Experiencing pain with sex can feel confusing, upsetting, and deeply isolating – yet it’s far more common than most people realise. Many people struggle silently out of embarrassment, shame, or the belief that discomfort is “just part of life,” especially after childbirth, during menopause, or when stress levels are high. But the truth is pain with sex (dyspareunia) is common but never normal, and you can do something about it.
If you’re in Wellington and finding intimacy difficult, painful, or something you now avoid, you’re not alone. Sexual pain can be caused by pelvic floor muscle tension, hormonal changes, scar sensitivity, birth trauma, endometriosis, vulvodynia, vaginismus, and many other conditions. Emotional factors such as fear, anxiety, or past trauma can also play a significant role too – often contributing to pelvic floor overactivity without the person even realising it.
The good news is that pelvic floor physiotherapy is an effective, evidence-based treatment. With the right assessment and care, many people experience significant improvement – often faster than they expected.
In this article, we’ll discuss:
- what pain with sex actually is
- common symptoms and types of pain
- the most frequent causes
- myths and misconceptions
- when to seek help
- how pelvic floor physio supports recovery
- what to expect during pelvic health physiotherapy treatment
Let’s begin by understanding what pain with sex really means.
What Is Pain With Sex?
Pain with sex, or dyspareunia, refers to any pain before, during, or after sexual activity. It can present in many different ways.
Common Ways Pain With Sex Is Experienced
People describe pain with sex in many forms, including:
- Sharp pain at the vaginal entrance (often described as stinging or cutting)
- Burning pain during penetration
- Deep pelvic pain during thrusting
- Pain after sex, sometimes lasting hours or days
- Pain even with lubrication or gentle touch
- Emotional impact, such as fear, anxiety, or avoidance of intimacy
These sensations can happen occasionally, consistently, or only with certain partners or positions. Even mild discomfort is worth paying attention to – it can be helped.
Types of Pain With Sex
Understanding the type of pain helps guide treatment:
- Superficial dyspareunia — pain at the vaginal opening
- Deep dyspareunia — pain further inside the pelvis
- Primary dyspareunia — present from a person’s first sexual experiences
- Secondary dyspareunia — develops later in life
- Situational pain — only in specific positions or circumstances
- Consistent pain — happens every time
What Causes Pain With Sex?
Pain with sex is rarely caused by just one thing.
Is pain with sex normal?
No. While many people experience it at some point, pain during sex is never normal. Pain is the body’s protective signal that something isn’t right – whether physically, hormonally, or emotionally.
Can tight pelvic floor muscles cause pain with sex?
Yes, absolutely. This is one of the most common physical contributors.
Pelvic floor muscles may become tight or overactive due to:
- clenching from stress
- fear of pain
- bracing patterns developed after childbirth
- long-term guarding
- trauma or medical procedures
When these muscles cannot relax, penetration becomes painful or impossible.
Hormonal changes and menopause: can this cause pain?
Yes. Lower oestrogen during perimenopause, menopause, or breastfeeding can cause:
- vaginal dryness
- thinning tissue
- less elasticity
- increased sensitivity
These factors can contribute to burning, irritation, and pain with sex.
Sexual pain after childbirth – is this common?
Very common — but still not normal. Causes include:
- perineal scar sensitivity
- birth trauma
- pelvic floor muscle tension
- healing changes in vaginal tissue
- breastfeeding-related dryness
These factors can occur individually or overlap.
What medical conditions can cause pain with sex?
Painful intercourse may be linked to:
- Endometriosis
- Pelvic inflammatory disease (PID)
- Vulvodynia
- Vaginismus
- Chronic pelvic pain syndromes
- Recurrent UTIs or thrush
- Dermatological conditions (e.g., lichen sclerosus)
Emotional or psychological factors
Pain with sex is deeply connected to the nervous system.
Contributing factors include:
- fear of pain
- anxiety
- history of trauma
- stress causing pelvic floor guarding
Your body always remembers comfort and safety – and physiotherapy can help retrain these systems gently.
When Should You Seek Help for Pain With Sex?
It’s time to seek support when:
- pain is severe, worsening, or accompanied by bleeding
- discomfort is interfering with intimacy or relationships
- you’re avoiding sex because of fear or pain
- lubricants or warm-up activities don’t help
- pain continues for more than a few weeks
- sex feels impossible or too uncomfortable to try
Early intervention leads to better outcomes. The longer pain persists, the more the pelvic floor and nervous system reinforce protective patterns.
