Why Does Sex Hurt? Understanding Painful Sex, Vaginismus, and How Sex Therapy Can Help

Why Does Sex Hurt? Understanding Painful Sex, Vaginismus, and How Sex Therapy Can Help

Many people quietly search questions like “Why does sex hurt?”, “Is painful sex normal?”, or “What is vaginismus?” late at night, often feeling confused, frustrated, or alone. Painful sex is far more common than most people realize, yet it is rarely talked about openly.

Our team of experienced sex therapists work with individuals and couples who are navigating painful sex, vaginismus, and the emotional toll these experiences can create. Pain during sex is not something that needs to be tolerated or ignored. With the right support, it is both understandable and treatable.

This article answers the most common questions people ask about painful sex and vaginismus and explains how sex therapy can help restore comfort, confidence, and intimacy.

Why Does Sex Hurt?

One of the most common search queries is simply, “Why does sex hurt?” Pain during sex, clinically referred to as dyspareunia, can have multiple contributing factors. These may include pelvic floor muscle tension, hormonal changes, medical conditions, anxiety, past trauma, or sexual shame.

Painful sex can occur even when someone feels aroused or emotionally connected to their partner. Many people wonder why penetration hurts even with lubrication or why sex hurts sometimes but not others. These experiences often reflect how closely the body and nervous system are connected to emotional stress, expectations, and fear.

Painful sex is not “all in your head,” but it is also rarely just a physical issue. This is where sex therapy becomes an essential part of treatment.

What Is Vaginismus?

Another highly searched question is, “What is vaginismus?” Vaginismus involves involuntary tightening of the pelvic floor muscles, making penetration painful or impossible. People often ask if vaginismus is real or psychological. The answer is that it is very real and involves both physical and emotional components.

Common questions include:

• How do I know if I have vaginismus?

• What does vaginismus feel like?

• Can vaginismus start suddenly or after childbirth?

• Is vaginismus permanent?

Vaginismus can develop due to anxiety, sexual trauma, medical procedures, chronic pain, religious or cultural sexual shame, or fear of penetration. It is not a personal failure or a sign that something is “wrong” with the body.

Is Painful Sex Normal?

While painful sex is more common than you’d expect, it is not something that should be accepted as normal or unavoidable. Pain is the body’s signal that something needs attention.

Questions such as “Why does sex hurt after childbirth?” or “Why does sex hurt after menopause?” are especially common. Hormonal shifts, tissue changes, and life stressors can all play a role. Sex therapy helps individuals understand these changes and develop strategies to reduce pain and rebuild comfort.

Can Anxiety or Stress Cause Painful Sex?

A frequent question is, “Can anxiety cause painful sex?” The short answer is yes. When the nervous system is in a state of stress, the body often responds by tightening muscles, including the pelvic floor. This can lead to pain during penetration or a feeling that the body “shuts down” during sex.

This could explain why tampons may feel fine while sex hurts or why pain appears inconsistently. These patterns often point to nervous system responses rather than structural problems alone.

How Is Vaginismus or Painful Sex Treated?

One of the most common questions people search is, “Can painful sex or vaginismus be treated?” The answer is yes. Effective treatment often involves a combination of emotional, physical, and relational support rather than a single solution.

Painful sex rarely has only one cause. Muscle tension, nervous system responses, anxiety, trauma, hormonal changes, and relationship dynamics often interact. Because of this, treatment is most successful when it addresses both the body and the mind.

How Sex Therapy Helps with Painful Sex

Sex therapy plays a central role in helping individuals understand and heal from painful sex and vaginismus. Our team of Chicago sex therapists provide a safe, nonjudgmental space where clients can talk openly about experiences that are often accompanied by shame, fear, or frustration.

Sex therapy helps by:

Reducing fear and anxiety. Many people notice their bodies tense automatically during intimacy. Sex therapy helps identify fear responses in the nervous system and teaches tools to calm the body, making pain less likely to occur.

