The Silent Taboo: Why Pain with Intercourse Isn’t “Normal” (And What You Can Do About It)
Why Does Sex Hurt?
Pain during sex, also known as dyspareunia, can happen for many reasons:
Pelvic floor dysfunction - muscles that are too tight, weak, or uncoordinated
Hormonal changes - like postpartum or perimenopause, when estrogen is low and tissues are more sensitive
Scar tissue - after tearing with a vaginal delivery, c-section, episiotomy, or pelvic surgery
Conditions like endometriosis, vaginismus, or vulvodynia
Emotional factors - stress, anxiety, trauma, or relationship challenges that heighten pain perception
The truth is, painful sex is rarely caused by one single issue. It’s often a complex interaction between the body and the nervous system. That’s why lasting recovery requires looking at both.
The Role of the Nervous System in Pain
Pain isn’t just a physical sensation - it’s the brain’s interpretation of threat.
When your body perceives something as unsafe, your nervous system responds by tightening muscles, increasing sensitivity, and amplifying pain signals. Over time, even neutral touch can feel threatening, because your brain has learned to associate intimacy with danger.
This is why painful sex can’t always be explained by physical findings alone. Some women with very tight pelvic floor muscles feel no pain. Others with seemingly mild dysfunction report severe discomfort.
As one study on chronic pelvic pain noted:
“The central nervous system plays a key role in maintaining and amplifying pelvic pain, even when the initial injury has healed.” (Fenton et al., 2015, Journal of Women’s Health)
This is also why pain is not “all in your head.” It’s in your nervous system - real, protective, and trainable.
What Pelvic Floor Physiotherapists Can Do
As a pelvic floor physiotherapist, my role is to help you reconnect with your body, reduce pain, and restore safe, comfortable intimacy. Here’s how we do it:
1. Thorough Assessment
We start with listening (really listening). What you’ve been through matters. Then, we assess pelvic floor muscles for tone, coordination, scar tissue, and trigger points, while always working within your comfort.
2. Manual Therapy
Gentle internal and external techniques help release tight pelvic muscles, reduce scar tissue restrictions, and improve blood flow.
3. Exercises & Relaxation Strategies
Not all pelvic floor exercises are Kegels. Often, women with pain need relaxation, stretching, and down-training. We guide you through personalized movements that teach your muscles how to let go.
4. Education & Empowerment
We teach you about your body, pain science, and strategies to build safety and confidence. Knowledge is power and power calms fear.
5. Home Programs
From breathing techniques to use of vaginal dilators, you’ll have tools to practice at home between visits.
Why Psychotherapy Is Part of the Healing Equation
Here’s the piece most women never hear: pain with sex isn’t just about the pelvic floor.
Because the nervous system amplifies pain, the emotional and psychological side must be addressed alongside the physical. Stress, anxiety, fear, and past trauma can all make pain worse, even when the body is otherwise healthy.
That’s where psychotherapy comes in. By working with a therapist who understands women’s health and sexual pain, you can:
Reframe unhelpful thought patterns around intimacy
Reduce anxiety and hypervigilance around sex
Process past trauma in a safe environment
Learn tools for stress regulation and nervous system calming
Research backs this up. A systematic review found that combining pelvic floor physiotherapy and cognitive-behavioral therapy (CBT) significantly improved outcomes for women with vaginismus and dyspareunia compared to physiotherapy alone (Bergeron et al., 2010, Journal of Sex & Marital Therapy).
In other words: the best results come when body and mind are treated together.
Our Integrated Approach at Makewell Health
At Makewell, we believe women deserve more than band-aid solutions. Our model is collaborative: physiotherapy + psychotherapy + other modalities when needed (like naturopathic medicine or acupuncture for hormonal balance).
This isn’t just about eliminating pain - it’s about restoring trust in your body, rebuilding intimacy, and giving you the freedom to enjoy sex again without fear.
What Healing Looks Like (Yes, It’s Possible)
Healing doesn’t happen overnight, but it does happen. With a personalized, integrative plan, most women see:
Decreased pain intensity and frequency
Greater comfort with intimacy
Improved pelvic floor awareness and control
Reduced anxiety and fear around sex
A sense of empowerment and confidence in their bodies
Final Thoughts: You Are Not Broken
If you’ve been told to just “drink a glass of wine and relax,” or that pain is your “new normal,” I want you to hear this clearly: you are not broken.
Pain with sex is common, but it is not normal and it is treatable. With pelvic floor physiotherapy, psychotherapy, and an approach that respects both body and mind, intimacy can become safe, comfortable, and enjoyable again.
You deserve pleasure. You deserve connection. You deserve a body you can trust.
References
Bergeron S, et al. (2010). Combined cognitive-behavioral therapy and physiotherapy for women with dyspareunia: A randomized clinical trial. Journal of Sex & Marital Therapy, 36(4), 294–313.
Fenton B, et al. (2015). Chronic pelvic pain: The role of central sensitization and psychological factors. Journal of Women’s Health, 24(9), 713–720.
Rosenbaum TY. (2005). Pelvic floor involvement in sexual pain disorders: A multidisciplinary approach to treatment. Journal of Sex & Marital Therapy, 31(4), 281–288.