If Sex Hurts, It’s Time to Talk About Your Pelvic Floor

Pain with sex is common, but it’s not normal, and you don’t have to just accept it. Research shows up to 75% of women experience pain with intercourse at some point in their lives, and somewhere around 10–28% of women have pain with most or every sexual encounter. Yet very few ever receive treatment. So many women are told “this is just how it is,” “it’s in your head,” or “this happens after kids.” 

That could not be farther from the truth. Relief and healing is possible, and we see massive change in our patients who come in specifically for painful intercourse.

To note, this isn’t just a women’s issue. Men can also experience pelvic-floor-related pain with erections, ejaculation, or after sex. Pelvic floor dysfunction is a real, physical condition affecting both men and women. The good news? Pelvic floor PT is one of the most effective, evidence-supported treatments.

Read more about how we treat pelvic pain.

Why does sex hurt?

There are multiple pelvic-floor-related causes, including:

• Tight pelvic floor muscles
• Vaginismus (reflex tightening of the vaginal walls)
• Pelvic floor guarding after trauma or medical procedures
• Scar tissue postpartum or after surgery
• Prolapse
• Overactive pelvic floor as an anxiety / stress response
• Nerve irritation in the pelvis
• Hormonal changes postpartum or peri/menopause

Sometimes the original trigger is physical. Sometimes it’s emotional. Most often it’s a combination. The nervous system and the pelvic floor are deeply connected, and when the brain senses danger, the pelvic floor tightens. Over time, that tension becomes the “norm” and sex becomes painful.

How pelvic floor therapy helps

Pelvic PT is not just Kegels; it’s targeted rehab for the pelvic floor, nervous system, and connective tissues. We help lengthen and relax pelvic floor muscles that are holding tension, improve blood flow and comfort, and support safe, pain-free penetration. When needed, we can use tools like pelvic wands or dilators to gradually retrain tissues and build comfort again — at a pace that is gentle and appropriate. We also teach strategies for nervous system down-training and pelvic floor acceptance, which helps the body un-learn the association between touch and pain. Yes, we do strengthening too, but only when appropriate.

Strength without tissue relaxation doesn’t help pain.

This work can also support men. We address pelvic trigger points, breath mechanics, pelvic nerve irritation, and the muscular patterns that create painful erections or ejaculation.

What you can do now

There are plenty of online tips and pelvic stretches floating around, but the truth is sexual pain is complex. Sometimes self-treating with random exercises can actually make it worse. Getting a pelvic floor evaluation helps determine why you’re having pain, how your muscles are behaving, and what the right approach is to retrain your system. If trauma is part of your history, working with a mental health therapist alongside pelvic PT can be a powerful, safe combination.

Bottom line

If sex hurts, please know you’re not alone, and you absolutely can enjoy intimacy again! With the right support, your nervous system, tissues, and pelvic floor can relearn comfort and acceptance. Pelvic PT can guide you through this with compassion and expertise, so you can reclaim pleasure, connection, and confidence in your own body and with partners.

Not sure is pelvic PT is right for you? We’d love to chat more! Schedule a discovery call so we can get a better understanding of what you have going on, and answer any of your remaining questions!