Addressing sexual shame and beliefs. Questions such as “Is vaginismus all in my head?” or “Am I broken if sex hurts?” are common. Sex therapy helps clients understand that painful sex is not a personal failure. Challenging shame-based beliefs can significantly reduce muscle tension and avoidance.

Supporting gradual, pressure-free intimacy. Sex therapy does not focus on “pushing through” penetration. Instead, therapists guide clients through gradual, non-penetrative intimacy exercises that build safety, trust, and comfort. This approach often reduces pain by removing performance pressure.

Improving communication with partners. Painful sex can strain relationships. Sex therapy helps individuals and couples learn how to talk about pain, boundaries, and desire in ways that foster understanding rather than guilt or fear.

How Pelvic Floor Physical Therapy Helps

Many people also search questions like, “Does pelvic floor therapy help vaginismus?” or “Do pelvic floor exercises work for painful sex?” Pelvic floor physical therapy is often a crucial part of treatment.

Pelvic floor physical therapists are trained to assess and treat muscle tension, coordination, and pain in the pelvic region. For individuals with vaginismus or painful penetration, therapy may include:

Muscle relaxation and coordination work. Rather than strengthening, treatment often focuses on learning how to relax overactive pelvic floor muscles and improve control.

Education about pelvic anatomy. Understanding how the pelvic floor works can reduce fear and confusion. Many people feel relief simply learning that their symptoms have a physical explanation.

Gentle, gradual exposure. When appropriate, pelvic floor therapists may use manual techniques or guide clients in using vaginal dilators at a pace that feels safe and controlled. These tools are never forced and are introduced thoughtfully.

Collaboration with sex therapy. Pelvic floor physical therapy is most effective when paired with sex therapy. Addressing muscle tension without addressing fear or anxiety can limit progress.

Why Combining Sex Therapy and Pelvic Floor Physical Therapy Works

A common concern is, “Which treatment should I start with?” In many cases, combining sex therapy and pelvic floor physical therapy leads to the best outcomes.

Sex therapy addresses the emotional and relational aspects of pain, while pelvic floor physical therapy focuses on the physical patterns contributing to discomfort. Together, they help retrain both the nervous system and the muscles to respond differently during intimacy.

Clients often find that as anxiety decreases through therapy, physical treatment becomes more effective. Similarly, as physical discomfort lessens, emotional safety and desire increase.

How Long Does Treatment Take?

Another frequent question is how long treatment will take. The answer varies depending on the individual, the severity of symptoms, and contributing factors such as trauma history or medical conditions.

Some clients notice improvements within a few months, while others benefit from longer-term support. Progress is rarely linear, and setbacks are normal. What matters most is moving at a pace that feels safe and sustainable.

Can You Heal Without Penetration Being the Goal?

Many people worry that treatment will pressure them toward penetrative sex. Effective treatment does not treat penetration as the goal. Instead, the focus is on comfort, agency, and pleasure.

Many individuals discover that redefining intimacy and expanding their understanding of sexual connection reduces pressure and supports healing. Penetration often becomes easier when it is no longer the central focus.

When to Seek Support

If painful sex or vaginismus is affecting confidence, desire, or relationships, seeking support sooner rather than later can prevent symptoms from becoming more entrenched. Working with a sex therapist and, when appropriate, a pelvic floor physical therapist can provide clarity, relief, and a clear path forward.

Painful sex and vaginismus are treatable conditions. With compassionate, coordinated care that addresses both emotional and physical experiences, individuals and couples can move toward intimacy that feels safe, comfortable, and connected.

Why Do I Feel Shame Around Sex, and How Can I Overcome It?

Why Do I Feel Shame Around Sex, and How Can I Overcome It?

Shame around sex is something many people carry quietly, sometimes for years. Maybe you find yourself pulling away from intimacy, feeling anxious in the bedroom, or avoiding conversations with your partner because sex feels too uncomfortable to talk about. You may even wonder, “What’s wrong with me?”

