Why Sex Hurts and How to Fix it

Sex should be an enjoyable experience, but for some women it can be a real pain. Medically, painful sex is referred to by a few different names: dyspareunia, vaginismus, vulvodynia or genito-pelvic pain penetration disorder. Co-founder of The Pelvic Expert, Heba Shaheed shares why sex can sometimes hurt and how to fix it.




A non-relaxing or tense pelvic floor is one of the main causes of painful sex. During sex, the pelvic floor should relax and the vagina should expand. But in some women, the pelvic floor muscles tighten and become painful. Dyspareunia is the blanket term used by medical professionals to describe painful sex.

Painful sex affects approximately 15% of women. There appears to be a rise in the prevalence of sexual pain and this can be attributed to a number of different factors:

– Clenching your pelvic floor and core all the time
– Doing too many kegels
– Stress or anxiety
– Hormonal issues such as low estrogen, making the vagina drier
– Yeast infections or recurrent UTIs
– Chronic constipation
– Difficult childbirth
– Trauma or abuse
– Pelvic conditions such as endometriosis or pelvic organ prolapse


Vaginismus is an involuntary tightening of the pelvic floor muscles during attempted penetration, which can prevent intercourse altogether. When the muscles tighten, women can feel pain, which can range from a mild discomfort to severe pain that can be stinging, burning, tearing or aching.

Vaginismus is not something women have control over, and some women may be completely unaware that it is happening. In some women the muscles can become so tight, that it feels like the vagina is totally closed, and intercourse can’t even happen. In others, intercourse needs to be stopped because the tightness of the muscles causes too much pain.


Vulvodynia is pain felt in the vulva area for at least 3 months, and it is usually described as a burning pain. It can be burning pain localised at the clitoris, or localised in the vestibule (the inner part of the vulva just outside of the vagina), or it can be generalised burning pain across the whole vulvovaginal area.

Vulvodynia can be provoked by intercourse, and women will experience a burning pain at the vulvovaginal area either during or after intercourse. There is a misconception that vulvodynia is a “depressed vagina” in need of more sex. Unfortunately, more sex can actually aggravate vulvodynia.

The term “depressed vagina” has come about as vulvodynia responds well to the use of amitriptyline, which is a drug previously used to treat depression. In vulvodynia, a much lower dose of oral amitriptyline is taken, or a topical cream is applied to the sensitive areas. Amitriptyline works to lower the sensitivity of the nervous system, which decreases pain.


It takes approximately 30-45 minutes for a woman’s body to reach full arousal. At full arousal, the vagina has expanded, the pelvic floor muscles have relaxed, the cervix has lifted and there’s increased lubrication. This is the ideal environment for penetrative sex.

Unfortunately the average total time for sexual play is about 20 minutes. Which means that most women have not even become fully aroused to enjoy sex. There seems to be this rush to get to the end, but for most women, the foreplay is more enjoyable than the intercourse. So take your time, and enjoy the journey.


You don’t have to rely on your natural juices for sex, especially if you’re the type of woman who doesn’t make enough lubrication no matter how aroused you are. Use as much lubricant as you need, and try to go as natural as possible e.g. coconut oil or olive oil. When using condoms, water-based lubricant brands such as Yes are chemical-free and gentle on the vaginal area.


To get optimal results women who suffer from painful sex must see a women’s health physiotherapist, as they are trained in pelvic floor assessments. While sex therapy and psychology has its place for managing the emotional issues associated with painful sex, pelvic physiotherapy is essential for treating the physical issues.

A women’s health physiotherapy assessment will involve a vaginal examination (so be prepared to remove your undies). The physiotherapist will teach you how to relax your pelvic floor muscles and may also teach you to use vaginal dilators to stretch your tight muscles. In many cases, the physiotherapist may also use some massage techniques inside your vagina to release your pelvic floor.

You don’t have to put up with pain during sex. It may be common, but it’s not normal. See your local women’s health physiotherapist today.

As published on Rescu http://rescu.com.au/why-sex-hurts-and-how-to-fix-it/

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