Having Painful Sex? Look to Your Pelvic Floor

There are so many unanswered questions and awkward taboos about what happens in the bedroom, but there shouldn't be any of that when pain is involved. Painful sex can happen for any number of reasons—the connection with your partner, a tight pelvic floor or perhaps stress and emotions. The good news is that there are ways to help, and Sex and Relationship Therapist Dr. Carli Blau is here to answer some top questions.

What’s the connection between the pelvic floor and painful sex? 

If the pelvic floor is inflamed or tight it can cause physical discomfort during sexual activity, foreplay and even sexual intercourse. Sometimes women even experience nerve pain from pelvic floor dysfunction that can impact that vestibule (entrance of the vagina) or other areas of the vagina and vulva.

How can women having painful sex begin to incorporate pelvic floor exercises into their routine? 

If you are experiencing pelvic pain, or pain in or around your vagina I would suggest seeing an OB/GYN and a pelvic floor therapist for a comprehensive exam to determine the cause of your pain. This is particularly important to do prior to incorporating pelvic floor exercises from the Pvolve Method as they can exacerbate painful symptoms. 

What can women do during sex to help with this pain? 

Many women (and men too, because men also experience pelvic floor dysfunction!) who experience painful sex often go to pelvic floor physical therapy. Sex therapy can be a great option too. Sex therapy is talk-only psychotherapy focused on understanding a persons experience with sex. Sex is more than just a physical experience; it is a full body experience that incorporates the mind! While physical parts of the body may be worked on in physical therapy,  the mental and emotional parts are left behind. Oftentimes when sex is painful due to a medical condition, people can develop a fear to engage in sexual activity. This fear is more than just physical; it's psychological and often about control, not just the physical pain.

Is it true that sex shouldn’t hurt, and if it does, something is wrong?

I always tell clients, sex isn’t always comfortable, but that doesn’t always mean if it is occasionally painful that something is wrong. If you’re bleeding every time you have sex, or if it is painful every time, it is important to see a doctor for a proper evaluation. However, if sex sometimes hurts, it could be as simple as a lack of lubrication, a tight pelvic floor, stress and tension or even just penetration that was too deep. If you aren’t lubricated or relaxed enough, sex can be incredibly uncomfortable and that does not mean something is wrong. It simply means you may just need a great lube and a few deep breaths. Lubrication is so incredibly important, and yet something not discussed enough. 

Often women tell their doctors about pain related to sexual contact but do not discuss the types of sexual activity or positions with their doctor.  It is unfortunate, but most doctors are not taught more than basic sex education in their training to become medical providers. I hope that as we continue to grow and develop more programs that we begin to incorporate more than sex education based in biology, but one that creates comfort for providers to discuss sex related issues and experiences with their patients.

Why can sex be painful after you haven’t done it in a while? 

If you work out for the first time in months, or have never worked out and then begin, you are going to be sore. It is the same thing with sex. The vagina and pelvic floor are parts of the body made up of muscles and tissue that can become uncomfortable when penetrated for the first time in a long time. It may not even hurt during the sexual contact when endorphins and dopamine are released in the brain due to pleasure, but may be uncomfortable afterward. This is a great example of why sometimes discomfort doesn’t mean something is wrong! If you haven’t done Pvolve in a month, and then did a work out you’d probably be sore… think of it the same way!  


Dr. Carli BlauLMSW, M.Ed., M.A., Ph.D. in Clinical Sex Therapy, is a Licensed Sex and Relationship Therapist who specializes in women’s health including infertility, endometriosis, and PCOS. She is certified in Maternal Mental Health, received her Master’s of Social Work from Columbia University, a Master of Education in Human Sexuality from Widener University, and is currently working on her Ph.D. in Clinical Sex Therapy studying infertility and sexual esteem in women trying to conceive. 

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