Pain With Sex: Why it Happens, The Pelvic Floor, and Menopause
Is Pain With Sex Normal?
The short answer is no. Pain with sex is very common but also not something that should be accepted. Pain with sex is often referred to as Dyspareunia, but for the sake of this blog, I’ll be using more plain language.
“Maybe this is just part of getting older.”
“Maybe sex is supposed to be uncomfortable after having children.”
“Maybe something is wrong with me.”
“Maybe my partner thinks I don't want intimacy anymore.”
Women who experience painful sex will often ask themselves these questions. It can feel very isolating and confusing. It affects self confidence and can interfere with relationships - both with a woman and her own body as well as with a woman and her partner. The location, timing, and type of pain can provide helpful clues as to the cause.
Pain may be:
at the vaginal opening
with initial penetration
deeper in the pelvis
during certain positions
after sex
like burning, tearing, pressure, aching, or muscle tension
You are not alone, and pain is your body communicating something—not a sign that you simply need to push through it.
Why Does Sex Hurt? Understanding the Different Causes of Pain With Sex
There can be different causes to painful sex. Sometimes there is one clear contributor, but oftentimes several factors interact. Here are 4 common reasons why sex may hurt.
Pelvic Floor Muscle Tension
The pelvic floor muscles sit at the base of the pelvis. Like any other muscle, they need to be able to both contract and relax. Sometimes these muscles become overactive or remain in a state of increased tension. When the muscles are already guarded or tense, tissue stretch with penetration may feel painful.
Possible sensations include:
burning
tightness
pressure
difficulty with penetration
feeling as though the body is “closing off”
feeling as if your partner is “hitting a wall”
pain during or after intercourse
In this case, strengthening your pelvic floor with kegels, will likely worsen your pain and discomfort. Instead, learning how to help relax your pelvic floor is often the main objective. Pelvic floor therapy helps to train your pelvic floor to relax, lengthen, and coordinate properly, so that the muscles can respond more appropriately to movement and pressure.
Why might someone’s pelvic floor become tight in the first place? Great question - you can learn more about the reasons behind this in my other blog here 👉 What Causes a Tight Pelvic Floor?
Hormonal Changes and Vaginal or Vulvar Tissue Changes
There are different times throughout a woman’s life where hormonal changes take place. These hormonal changes and can affect:
tissue sensitivity
lubrication
tissue elasticity
comfort with penetration
Hormonal changes occur most notably during the following times:
perimenopause
menopause
postpartum
breastfeeding
prolonged oral birth control usage
Pain, Guarding, and the Nervous System
Consider this very common cycle:
sex hurts —>your body anticipates pain —> muscle start to guard to protect —> tissues can’t relax and stretch as easily, causing penetration to become painful —> your brain receives additional information that penetration is threatening and your body must guard more.
This cycle is much more common than people realize. This response to pain is also not something that women do consciously. Your nervous system is designed to protect you. In this case, it’s trying to do it’s job but it becomes hypersensitive.
This is even more apparent when someone has a history of trauma. Trauma can be from childbirth, experiencing pain repeatedly, medical procedures, injury, or abuse. This is EXACTLY why pelvic floor therapy with a trauma-informed approachis essential!
You can learn more about what this means here 👇👇👇
What a Trauma-Informed Pelvic Floor Therapy Session Looks Like
Why Trauma Survivors Experience Pelvic Floor Dysfunction
Other Medical or Physical Contributors
Painful sex could also be associated with underlying conditions such as:
endometriosis
adenomyosis
vulvodynia
lichen sclerosis
infections or irritation
scar tissue
bladder or bowel conditions
other gynecological conditions
Considering other conditions such as these is why a comprehensive evaluation is needed. Oftentimes, a collaborative approach between a pelvic floor therapy evaluation and an evaluation by a medical provider (physician or midwife) is helpful to ensure the root cause of the problem is being identified and addressed.
Pain With Sex After Menopause: Why Can Sex Suddenly Become Painful?
For many women, pain with sex can appear or worsen during perimenopause or after menopause—even if intercourse was never painful before. This can be confusing and frustrating, especially when you feel like your body has suddenly changed without your permission.
Changes in Estrogen Can Affect Vaginal Comfort
As women move into perimenopause and then into menopause, estrogen levels decline. This drop in estrogen creates changes to the vulvar and vaginal tissues that affect lubrication, elasticity, and comfort. The medical community uses the term Genitourinary Syndrome of Menopause (GSM) to describe the symptoms that affect the vagina, vulva, and urinary tract, as a result of these hormonal changes.
The Pelvic Floor Can Still Be Part of the Picture
When these changes occur, pelvic floor dysfunction can set in.
Hormonal changes may make penetration more sensitive.
Anticipating discomfort can lead to guarding.
Pelvic floor muscles may become increasingly tense.
The nervous system may become more protective.
Other changes in strength, mobility, breathing mechanics, or movement patterns may also contribute.
So as you can see, menopause may be part of the story, but it does not automatically explain the whole story.
Why “Just Relax” Usually Isn't Helpful
Despite all of our knowledge and research, women are STILL being told “just relax,” “have a glass of wine,” “just use lube,” etc. In reality, muscles don't always relax because we tell them to and the nervous system may be responding protectively.
Women need support and understanding to know how her body is responding. Treatment should address the why, rather than simply trying to mask the pain. Pelvic floor therapy provides the one-on-one support to work through this process to determine what actually works for each woman individually.
Aside from the pelvic floor itself, looking at other factors that affect the pelvic floor are important to consider - such as movement patterns, posture, breathing strategies, bowel and bladder habits, and flexibility.
Pelvic floor therapy should never be something that is done to you. Your comfort, consent, and sense of safety matter above all else. Treatment can be adapted to meet you where you are.
Ready to Get Help for Pain With Sex?
Whether your pain started recently, began after childbirth, developed during perimenopause or menopause, or has been present for years, you deserve to better understand what your body is trying to tell you. You do not have to continue avoiding intimacy, pushing through pain, or wondering if this is “just something you have to live with.
At Restore Pelvic Health & Rehab, I take a whole-body and trauma-informed approach to pelvic health. Your evaluation is an opportunity to talk about your symptoms, your history, and your goals and begin identifying the factors that may be contributing to your pain.
📆Schedule a Pelvic Floor Evaluation📆
If you're looking for pelvic floor physical therapy for pain with sex in Delray Beach, Florida, I would be happy to help you explore whether pelvic floor therapy may be an appropriate part of your care.
Next On Your Reading List…
What a Trauma-Informed Pelvic Floor Therapy Session Looks Like (and why it’s so essential)
