrication
This one might seem obvious, but it's worth mentioning because it's so common.
When you're not fully aroused, your body doesn't produce as much natural lubrication, and the tissues of the vagina don't expand and lengthen in the way they're designed to during arousal.
Both vaginal dryness and insufficient arousal can make penetration uncomfortable or painful, and the friction during intercourse can cause irritation to the delicate tissues, especially at the vaginal opening.
The irritation doesn't just disappear the moment sex is over. It can stick around and cause burning, rawness, or soreness afterward.
If this sounds like you, taking more time for foreplay, using a good quality lubricant (I can give you recommendations), and making sure you feel relaxed and ready can make a huge difference.
Hormonal changes
Hormone levels, especially estrogen levels, play a huge role in vaginal health, and when hormone levels drop (which happens during breastfeeding, in menopause, or at certain points in your menstrual cycle), the tissues of the vagina can become thinner, dryer, and more fragile.
This is sometimes called vaginal atrophy, and it can make sex uncomfortable during and painful afterward.
You might notice burning, rawness, or even light bleeding after intercourse.
If hormonal changes are contributing to your pain, I can refer you to other specialists who can discuss hormone therapy or other medical treatments if needed.
When I type this out, it feels like I'm telling you that hormonal changes mean that pain with sex is inevitable, and that's not the case. Hormonal changes happen, and if you're having pain with sex when those hormonal changes happen, there are things that can be done to help you!
Infections or irritation
Sometimes pain after sex is caused by an infection or irritation, such as:
Yeast infections
Bacterial vaginosis
Sexually transmitted infections (STIs)
Urinary tract infections (UTIs)
Allergic reactions to soaps, lubricants, or latex
These conditions can cause burning, stinging, or soreness that might be worse after intercourse.
If you suspect an infection might be the culprit, it's worth getting checked out by your gynecologist.
Scar tissue or adhesions
If you've had any pelvic surgeries (like a C-section, hysterectomy, or other abdominal surgery) or if you had tearing or an episiotomy during childbirth, you might have scar tissue that's causing restrictions or pulling in the pelvic area.
Scar tissue doesn't move and stretch the way healthy tissue does, so it can cause pain during and after sex.
The good news is that manual therapy techniques can help improve the mobility of scar tissue and reduce the restrictions it's causing.
Endometriosis, pelvic inflammatory disease, or other conditions
There are also some medical conditions that can cause deep pelvic pain during and after sex, including:
Endometriosis (when tissue similar to the lining of the uterus grows outside the uterus)
Pelvic inflammatory disease (PID)
Ovarian cysts
Fibroids
Vulvodynia (chronic vulvar pain)
If you have deep, aching pain that seems to be coming from inside your pelvis, it's important to see your doctor to rule out these conditions.
But here's the thing: even if you do have one of these conditions, pelvic floor physical therapy can still help manage your symptoms and reduce pain.
The pain and tension cycle
One more thing I want to mention is that pain often creates a vicious cycle.
When you experience pain during or after sex, your nervous system goes on high alert. Your pelvic floor muscles might tense up in anticipation of pain the next time, which then actually makes the pain worse.
And the more this happens, the more your body learns to expect pain, and the more tense those muscles become.
Breaking this cycle is one of the main goals of pelvic floor physical therapy. We can help retrain your nervous system and your muscles to relax and release, so you can enjoy intimacy without fear or pain.
How pelvic floor physical therapy can help
So what can you expect if you decide to work with a pelvic floor physical therapist to address pain after sex?
First, we'll do a thorough assessment to figure out what's going on. This will include:
Discussing your symptoms and medical history
Assessing your pelvic floor muscles (both externally and internally, with your consent)
Evaluating your posture, breathing patterns, and overall muscle coordination
Checking for any scar tissue or restrictions
Based on what we find, I'll create a personalized treatment plan just for you.
Treatment might include:
Pelvic floor muscle relaxation techniques: Learning how to consciously relax and release tension in your pelvic floor muscles.
Manual therapy: Hands-on techniques to release tension, improve tissue mobility, and address scar tissue restrictions.
Breathing techniques: These can help calm your nervous system and reduce muscle tension.
Education: Understanding what's happening in your body and why, and learning strategies you can use at home between sessions.
Addressing other contributing factors: Pain after sex is often multifactorial. We might also work on things like constipation, bladder irritation, or positioning during intercourse.
When to seek help for pain after sex
If you're experiencing pain after sex, I encourage you to reach out for help sooner rather than later.
You don't need to wait until the pain is severe or unbearable. Even if it's mild or only happens sometimes, it's worth getting evaluated.
And please know that you're not being dramatic or overly sensitive. Pain after sex is a real problem that deserves real treatment.
I'd especially encourage you to make an appointment if:
You're avoiding intimacy because of pain or fear of pain
The pain is getting worse over time
The pain is affecting your relationship or your quality of life
You've tried things like lubricant or more foreplay and you're still having pain
You have other symptoms like bleeding, unusual discharge, or pelvic pain at other times
Where to find help for pain after sex in Durham
I know how isolating and frustrating it can be to deal with pain after sex. It's not something most people talk about openly, so you might feel like you're the only one struggling with this.
But I promise you, you're not alone. And more importantly, you don't have to keep suffering in silence and just dealing with it.
If you're local to Durham, NC or the surrounding areas, I would love to help you figure out what's causing your pain and create a plan to get you back to enjoying intimacy without discomfort. Pelvic PT can truly help you resolve these symptoms.
I'm here to help, and I'm looking forward to working with you!
To get started, reach out to schedule with me by filling out the contact form located here. You can always view my pelvic therapy rates on my website (transparency first).