The truth is, nothing is wrong with you. Sexual shame is incredibly common and it can affect anyone, regardless of age, gender, or relationship status. At Embrace Sexual Wellness, many of the individuals and couples we work with come to therapy because shame has created distance in their intimate lives. And while shame can feel heavy, it’s also something you can work through with the right support.

In this post, we’ll explore why so many people experience shame around sex and what you can do to begin moving toward healing and self-acceptance.

Understanding Sexual Shame

Sexual shame is the feeling that your desires, your body, or your experiences of intimacy are “bad,” “dirty,” or “wrong.” It’s often rooted in messages we’ve internalized, sometimes so deeply that we don’t even realize they’re there.

These messages can sound like:

• “Good girls/boys don’t do that.”

• “Men should always want sex.”

• “Wanting pleasure makes you selfish.”

• “Talking about sex is embarrassing or inappropriate.”

Over time, beliefs like these create a cycle of guilt and silence. Instead of experiencing intimacy as something natural and enjoyable, you may approach it with anxiety, fear, or self-criticism.

Where Does Sexual Shame Come From?

Shame around sex usually doesn’t appear out of nowhere— it’s shaped by the environments and systems we grow up in. Here are some of the most common sources:

Family and Early Upbringing

If you grew up in a household where sex was never discussed, or where it was framed as “dirty” or “bad,” those early messages can stick with you. Even if no one said the words directly, a lack of conversation can signal that sex is something to feel secretive about.

Religion or Cultural Beliefs

Many people grew up in religious or cultural settings where sex was tied to morality. You may have been taught that certain desires are sinful, or that sex outside of marriage is wrong. These beliefs can cause lasting conflict between your values and your natural curiosity or desire.

Societal Expectations and Gender Roles

Society sends strong, often contradictory messages about sex. Men are expected to always be ready for intimacy, while women are often shamed for wanting it “too much.” For LGBTQIA+ folks, kinky communities, or people in non-traditional relationships, the stigma can feel even heavier.

Past Trauma or Negative Experiences

Experiences such as sexual trauma, betrayal, or even painful early encounters can reinforce shame. When intimacy becomes linked with fear or hurt, it makes sense that you might struggle to feel safe, open, or confident in your body.

How Shame Affects Your Intimacy and Relationships

Sexual shame doesn’t just stay in your head. It can ripple into every part of your intimate life and affect your relationship. Some ways it might show up include:

• Avoidance of intimacy: You may pull away from your partner or avoid sex entirely.

• Performance anxiety: Worrying about “doing it right” instead of being present.

• Difficulty communicating: Feeling embarrassed or fearful about sharing your needs.

• Disconnection in relationships: When shame blocks honesty, it often creates distance.

• Low desire or arousal: Shame can shut down your body’s natural responses.

If this sounds familiar, you’re not alone. These struggles are exactly why many people seek out sex therapy to untangle the shame that gets in the way of connection and pleasure.

How to Begin Overcoming Sexual Shame

Healing from sexual shame takes time, but it is possible. The goal isn’t to erase the past, but to create new experiences that allow you to feel safe, authentic, and connected in your intimacy. Here are some steps that can help:

Recognize the Source

Start by noticing where your shame comes from. Was it an early message from your family? A cultural or religious teaching? A negative experience? Simply naming the source of shame can loosen its grip and remind you that it doesn’t define you.

Challenge Shame-Based Beliefs

Ask yourself: Is this belief true, or is it something I was taught to believe? For example, “I shouldn’t talk about what I like” can be reframed as “Sharing my desires helps my partner understand me and creates deeper intimacy.”

Practice Self-Compassion

Healing requires gentleness with yourself. If shame shows up, try replacing self-criticism with kindness and compassion for yourself. Remind yourself that what you’re experiencing is common and that you’re allowed to want pleasure and connection.

