Pain with Sex? It doesn’t have to be this way…

I often see clients of all genders and of all ages who have resigned themselves to a life without sex, because of pain. Some are doubting that they will ever have children because they can’t have sex. Some are doubting that their romantic relationships will last, or they avoid dating altogether, because of pain. Some are told by their friends or health care practitioners that painful sex is an inevitable result of having children, going through chemotherapy, or going through menopause. For others, sex has always been painful and they think that it is painful for everybody.

Having an active sex life is not important to everyone – some folks have no desire for sexual activity. Others, however, are wondering whether they can do anything to help themselves get back to a sexually fulfilled life. For those who would like to be able to participate in sexual activity and are limited because of pain, seeing a pelvic health physiotherapist can be helpful.

Painful sex does not necessarily mean that there is injury or disease present.
Painful sex can be a symptom of disease or injury so the first step would be a trip to your medical doctor to rule these out. Once you have medical clearance, you may consider seeing a pelvic health physiotherapist. They will be able to assess whether muscle tension, weakness, or lack of movement of your tissue is present, and they will be able to help you balance this out: reduce tension where there is too much, create strength where there is weakness, and mobilize tissues that are not moving. They will also be able to determine whether there is an emotional component to any muscle tension that you are experiencing, which takes me to my next point…

The cause of painful sex can be located entirely in your nervous system, and NOT in your muscles or other pelvic tissue.
Our pelvic floor muscles are directly linked to our sympathetic nervous system (our fight/ flight/ freeze/ fawn system). When our system is alerted to real or perceived threat, a direct message is sent to our pelvic floor muscles that we need protection, and these muscles contract. Imagine having pain with sex once, the next time around, your nervous system may say to itself: “Hey, last time this person had sex, it hurt. I’d better protect them the next time”…and it protects you by increasing muscle tension, possibly leading to more pain. This can become a self-perpetuation cycle. Your pelvic health physiotherapist will be able to teach you strategies to calm your protective nervous system. 

Painful sex does not only occur with intercourse.
Some people experience pain with arousal and/or orgasm and not with intercourse. This is usually due to too much tension. Some pelvic floor muscles become active with arousal, and if they are already tense, increasing that tension can lead to pain. Imagine having tense neck muscles, and then adding to that load by carrying a heavy backpack – this may lead to pain in the overworked muscles. Similarly, the muscle activation involved with arousal may lead to pain if these muscles are already tense. This is another situation where learning to soften your pelvic floor muscles will be helpful.

Persons of all genders experience painful sex.
Persons of all genders have a pelvic floor; therefore persons of all genders may experience painful sex, with similar causes and solutions. For example, some men begin to experience pain after they have undergone a vasectomy – often, this pain is due to a combination of muscle tension and decreased fascial mobility. Working with a pelvic floor physiotherapist may be helpful to anybody experiencing pain with sexual activity.

If you are experiencing pain with sexual activity, seeing a pelvic health physiotherapist may provide a solution for you. If you would like help finding a physiotherapist near you, or if you have any questions, you are invited to contact me at or schedule your appointment today. 

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