Causes and Solutions for Painful Intercourse: A Woman's Journey to Healing

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When Nicole started feeling pain during intercourse nearly a decade ago, she knew she had to find a solution. After seeing multiple specialists, she was diagnosed with labial hypoplasia, a condition where her outer labia were only partially formed. Following surgery to fix the issue, she felt a lot better and stayed pain-free, adding yoga to her routine to help her heal.

But six years later, the pain returned, this time during the early stages of penetration. Now 33, Nicole from California has been fighting for three years to get a proper diagnosis, but the cause of her pain still remains a mystery. She only allowed her first name to be used for privacy reasons. “I get a lot of ‘it’s probably anxiety or related to mental health,’ which is frustrating because I made so much progress and now feel like I’m being ignored,” Nicole shared.

Nicole’s struggle with painful sex is more common than it might seem. The American College of Obstetricians and Gynecologists estimates that nearly 3 in 4 women will experience painful intercourse at some point, whether it’s a short-term or ongoing problem. Sex therapist Eva Dillon from New York City says, “Sex should never be painful,” stressing that women shouldn’t have to deal with that.

There are many reasons why sex can be painful, including tight pelvic floor muscles, which are common in women who feel pain during sex, gynecological exams, or tampon use. Dr. Anna Falter, a physical therapist who specializes in pelvic floor therapy at the Cleveland Clinic, explains that muscle tightness can increase tension, causing pain.

Pelvic pain can also be linked to tension in other areas of the body, like the neck, lower back, and hips. Stress, past surgeries, traumatic experiences, or even unconsciously tensing muscles can contribute to the discomfort. Hormonal changes, like lower estrogen levels during menopause or postpartum, especially when breastfeeding, can lead to vaginal dryness, making intercourse painful.

For those dealing with pelvic floor muscle tension, pelvic floor physical therapy can help. Dr. Falter says this therapy can reduce pain and prevent muscles from tightening up again. A common technique is trigger point therapy, where pressure is applied to tight muscles to help them relax. This may be done vaginally by a therapist using a gloved and lubricated finger to target specific tight spots.

Patients can also learn how to do trigger point release at home using their fingers, a partner, a pelvic wand, or vaginal dilators. Falter adds that partners are welcome to join therapy sessions and learn strategies to help their loved one through the process, as long as both are comfortable with it. Another technique involves pelvic floor lengthening exercises, which are different from Kegel exercises because they focus on relaxing the pelvic floor muscles, often paired with diaphragmatic breathing, where patients breathe deeply to relax their abdomen, rib cage, and pelvic floor.

Dr. Falter suggests that women check in with their bodies throughout the day, especially when sitting or doing everyday tasks, to make sure they aren’t unintentionally tensing their pelvic muscles. Certain yoga poses, like child’s pose, butterfly stretch, and deep squat, can help release pelvic tension. It's best to seek a treatment plan that works for you, as everyone’s situation is different.

If your partner is experiencing pain during sex, there are steps you can take to help. Most importantly, stop immediately if there’s any pain. Continuing despite discomfort can create negative associations with sex and make future encounters harder. As Eva Dillon puts it, “At the end of any sexual encounter, you want to look forward to the next time with anticipation and delight.”

Communication is key, and both partners should be open about the pain and treatment process, especially if feelings of shame or inadequacy come up. Dr. Falter suggests that learning about what your partner is going through and the treatments they’re using can help you support and encourage them. For couples unable to have intercourse temporarily, Dillon suggests "outercourse" — non-penetrative activities like manual stimulation or oral sex — to maintain intimacy and pleasure.

Even if intercourse isn’t possible, simple acts like meaningful kisses or affectionate hugs can help strengthen the emotional bond. Dillon highlights the importance of these touches, saying, “They tell our nervous systems we’re safe and not alone.” Physical intimacy still matters, even without intercourse.

Despite not having a clear diagnosis, Nicole hasn’t given up on her desire for a fulfilling intimate relationship. She and her boyfriend have found creative ways to keep their intimacy alive without intercourse or penetration. They’ve also added pelvic floor therapies to their routine, which have helped reduce the pain during intimate moments, though it’s not without challenges.

Nicole shared, “I tend to feel really frustrated with my body and the pain since I don’t want to have these issues.” She added, “Physical intimacy can be such a huge part of a relationship, and sometimes I feel like I’m missing out.” Through all of this, the couple has grown closer, with their open conversations about intimacy making their emotional bond even stronger.