Communicate with Your Partner

Shame grows in silence. While it may feel scary, opening up to your partner about your feelings can reduce isolation and build trust. You don’t need to share everything at once; start small and notice how honesty shifts the dynamic between you.

Explore Mindfulness and Body Awareness

Shame often pulls you out of the moment and into self-judgment. Practices like mindfulness, grounding, or breath work can help you reconnect with your body in non-judgmental ways, making it easier to stay present during intimacy.

Seek Professional Support

Sometimes shame feels too heavy to navigate alone. Working with a sex therapist can give you tools, guidance, and a safe space to process your experiences. Therapy can help you rewrite the story you’ve been told about your sexuality and build new, empowering narratives.

How Therapy Can Help with Sexual Shame

We specialize in helping individuals and couples who are struggling with sexual shame, low desire, and intimacy challenges. In therapy, you’ll find a supportive space where nothing is “too much” or “too taboo” to talk about. Our therapists use evidence-based approaches like Cognitive Behavioral Therapy (CBT), Emotionally Focused Therapy (EFT), and mindfulness to help you:

• Untangle shame from your sense of self

• Identify and shift shame-based beliefs

• Rebuild intimacy and trust with your partner

• Learn healthier ways to express needs and desires

• Move toward confidence, pleasure, and connection

Shame doesn’t have to define your intimate life. With support, you can replace shame with self-acceptance and begin creating the fulfilling connections you deserve.

TLDR

If you’ve ever thought, “Something is wrong with me because of how I feel about sex,” you are not alone. Shame around sexuality is incredibly common, but it doesn’t have to be permanent. With compassion, awareness, and support, you can learn to let go of shame and reclaim intimacy as a source of joy and connection.

If you’re ready to start this journey, our team of sex therapists are here to help. We see clients in-person at our Chicago office and virtually in Illinois, Indiana, Idaho, Louisiana, and Kansas.

Schedule a free 10-minute consultation today and take the first step toward healing your relationship with intimacy and yourself.

Can Therapy Really Help with Sexual Performance Anxiety?

Sex is supposed to be pleasurable, right?

But for many people, sex doesn’t feel free, confident, or connected; it feels pressured, stressful, and full of second-guessing. If you've ever found yourself overthinking your performance in the bedroom, worrying about how your body is responding, or feeling frozen in moments that are supposed to feel intimate, you’re not alone.

Sexual performance anxiety is incredibly common, but it’s rarely talked about even in therapy spaces. And unfortunately, the silence often makes things worse. The good news? Therapy can help, and not just in a surface-level way. It can address the deeper emotional and relational patterns that keep performance anxiety in place and help you (and your partner) move toward real, connected intimacy.

Let’s break it down.

What Is Sexual Performance Anxiety?

Sexual performance anxiety is a form of anxiety that shows up in sexual situations whether you're about to have sex, thinking about sex, or trying to be intimate with a partner. It can affect people of all genders, sexual orientations, and relationship types.

It often sounds like this:

• “What if I can’t keep it up?”

• “What if I don’t finish?”

• “What if I don’t feel anything?”

• “What if they think I’m bad in bed?”

• “What if my body doesn’t respond the way it’s supposed to?”

• “What if I disappoint them?”

For some, performance anxiety leads to avoidance (e.g., avoiding sex, closeness, or even conversations about intimacy). For others, it shows up during sex as intrusive thoughts, tension, or a sense of being disconnected from your body. This can be frustrating, isolating, and, let’s be honest, deeply painful, especially if it’s affecting your relationship.

Common Causes of Sexual Performance Anxiety

Sexual performance anxiety rarely shows up out of nowhere. It's often connected to one or more of the following:

1. Cultural or religious shame about sex

Messages you received growing up about sex being "bad," "dirty," or only for reproduction can linger in the body and mind, even years later. These messages about sex can lead us to think we are ‘wrong’ for wanting to be intimate or thinking about engaging in sex with our partners.

