If you’ve ever experienced pain during intimacy, you are not alone. According to the American College of Obstetricians and Gynecologists, nearly three-quarters of women (75%) will experience painful intercourse at some point in their lives. It is incredibly common, yet rarely talked about

The medical term for this is dyspareunia, and if you are dealing with it, the first thing you need to hear is this: You are not broken, and you do not just have to “live with it.”

As a pelvic floor physiotherapist, I see people every day who have been told to “just relax” or “have a glass of wine.” This is not a solution, and in fact can often worsen the pain.

When clients come to see me for pain with intercourse, we always start with a thorough history, as pain with intercourse is often multi-factorial. It’s not usually just “tight” muscles. Skin, scar tissue, hormones, and the nervous system can all play a role, and all have to be addressed to treat the issue.

Here are some of the common reasons for pain with intercourse.

1. The Muscle Factor: Overactivity vs. Weakness

The pelvic floor is a sling of muscles supporting your bladder, bowel, and reproductive organs. When it comes to sexual pain, pelvic floor muscle tightness (hypertonicity or overactivity) is a primary culprit.

Think of it like a constant calf cramp. If those muscles are always clenched, trying to stretch them during penetration causes micro-tears and localized nerve guarding, creating a sharp, burning pain. Conversely, if the muscles lack fundamental strength and endurance, they can fatigue rapidly during sexual activity, leading to compensatory cramping, poor support, and structural aching.

2. Skin and Tissue Restrictions: Scarring & Hormones

The elasticity of the vulvo-vaginal tissue is highly sensitive.

• Scar Tissue: Post-partum perineal tears, episiotomies, or pelvic surgeries can leave rigid scar tissue behind. Unlike healthy, elastic tissue, scar tissue doesn’t stretch as easily under pressure, resulting in an intense tugging or tearing sensation.
• Hormones and Breastfeeding: Estrogen is the hormone responsible for keeping vaginal tissues thick, lubricated, and elastic. During breastfeeding, estrogen drops significantly, mimicking a temporary menopausal state. Similarly, in menopause, a condition known as Genitourinary Syndrome of Menopause (GSM) causes the vaginal walls to thin out, dry, and can become highly irritated.

When hormonal changes are contributing to pain, treatment often requires a multidisciplinary approach. Hormone optimization, when appropriate, can help restore tissue health from within. In addition, technologies such as EMFEMME 360 can support vaginal tissue quality by promoting collagen remodeling, improving hydration, increasing circulation, and enhancing tissue elasticity. When combined with pelvic floor physiotherapy & EMSELLA, these therapies can help create a healthier, more comfortable environment for intimacy.

3. The Kinetic Chain: Posture and the Abdominal Wall

Tension in your pelvic floor can come from many different areas, for example, the jaw, glutes, groin and feet all contribute to tension in the pelvic floor.

Poor posture such as a chronic anterior pelvic tilt (arching the low back) or a slouched, tucked-tailbone posture alters the resting length of your pelvic floor muscles. If your pelvis is constantly misaligned, your pelvic floor has to work overtime just to keep you stable, locking it into a protective, painful spasm.

What the Science Says: Does Pelvic PT Actually Work?

If you’re wondering whether physical therapy can actually make a difference for a problem this intimate, the research is overwhelmingly clear.

Recent medical literature confirms that pelvic floor physiotherapy is a highly effective, evidence-based, first-line treatment for sexual pain disorders (Fernández-Pérez et al., 2023). A major systematic review and meta-analysis demonstrated that specialized physical therapy interventions significantly reduce perceived pain intensity and dramatically improve the overall quality of life for individuals struggling with dyspareunia (Fernández-Pérez et al., 2023).

Even when dealing with complex hormonal shifts like GSM, clinical studies highlight that structured pelvic floor muscle training helps normalize muscle tone, increases local blood flow to promote tissue healing, and restores structural comfort (International Society for the Study of Women’s Sexual Health guidelines).

How Pelvic Floor Physiotherapy Helps

When you come into a pelvic health clinic, we don’t just hand you a sheet of exercises. We treat the whole body. Here is what your recovery process might look like:

• Down-Training & Relaxation: If your muscles are overly tight, we teach you how to systematically relax and lengthen them using diaphragmatic breathing, biofeedback, and specialized pelvic floor stretches.
• Manual Therapy & Scar Mobilization: Using gentle, hands-on techniques, we can release painful myofascial trigger points internally and perform targeted massage on postpartum or surgical scar tissue to restore its natural elasticity.
• Core and Postural Retraining: We evaluate how your hips, low back, and abdominal wall move together. By balancing the tension in your core and aligning your posture, we take the constant, defensive strain off your pelvic floor.
• Graduated Exposure & Desensitization: Using tools like specialized vaginal dilators, or release wands we can help retrain your brain and nervous system to realize that penetration can be safe, controlled, and pain-free.

Take the First Step

Intimacy should be a source of connection, pleasure, and joy; not apprehension and physical discomfort. If you are experiencing pain with intercourse, your body is simply trying to tell you that something in the system is out of balance.

You don’t have to navigate this alone. Reach out to a certified pelvic floor physiotherapist today to schedule a comprehensive assessment. Let’s work together to help you reclaim your comfort, your confidence, and your body.

Leah Milne, MScPT, BScKin

Pelvic Floor Physiotherapist

Fernández-Pérez, J. J., Arribas-García, S., & Pérez-Milena, A. (2023). Effectiveness of physical therapy interventions in women with dyspareunia: A systematic review and meta-analysis. BMC Women’s Health, 23(1), 387. https://doi.org/10.1186/s12905-023-02534-1