How Pelvic Floor Physio Helps Treat Sexual Pain
A Gentle, Trauma-Informed Approach
Many people fear that pelvic physio will be painful or overwhelming, especially if internal exams have been uncomfortable in the past.
A trauma-informed physiotherapist will always:
- work at your pace
- prioritise consent and comfort
- explain every step
- give you full control
Nothing happens without your permission.
What to Expect at Your First Appointment
Your physio will begin with a conversation about your symptoms, history, and any emotional or physical factors affecting your pain.
They may assess:
- pelvic floor muscle tension
- scar tissue
- breathing patterns
- posture and movement
- coordination of pelvic floor relaxation
Internal assessment is completely optional – and only performed with your consent. For more information on what to expect at your first appointment click here.
How Pelvic Floor Physio Treats Pain With Sex
Treatment may include:
- pelvic floor muscle relaxation training
- gentle hands-on massage
- internal muscle release techniques
- scar tissue mobilisation
- breathing and down-training techniques
- nervous system calming strategies
- graded exposure and desensitisation
- advice on lubrication, positions, and pacing
- collaborative care with GPs or specialists when needed
Tools that May Help
Your physio may recommend:
- dilators (with guided use)
- a pelvic wand
- lubricants or moisturisers
- vaginal oestrogen (via GP)
Pain With Sex After Birth: Why It Happens and How Physio Helps
Postpartum pain with sex is common due to:
- scar tissue sensitivity
- pelvic floor muscle over-recruitment
- fear of pain and resulting clenching
- breastfeeding-related dryness
- healing tissues
- prolapse contributing to discomfort
Your physio can guide safe, supported return to intimacy.
Is pain with sex normal postpartum?
It is common but not normal – and it is treatable.
Menopause and Pain With Sex
Hormonal shifts can cause:
- dryness
- reduced elasticity
- increased sensitivity
- pelvic floor stiffness
Physio helps by improving relaxation, mobility, comfort, and confidence. Moisturisers, lubricants, and vaginal oestrogen may also help. We can help by recommending suitable products.
Myths About Pain With Sex (And What the Research Says)
“Just relax, it’s in your head.”
Pain is real — and often physical.
“It’s normal after babies.”
Common doesn’t mean normal.
“If you push through it, the pain will stop.”
This often increases pelvic floor tension.
“Only women with trauma have painful sex.”
Pain can have many causes – trauma is only one.
Self-Help Strategies for Pain With Sex (At-Home Support)
Helpful strategies include:
- diaphragmatic breathing
- pelvic floor relaxation exercises
- positions that reduce discomfort
- good quality lubricants
- vaginal moisturisers
- warm-up and pacing
- avoiding clenching and guarding
- communicating openly with your partner
We always give appropriate home exercise / advice – based on what we find in our assessment.
When Pain With Sex Is Linked to Trauma
At Pelvic Health Physiotherapy, we are all trained in trauma-informed care.
This includes:
- full consent and choice
- working gently and collaboratively
- understanding the nervous system’s role
- linking with psychologists, counsellors, or sex therapists when helpful
Pain with sex related to trauma is treatable. If you have a sensitive claim, we can work with you and your therapist, at your own pace.
How Long Does It Take to See Improvement?
Improvement varies depending on the cause, but many people notice changes within a few sessions, and some find immediate relief.
Getting Help in Wellington
If you’re ready to address your pain, our Wellington clinic offers:
- expert pelvic floor dysfunction care
- support for sexual pain, postpartum issues, and menopause changes
- trauma-informed physiotherapy
- discreet, compassionate appointments
You deserve comfortable, pain-free intimacy. We’re here to help.
Conclusion
Pain with sex is common but not normal, and it is highly treatable. With the right support – especially from an experienced pelvic floor physiotherapist – you can understand the cause, break the cycle of tension and fear, and return to comfortable, confident intimacy.
You don’t have to keep struggling. Help is available, and your recovery can begin today.
To book an appointment with us, or for further information, click here
Other resources
Birth Trauma Aotearoa – click here
Sexual Wellbeing Aotearoa – click here
Wellington help (help following sexual harm) – click here