2. High pressure to perform

Especially for men, there's often pressure to “initiate,” “stay hard,” “last long,” or “satisfy your partner” all while being relaxed and confident. That's a lot of pressure for something that's supposed to be mutually enjoyable.

3. Body image concerns

If you're worried about how your body looks or functions during sex, it's hard to be present.

4. Past sexual trauma or negative experiences

Unresolved trauma or even one awkward, painful, or embarrassing sexual encounter can shape how you feel about intimacy moving forward.

5. Relationship issues

Ongoing conflict, lack of trust, or emotional disconnection can make sex feel like a performance instead of a shared experience.

6. Stress, anxiety, and mental health

Generalized anxiety, depression, and chronic stress (especially from work, parenting, or caregiving roles) can impact desire, arousal, and confidence.

So, Can Therapy Really Help?

Yes, and here’s how. At Embrace Sexual Wellness, we work with individuals and couples who are dealing with the emotional, relational, and physical challenges of sexual performance anxiety.

Therapy can help you:

1. Understand what’s really going on

Performance anxiety is rarely just about what’s happening in the moment. Therapy helps uncover what’s fueling the anxiety, whether it’s past experiences, shame, fear of failure, or relational dynamics. You get to explore your story in a safe, supportive space.

2. Interrupt the anxiety-thought cycle

In therapy, you’ll learn how to identify and challenge anxious thoughts before they spiral into shutdown or panic. This might involve CBT techniques, mindfulness practices, or somatic awareness, all aimed at helping you stay present and grounded during intimacy.

3. Reconnect with your body

Performance anxiety pulls you out of your body and into your head. Therapy helps you rebuild a relationship with your body that feels safe, attuned, and responsive, not judgmental or critical. This can be especially healing for people who’ve experienced dissociation or discomfort during sex.

4. Communicate with your partner more openly

If you're in a relationship, therapy can support both of you in having honest, shame-free conversations about sex. You’ll learn to express needs, set boundaries, and understand each other’s triggers so sex becomes a space of trust, not pressure.

5. Heal from past experiences

Whether you’ve been through trauma, rejection, or simply years of sexual avoidance, therapy offers a chance to heal. You don’t have to carry the weight of old experiences into every intimate moment.

6. Create a new sexual narrative

Instead of sex being about performance, pressure, or expectation, therapy helps you define what you want sex to mean. Perhaps it’s connection, pleasure, playfulness or safety or a combination. You get to rewrite the script.

What to Expect in Sex Therapy

You don’t have to show up with all the answers. You don’t need to be in crisis. You just need to be willing to be curious and honest with yourself and your therapist.

We’ll create a space that’s affirming, nonjudgmental, and tailored to you. Some clients come for individual therapy; others come as a couple. Either way, therapy is always consent-based, collaborative, and deeply respectful of where you are in your journey.

We often hear clients say things like:

“I wish I’d started this sooner.”

“I am so relieved I found you to help us.”

“I thought I was broken, but I just needed someone to help me understand what was really going on.”

You’re not broken. You’re human. And you don’t have to figure this out alone.

Sex Therapy in Chicago

At Embrace Sexual Wellness, we offer specialized comprehensive care in sex therapy that targets your goals. While we are based in Chicago, Illinois, we’re also licensed to support clients in Idaho, Indiana, Kansas, and Louisiana. Whether you're local or working with us virtually, you’ll receive compassionate, expert care grounded in science and rooted in human connection.

TLDR

Sexual performance anxiety can make intimacy feel like a test you’re always failing, but it doesn’t have to stay that way. Therapy can help you understand your anxiety, shift your mindset, reconnect with your body, and build a sex life that actually feels good for you and your partner. You don’t need to power through, shut down, or pretend everything’s fine. You can talk about it. You can work on it and find new strategies to approach intimacy with more ease.